Journal of General Internal Medicine

, Volume 18, Issue 5, pp 357–363

Physician and patient factors associated with ordering a colon evaluation after a positive fecal occult blood test

  • Barbara Turner
  • Ronald E. Myers
  • Terry Hyslop
  • Walter W. Hauck
  • David Weinberg
  • Timothy Brigham
  • James Grana
  • Todd Rothermel
  • Neil Schlackman
Original Articles

DOI: 10.1046/j.1525-1497.2003.20525.x

Cite this article as:
Turner, B., Myers, R.E., Hyslop, T. et al. J GEN INTERN MED (2003) 18: 357. doi:10.1046/j.1525-1497.2003.20525.x

Abstract

OBJECTIVE: Successful colorectal cancer screening relies in part on physicians ordering a complete diagnostic evaluation of the colon (CDE) with colonoscopy or barium enema plus sigmoidoscopy after a positive screening fecal occult blood test (FOBT).

DESIGN: We surveyed primary care physicians about colorectal cancer screening practices, beliefs, and intentions. At least 1 physician responded in 318 of 413 (77%) primary care practices that were affiliated with a managed care organization offering a mailed FOBT program for patients aged ≥50 years. Of these 318 practices, 212 (67%) had 602 FOBT+ patients from August through November 1998. We studied 184 (87%) of these 212 practices with 490 FOBT+ patients after excluding those judged ineligible for a CDE or without demographic data. Three months after notification of the FOBT+ result, physicians were asked on audit forms if they had ordered CDEs for study patients. Patient- and physician-predictors of ordering CDEs were identified using logistic regression.

MEASUREMENTS AND MAIN RESULTS: A CDE was ordered for only 69.5% of 490 FOBT+ patients. After adjustment, women were less likely to have had CDE initiated than men (adjusted odds, 0.66; confidence interval, 0.44 to 0.97). Physician survey responses indicating intermediate or high intention to evaluate a FOBT+ patient with a CDE were associated with nearly 2-fold greater adjusted odds of actually initiating a CDE in this circumstance versus physicians with a low intention.

CONCLUSIONS: Primary care physicians often fail to order CDE for FOBT+ patients. A CDE was less likely to be ordered for women and was influenced by physician’s beliefs about CDEs.

Key words

colorectal neoplasms primary health care occult blood mass screening attitude of health personnel 

Copyright information

© Society of General Internal Medicine 2003

Authors and Affiliations

  • Barbara Turner
    • 1
  • Ronald E. Myers
    • 2
  • Terry Hyslop
    • 4
  • Walter W. Hauck
    • 4
  • David Weinberg
    • 3
  • Timothy Brigham
    • 5
  • James Grana
    • 2
    • 6
  • Todd Rothermel
    • 6
  • Neil Schlackman
    • 7
  1. 1.the Division of General Internal MedicineUniversity of PennsylvaniaPhiladelphia
  2. 2.Division of Genetic and Preventive MedicineThomas Jefferson UniversityPhiladelphia
  3. 3.Division of GastroenterologyThomas Jefferson UniversityPhiladelphia
  4. 4.Biostatistics Section, Division of Clinical PharmacologyThomas Jefferson UniversityPhiladelphia
  5. 5.Department of Medicine, and Office of Continuing Medical EducationThomas Jefferson UniversityPhiladelphia
  6. 6.U.S. Quality Algorithms, Inc.USA
  7. 7.U.S. Quality Algorithms, Inc.Blue Bell

Personalised recommendations