title: Colonoscopy screening rates among patients of colonoscopy-trained African American primary care physicians.
abstract: BACKGROUND
  When performed competently, colonoscopy screening can reduce colorectal cancer rates, especially in high-risk groups such as African Americans. Training primary care physicians (PCPs) to perform colonoscopy may improve screening rates among underserved high-risk populations.
  
  
  METHODS
  The authors compared colonoscopy screening rates and computed adjusted odds ratios for colonoscopy-eligible patients of trained African American PCPs (study group) versus untrained PCPs (comparison group), before and after initiating colonoscopy training. All colonoscopies were performed at a licensed ambulatory surgery center with specialist standby support. Retrospective chart review was conducted on 200 consecutive, established outpatients aged ≥50 years at each of 12 PCP offices (7 trained African American PCPs and 5 untrained PCPs, practicing in the same geographic region). There were a total of 1244 study group and 923 comparison group patients.
  
  
  RESULTS
  Post-training colonoscopy rates in both groups were higher than pretraining rates: 48.3% versus 9.3% in the study group, 29.6% versus 9.8% in the comparison group (both P < .001). African American patients in the study group showed a >5-fold increase (8.9% pretraining vs 52.8% post-training), with no change among whites (18.2% vs 25.0%). Corresponding pretraining and post-training rates among comparison patients were 10.4%% and 38.7%, respectively, among African Americans (P < .001), and 13.3% versus 13.2%, respectively, among whites. After adjusting for demographics, duration since becoming the PCP's patient, and health insurance, the study group had a 66% higher likelihood of colonoscopy in the post-training period (odds ratio, 1.66; 95% confidence interval, 1.30-2.13), and African Americans had a 5-fold increased likelihood of colonoscopy relative to whites.
  
  
  CONCLUSIONS
  Colonoscopy-trained PCPs may help reduce colorectal cancer disparities.
authors.affiliation: Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA. sxirasagar@sc.edu
authors.forename: Sudha
authors.initials: S
authors.lastname: Xirasagar
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Hurley
authors.forename: James B
authors.initials: JB
authors.lastname: Burch
authors.forename: Ali
authors.initials: A
authors.lastname: Mansaray
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert
mesh_terms: D001741:Black or African American; D000368:Aged; D003113:Colonoscopy / Q000193:education* / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000193:education*; D044465:White People