title: Challenges in the management of positive fecal occult blood tests.
abstract: BACKGROUND
  Many patients with a positive fecal occult blood test (FOBT) do not undergo follow-up evaluations.
  
  
  OBJECTIVE
  To identify the rate of follow-up colonoscopy following a positive FOBT and determine underlying reasons for lack of follow-up.
  
  
  METHODS
  It is a retrospective chart review.
  
  
  METHODS
  The subject group consisted of 1,041 adults with positive FOBTs within a large physician group practice from 2004 to 2006.
  
  
  METHODS
  We collected data on reasons for ordering FOBT, presence of prior colonoscopy, completed evaluations, and results of follow-up tests. We fit a multivariable logistic regression model to identify predictors of undergoing follow-up colonoscopy.
  
  
  RESULTS
  Most positive FOBTs were ordered for routine colorectal cancer screening (76%), or evaluation of anemia (13%) or rectal bleeding (7%). Colonoscopy was completed in 62% of cases, with one-third of these procedures identifying a colorectal adenoma (29%) or cancer (4%). Factors associated with higher rates of follow-up colonoscopy included obtaining the FOBT for routine colorectal screening (odds ratio (OR) 1.59, 95% confidence interval (CI) 1.11-2.29) and consultation with gastroenterology (OR 1.99, 95% CI 1.46-2.72). Patients were less likely to undergo colonoscopy if they were older than 80 years old (OR 0.54, 95% CI 0.31-0.92), younger than 50 years old (OR 0.44, 95% CI 0.28-0.70), uninsured (OR 0.50, 95% CI 0.27-0.93), or had undergone colonoscopy within the prior five years (OR 0.32, 95% CI 0.23-0.44).
  
  
  CONCLUSIONS
  Clinical decisions and patient factors available at the time of ordering an FOBT impact performance of colonoscopy. Targeting physicians' understanding of the use of this test may improve follow-up and reduce inappropriate use of this test.
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Sandhya K
authors.initials: SK
authors.lastname: Rao
authors.forename: Thad F
authors.initials: TF
authors.lastname: Schilling
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Sequist
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D006123:Group Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards; D008485:Medical Audit; D008875:Middle Aged; D009780:Occult Blood; D016017:Odds Ratio; D012017:Referral and Consultation; D016312:Treatment Refusal