Predictors of primary care provider adoption of CT colonography for colorectal cancer screening
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To examine factors influencing primary care provider (PCP) adoption of CT colonography (CTC) for colorectal cancer (CRC) screening.
Materials and methods
We performed a retrospective cohort study linking electronic health record (EHR) data with PCP survey data. Patients were eligible for inclusion if they were not up-to-date with CRC screening and if they had CTC insurance coverage in the year prior to survey administration. PCPs were included if they had at least one eligible patient in their panel and completed the survey (final sample N = 95 PCPs; N = 6245 patients). Survey data included perceptions of CRC screening by any method, as well as CTC specifically. Multivariate logistic regression estimated odds ratios and 95% confidence intervals for PCP and clinic predictors of CRC screening by any method and screening with CTC.
Substantial variation in CTC use was seen among PCPs and clinics (range 0–16% of CRC screening). Predictors of higher CTC use were PCP perceptions that CTC is effective in reducing CRC mortality, higher number of perceived advantages to screening with CTC, and Internal Medicine specialty. Factors not associated with CTC use were PCP perceptions of less organizational capacity to meet demand for colonoscopy, number of perceived disadvantages to screening with CTC, PCP age and gender, and clinic factors.
Significant variation in PCP adoption of CTC exists. PCP perceptions of CTC and specialty practice were related to CTC adoption. Strategies to increase PCP adoption of CTC for CRC screening should include emphasis on the effectiveness and advantages of CTC.
KeywordsColorectal cancer screening CT colonography Primary care providers
Compliance with ethical standards
This work was supported by the National Cancer Institute (Grants R01 CA144835 and P30 CA014520); the National Center for Advancing Translational Sciences (Grant UL1TR000427); the American Cancer Society (Grant MRSG-13-144-01-CPHPS); and the UW Health Innovation Program.
Conflict of interest
Perry J. Pickhardt is co-founder of VirtuoCTC and shareholder in SHINE, Elucent, and Cellectar Biosciences. David H. Kim is co-founder of VirtuoCTC, consultant for Viatronix, on the Medical Advisory Board for Digital ArtForms, and shareholder in Cellectar and Elucent. Patrick R. Pfau serves on the Scientific Advisory Board of Exact Sciences. The other authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Statement of informed consent was not applicable since the manuscript does not contain any patient data.
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