Predictors of colorectal cancer screening in diverse primary care practices.
BACKGROUND
To explain why rates of colorectal cancer (CRC) screening including fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), colonoscopy (CS), and barium enema (BE), are low, this study assessed determinants of CRC screening from medical records.


METHODS
Data were abstracted from patients aged > or =64 years selected from each clinician from 30 diverse primary care practices (n = 981). Measurements included the rates of annual FOBT, ever receiving FOBT, ever receiving FS/CS/BE under a combination variable, endoscopy/barium enema (EBE).


RESULTS
Over five years, 8% had received annual FOBT, 53% had ever received FOBT and 22% had ever received EBE. Annual FOBT was negatively associated with female gender, odds ratio (OR) = .23; 95% confidence interval = .12-.44 and positively associated with routinely receiving influenza vaccine, OR = 2.55 (1.45-4.47); and more office visits: 3 to <5 visits/year, OR = 2.78 (1.41-5.51), and > or =5 visits/year, OR = 3.35 (1.52-7.42). Ever receiving EBE was negatively associated with age > or =75 years, OR = .66 (.46-.95); being widowed, OR = .59 (.38-.92); and positively associated with more office visits: 3 to <5 visits/year, OR = 1.83 (1.18-2.82) and > or =5 visits/year, OR = 2.01 (1.14-3.55).


CONCLUSIONS
Overall CRC screening rates were low, but were related to the number of primary care office visits. FOBT was related to immunization status, suggesting the possible benefit of linking these preventive services.
Zimmerman
Richard K
RK
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, 3518 5th Avenue, Pittsburgh, PA, USA. zimmer@pitt.edu
Nowalk
Mary Patricia
MP
Tabbarah
Melissa
M
Grufferman
Seymour
S
D000368:Aged; D001466:Barium Sulfate; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D004733:Enema; D005260:Female; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008485:Medical Audit; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010414:Pennsylvania; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D012812:Sigmoidoscopy / Q000706:statistics & numerical data*
D001466:Barium Sulfate