Journal of General Internal Medicine

, Volume 27, Issue 8, pp 940–944

The Role of Primary Care Physicians in Improving Colorectal Cancer Screening in Patients with HIV

  • Florence Momplaisir
  • Judith A. Long
  • Gia Badolato
  • Kathleen A. Brady
Original Research

ABSTRACT

BACKGROUND

As HIV positive patients live longer, they become susceptible to the development of non-AIDS defining malignancies. Little is known about routine cancer screening practices in that population and the factors associated with cancer screening.

OBJECTIVE

Evaluate 1) the proportion of patients with HIV who had any type of colorectal cancer (CRC) screening and 2) whether having a primary care physician (PCP) or seeking care in an integrated care practice is associated with higher CRC screening.

DESIGN

A cross-sectional chart abstraction study of patients with HIV enrolled in the Philadelphia Medical Monitoring Project (MMP).

PARTICIPANTS

MMP participants age 50 and older.

MAIN MEASURES

CRC screening defined as having a documented colonoscopy, sigmoidoscopy, barium enema, or fecal occult blood test after the age of 50.

KEY RESULTS

Out of 123 chart abstractions performed, 115 had a complete clinical record from MMP. The majority of the population was male (71.3%), Black/Hispanic (73.8%) and between the age of 50 and 59 (71.3%). 45.2% of patients did not have a PCP. The overall proportion of patients who received CRC screening was 46.9%. Having a documented PCP was the only factor strongly associated with CRC screening. Rates of screening were 66.7% among those with a PCP versus 28.5% among those without a PCP (χ2p < 0.001). After adjusting for race, socioeconomic status, substance and alcohol abuse, the odds of getting CRC screening in those with a PCP was 4.59 (95% CI 2.01-10.48, p < 0.001). The type of practice where patients were enrolled into care was not associated with CRC screening.

CONCLUSIONS

Having a PCP significantly increases the likelihood of receiving CRC screening in patients with HIV. Competency in addressing primary care needs in HIV clinics will only become more important as patients with HIV age.

KEY WORDS

colorectal cancer screening HIV primary care infectious diseases specialists model of care 

REFERENCES

  1. 1.
    Frisch M, Biggar RJ, Engels E, et al. Association of cancer with AIDS-related immunosuppression in adults. JAMA. 2001;285(13):1736–45.PubMedCrossRefGoogle Scholar
  2. 2.
    Engels E, Biggar R, Hall H, et al. Cancer risk in people infected with human immunodeficiency virus in the United States. Int J Cancer. 2008;123:187–94.PubMedCrossRefGoogle Scholar
  3. 3.
    Patel P, Hanson D, Sullivan P, et al. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann Intern Med. 2008;148:728–36.PubMedGoogle Scholar
  4. 4.
    US Cancer Statistics Working Group. United States cancer statistics. 1999–2007 Cancer Incidence and Mortality Data. Available at http://www.cdc.gov/cancer/colorectal. Accessed March 10, 2011.
  5. 5.
    Reinhold JP, Moon M, Tenner CT, Poles MA, Bini EJ. Colorectal cancer screening in HIV-infected patients 50 years of age and older: missed opportunities for prevention. Am J Gastroenterol. 2005;100:1805–12.PubMedCrossRefGoogle Scholar
  6. 6.
    Iqbal S, Browne-McDonald V, Cerulli MA. Recent trends for colorectal cancer screening in HIV-infected patients. Dig Dis Sci. 2009;55(3):761–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Landon BE, Wilson IB, McInnes K, Landrum MB, Hirschhorn LR, Marsden PV, Cleary PD. Physician specialization and the quality of care for human immunodeficiency virus infection. Arch Intern Med. 2005;165:1133–9.PubMedCrossRefGoogle Scholar
  8. 8.
    CDC. Medical Monitoring Project (MMP). http://www.cdc.gov/hiv/topics/treatment/mmp. Accessed March 10, 2011.
  9. 9.
    CDC. Vital signs: colorectal cancer screening among adults aged 50–75 years — United States, 2008. MMWR Morb Mortal Wkly Rep. 2010;59:808–12.Google Scholar
  10. 10.
    Lewden C, Salmon D, Morlat P, et al. Causes of death among human immunodeficiency virus (HIV)–infected adults in the era of potent antiretroviral therapy: Emerging role of hepatitis and cancers, persistent role of AIDS. Int J Epidemiol. 2005;34:121–30.PubMedCrossRefGoogle Scholar
  11. 11.
    Mocroft A, Brettle R, Kirk O, et al. Changes in the cause of death among HIV positive subjects across Europe: Results from the EuroSIDA study. AIDS. 2002;16:1663–71.PubMedCrossRefGoogle Scholar
  12. 12.
    Carrascal AF, Montesano-Ostrander K, Rukeyser J, Agins BD. Training HIV clinicians and building a clinical workforce: the experience in New York State. AIDS Public Policy J. 2005;20(3–4):102–7.PubMedGoogle Scholar
  13. 13.
    Landon BE, Wilson IB, Wenger NS, et al. Specialty training and specialization among physicians who treat HIV/AIDS in the United States. J Gen Intern Med. 2002;17:12–22.PubMedCrossRefGoogle Scholar
  14. 14.
    Sheth AN, Moore RD, Gebo KA. Provision of general and HIV-specific health maintenance in middle aged and older patients in an urban HIV clinic. AIDS Patient Care STDS. 2006;20:318–25.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Florence Momplaisir
    • 1
  • Judith A. Long
    • 1
    • 2
  • Gia Badolato
    • 3
  • Kathleen A. Brady
    • 3
  1. 1.Division of General Internal MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  2. 2.Philadelphia VA Center for Health Equity Research and PromotionPhiladelphiaUSA
  3. 3.Philadelphia Department of Public HealthPhiladelphiaUSA

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