Colorectal carcinoma screening procedure use among primary care patients.
BACKGROUND
Despite evidence-based recommendations for colorectal carcinoma screening, population-based surveys report low screening rates. To the authors' knowledge, the extent to which screening procedures are used by patients seen in primary care is not as clear. The authors estimated the annual and 5-year colorectal carcinoma screening procedure use among a cohort of primary care patients and evaluated the correlation between patient characteristics and the use of screening procedures.


METHODS
The authors identified a cohort of patients (n = 21,833 patients) ages 55-70 years who had a primary care visit in 2003 and who were enrolled in a health plan for the 5-year period ending December 31, 2003. Using automated data for the 5-year period ending December 31, 2003, information on patient sociodemographic characteristics, primary care and health maintenance examination (HME) visits, comorbid diagnoses, income, and screening receipt was compiled. The latter included barium enema, colonoscopy, fecal occult blood testing (FOBT), and flexible sigmoidoscopy use.


RESULTS
Approximately one-half of insured, primary care patients (54%) received recommended colorectal carcinoma screening procedures over the 5-year observation period. Among individuals who received screening, colonoscopy was used most frequently (39.9%), followed by flexible sigmoidoscopy testing alone (28.3%) or in combination with FOBT (4.3%). Annual screening rates increased by 3.1% between 1999 and 2003. Among individuals who did not receive recommended colorectal carcinoma screening, 64% had at least 3 HME visits, and 41% received at least 1 FOBT. Increasing HME visits and other primary care visit frequency, along with increasing age, income, male gender, and African-American race, were associated with screening receipt.


CONCLUSIONS
Significant opportunities exist to increase colorectal carcinoma screening among primary care patients.
Lafata
Jennifer Elston
JE
Center for Health Services Research, Henry Ford Health System, Detroit, Michigan 48202, USA. jlafata1@hfhs.org
Williams
L Keoki
LK
Ben-Menachem
Tamir
T
Moon
Christina
C
Divine
George
G
D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology*; D017677:Age Distribution; D000368:Aged; D017609:Barium Compounds; D015331:Cohort Studies; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D004733:Enema; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D012812:Sigmoidoscopy / Q000379:methods / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
D017609:Barium Compounds