title: Predictors of colorectal cancer screening from patients enrolled in a managed care health plan.
abstract: BACKGROUND
  Despite the growing recognition of the importance of colorectal cancer (CRC) screening in reducing cancer mortality, national screening rates are low, indicating a critical need to understand the barriers and remedies for underutilization of CRC screening tests.
  
  
  METHODS
  Using results from independent cross-sectional telephone surveys with patients aged>or=50 years performed before (2000; n=498) and after (2003; n=482) a quality improvement intervention for CRC screening within a large managed care health plan, the trends and predictors of CRC screening with fecal occult blood test (FOBT) and/or endoscopy (flexible sigmoidoscopy/colonoscopy) were examined from a patient perspective.
  
  
  RESULTS
  In 2000, patient reported screening rates within guidelines were 38% for any test, 23% for endoscopy, and 22% for FOBT. In 2003, screening rates increased to 50% for any test, 39% for endoscopy, and 24% for FOBT. Having discussed CRC with a doctor significantly increased the odds of being screened (FOBT: odds ratio [OR], 2.09 [95% confidence interval (95% CI), 1.47-2.96]; endoscopy: OR, 2.33 [95% CI, 1.67-3.26]; and any test: OR, 2.86 [95% CI, 2.06-3.96]), and reporting barriers to CRC in general decreased the odds of being screened (FOBT: OR, 0.76 [95% CI, 0.60-0.95]; endoscopy: OR, 0.74 [95% CI, 0.60-0.92]; and any test: OR, 0.66 [95% CI, 0.54-0.80]).
  
  
  CONCLUSIONS
  Although screening rates increased over the 3-year period, evidence was found of ongoing underutilization of CRC screening. The 2 strongest determinants of obtaining CRC screening were provider influence and patient barriers related to CRC screening in general, pointing to the need for multilevel interventions that target both the provider and patient.
authors.affiliation: Veterans Affairs, Greater Los Angeles Health Services Research and Development Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, California 91343-2036, USA. Melissa.Farmer@va.gov
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Farmer
authors.forename: Roshan
authors.initials: R
authors.lastname: Bastani
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.forename: Michael
authors.initials: M
authors.lastname: Belman
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D011795:Surveys and Questionnaires