title: Healthcare system factors and colorectal cancer screening.
abstract: BACKGROUND
  Developing effective programs to promote colorectal cancer (CRC) screening requires understanding of the effect of healthcare system factors on access to screening and adherence to guidelines.
  
  
  METHODS
  This study assessed the role of insurance status, type of plan, the frequency of preventive health visits, and provider recommendation on utilization of CRC screening tests using a cross-sectional, random-digit-dial survey of 1002 Massachusetts residents aged > or =50.
  
  
  RESULTS
  A broad definition of CRC screening status included colonoscopy or barium enema (screening or diagnostic) within 10 years, flexible sigmoidoscopy (FSIG) within 5 years, and fecal occult blood testing (FOBT) in the past year as options; 51.7% of subjects aged 50 to 64 and 61.5% of older subjects were current. The uninsured had the lowest current testing rate. Among insured participants, type of insurance had little impact on CRC testing; older subjects enrolled in HMOs had marginally higher rates, although not statistically significant. Increased frequency of preventive health visits and ever receiving a physician's recommendation for FSIG or ever receiving FOBT cards were associated with higher rates of CRC screening among both age groups.
  
  
  CONCLUSIONS
  Even when broad criteria are used to define current CRC screening status, a substantial proportion of the age-eligible population remains underscreened. Obtaining regular preventive care and receiving a physician's recommendation for screening appear to be potent facilitators of screening that should be considered in designing promotional efforts.
authors.affiliation: Medical School, University of Massachusetts, Worcester 01655, USA. Jane.Zapka@umassmed.edu
authors.forename: Jane G
authors.initials: JG
authors.lastname: Zapka
authors.forename: Elaine
authors.initials: E
authors.lastname: Puleo
authors.forename: Maureen
authors.initials: M
authors.lastname: Vickers-Lahti
authors.forename: Roger
authors.initials: R
authors.lastname: Luckmann
mesh_terms: D000368:Aged; D017609:Barium Compounds; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D005459:Fluorides; D006295:Health Resources / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009780:Occult Blood; D012812:Sigmoidoscopy / Q000706:statistics & numerical data
chemical_list: D017609:Barium Compounds; C055150:barium fluoride; D005459:Fluorides