title: Is anyone listening? Variation in PSA screening among providers for men 75+ before and after United States Preventive Services Task Force recommendations against it: a retrospective cohort study.
abstract: BACKGROUND
  In 2008, the United States Preventive Services Task Force recommended against prostate specific antigen (PSA) testing for cancer screening in men age 75+.
  
  
  OBJECTIVE
  To assess PSA screening by primary care physicians (PCPs) before and after recommendations.
  
  
  METHODS
  In 2013, this retrospective cohort study analyzed PCPs in Texas with 20+ male patients aged 75+ in both 2007 and 2010, with Parts A and B Medicare. The main outcome was percent of PCP's male patients 75+ who received PSA testing ordered by the PCP in 2007 and 2010, with no recent symptoms suggestive of prostate cancer.
  
  
  RESULTS
  In both 2007 and 2010, 1,083 PCPs cared for at least 20 men aged 75 or older. The rate of PSA screening ordered by PCPs was 33.2% in 2007 and 30.6% in 2010. In multilevel analyses controlling for patient characteristics, the variation in PSA screening attributable to the PCP (intraclass correlation coefficient) increased from 23% in 2007 to 26% in 2010, p<0.001. Men with PCPs older than age 60 had 9% lower odds (95% CI, 1-17%) in 2010 compared to 2007 of receiving a PSA test, vs. a 4% increase (95% CI, 4% decrease to 12% increase) in men with PCPs aged 50 or younger. Patients with Board Certified PCPs had a 12% lower odds (95% CI, 8% to 16%) from 2007 to 2010, vs. 2% increase (95% CI 11% decrease to 18% increase) in men with PCPs without board certification.
  
  
  CONCLUSIONS
  The USPSTF recommendation did not increase consensus among PCPs regarding PSA screening of older men.
authors.affiliation: Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, United States of America; The Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America; The Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, United States of America.
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
authors.affiliation: Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, United States of America; The Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jaramillo
authors.affiliation: Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, United States of America.
authors.forename: Liu
authors.initials: L
authors.lastname: Yang
authors.affiliation: Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, United States of America; The Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, United States of America.
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.affiliation: Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, United States of America; The Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, United States of America.
authors.forename: Alai
authors.initials: A
authors.lastname: Tan
mesh_terms: D026683:Advisory Committees / Q000331:legislation & jurisprudence*; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D058007:Physicians, Primary Care / Q000523:psychology*; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D012189:Retrospective Studies; D013781:Texas
chemical_list: D017430:Prostate-Specific Antigen