Primary care provider perceptions of barriers to and facilitators of colorectal cancer screening in a managed care setting.
BACKGROUND
Colorectal cancer (CRC) screening tests (e.g., fecal occult blood testing [FOBT], flexible sigmoidoscopy [FS], etc.) are underused. Primary care providers (PCPs) play a critical role in screening, but barriers to and facilitators of screening as perceived by PCPs in managed care settings are poorly understood. The objectives of the current study were to describe current CRC screening practices and to explore determinants of test use by PCPs in a managed care setting.


METHODS
In 2000, a self-administered survey was mailed to a stratified, random sample of 1340 PCPs in a large, network model health maintenance organization in California.


RESULTS
The survey response rate was 67%. PCPs indicated that 79% of their standard-risk patients were screened for CRC. PCP-reported median rates of recommendation for the use of specific screening tests were 90% for FOBT and 70% for FS. In logistic regression models, perceived barriers to the use of FOBT and FS included patient characteristics (e.g., education) and PCP-related barriers (e.g., failure to recall that patients were due for testing). Perceived facilitators of the use of FOBT and FS included interventions targeting certain aspects of the health care system (e.g., reimbursement) and interventions targeting certain aspects of the tests themselves (e.g., provision of evidence of a test's effectiveness). Assignment of high priority to screening, integrated medical group (as opposed to independent practice association) affiliation, and the proportion of patients receiving routine health maintenance examinations were positively associated with reported test use.


CONCLUSIONS
CRC screening tests appear to be underused in the managed care setting examined in the current study. The perceived barriers and facilitators that were identified can be used to guide interventions aimed at increasing recommendations for, as well as actual performance of, CRC screening.
Dulai
Gareth S
GS
Division of Gastroenterology, Center for Ulcer Research and Education, Greater Los Angeles Veterans Administration Healthcare System, and Department of Medicine, School of Medicine, University of California-Los Angeles, 90073, USA. gdulai@mednet.ucla.edu
Farmer
Melissa M
MM
Ganz
Patricia A
PA
Bernaards
Coen A
CA
Qi
Karen
K
Dietrich
Allen J
AJ
Bastani
Roshan
R
Belman
Michael J
MJ
Kahn
Katherine L
KL
D000328:Adult; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D002140:California; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006300:Health Services Misuse; D006801:Humans; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000592:standards / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D011336:Probability; D018570:Risk Assessment; D012737:Sex Factors; D011795:Surveys and Questionnaires