title: Physician and patient factors associated with ordering a colon evaluation after a positive fecal occult blood test.
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).
  
  
  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.
authors.affiliation: Division of General Internal Medicine (BT), University of Pennsylvania, Philadelphia, PA, USA. bturner@mail.med.upenn.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Turner
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Myers
authors.forename: Terry
authors.initials: T
authors.lastname: Hyslop
authors.forename: Walter W
authors.initials: WW
authors.lastname: Hauck
authors.forename: David
authors.initials: D
authors.lastname: Weinberg
authors.forename: Timothy
authors.initials: T
authors.lastname: Brigham
authors.forename: James
authors.initials: J
authors.lastname: Grana
authors.forename: Todd
authors.initials: T
authors.lastname: Rothermel
authors.forename: Neil
authors.initials: N
authors.lastname: Schlackman
mesh_terms: 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
chemical_list: D001466:Barium Sulfate