title: Predictors of Poor Adherence of US Gastroenterologists with Colonoscopy Screening and Surveillance Guidelines.
abstract: BACKGROUND
  The US Multi-Society Task Force on Colorectal Cancer published guidelines for colonoscopy screening and surveillance in 2008 and affirmed them in 2012. Characteristics associated with guideline adherence among US gastroenterologists have not been assessed.
  
  
  OBJECTIVE
  Assess awareness and adherence of US gastroenterologists with national guidelines for colonoscopy screening and surveillance and predictors of adherence to guidelines.
  
  
  METHODS
  A Web-based survey was administered to gastroenterologists in various practice settings across the USA.
  
  
  RESULTS
  A total of 306 gastroenterologists completed the survey; 86 % reported awareness of the guidelines. Low-volume colonoscopists (<20/month) were less likely to be aware of the guidelines (OR 0.26, p = 0.03) compared to high-volume colonoscopists (>100/month). Those completing training before 1990 were less likely to report following guidelines (OR 0.37, p = 0.01). Adherence with guidelines was then assessed via clinical scenarios. Compared to physicians finishing training in 1991-2010, less adherence was seen in those finishing before 1990 (OR 0.75, p < 0.001) or currently in training (OR 0.72, p = 0.004). Compared to the Western USA, less adherence was seen in the Midwest (OR 0.69, p = 0.001), Northeast (OR 0.63, p < 0.001), and South (OR 0.59, p < 0.001). Lower adherence was seen among non-academic physicians (OR 0.72, p = 0.001) and low-volume colonoscopists (OR 0.52, p < 0.001).
  
  
  CONCLUSIONS
  There is poor adherence with colonoscopy screening and surveillance guidelines among US gastroenterologists. Poor adherence was associated with being in training or finishing training before 1990, practicing in the South, non-academic settings, and low colonoscopy volume. These findings can target interventions for quality improvement in colorectal cancer screening and surveillance.
authors.affiliation: Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, 1365 Clifton Road, Building B, Suite 1200, Atlanta, GA, 30322, USA, heba.iskandar@emory.edu.
authors.forename: Heba
authors.initials: H
authors.lastname: Iskandar
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.forename: Jill
authors.initials: J
authors.lastname: Elwing
authors.forename: Dayna
authors.initials: D
authors.lastname: Early
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
authors.forename: Jean S
authors.initials: JS
authors.lastname: Wang
mesh_terms: D003113:Colonoscopy / Q000592:standards*; D005762:Gastroenterology / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D011159:Population Surveillance