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


METHODS
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.


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.
Turner
Barbara
B
Division of General Internal Medicine (BT), University of Pennsylvania, Philadelphia, PA, USA. bturner@mail.med.upenn.edu
Myers
Ronald E
RE
Hyslop
Terry
T
Hauck
Walter W
WW
Weinberg
David
D
Brigham
Timothy
T
Grana
James
J
Rothermel
Todd
T
Schlackman
Neil
N
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001466:Barium Sulfate; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis*; D004733:Enema; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D010821:Physicians, Family / Q000523:psychology*; D011364:Professional Practice; D012737:Sex Factors
D001466:Barium Sulfate