Abstract B102: Colorectal cancer screening practice among primary care physicians in rural, Indian Health Service, and community health center facilities
Authors: Nodora Jesse 
Published: December 2010

Purpose of Study: Colorectal cancer (CRC) can be prevented via screening by the detection and removal of colorectal adenomas. Among the different barriers to CRC screening, recommendation from a health care provider is key. A 2010 NIH CRC screening consensus panel identified the need to assess physician practices. Given this gap, we report results from a survey of primary care physicians (PCPs) that assessed CRC screening practice in the state of Arizona, including whether clinicians adhere to the recommended screening guidelines and an analysis of rural vs. urban physicians. Furthermore, given that a large proportion of racial/ethnic minorities and other underserved populations receive care in public health (PH)/Indian Health Service (IHS) facilities and community health centers (CHCs), we also compared these to academic facilities.

Experimental Procedures: A survey was mailed to 1,838 family practice and general internal medicine physicians in Arizona in 2005. Respondents provided characteristics of their clinical practice, geographic location, and described their CRC screening practices, including which guidelines they followed. Based on the PCP responses, we classified respondents into two groups: those that demonstrated correct knowledge of the national CRC screening guidelines and those that did not.

Data Summary: Nine hundred and eighty four (984) PCPs responded to the survey (54% response rate). Over half (54.4%) of the respondents were in family practice and 44.4% were in internal medicine. One quarter (25.1%) were under the age of 40,33.4% were between 40 and 49, and 41.5% were 50 or older. The majority were male (69.1%) and 46.4% had been in practice for 15 or more years. Most practitioners were in group (45.4%) or solo practice (24.1%). Of all respondents, 169 (17.6%) reported serving in a rural area, 9.7% reported practicing in a PH/IHS facility, and 5.2% in a CHC. Compared to PCPs practicing in academic facilities, those serving in PH/IHS settings were equally likely to follow CRC guidelines (71.7% vs. 70.7%, respectively; odds ratio [OR]=1.00); however, CHC clinicians were less likely to follow such guidelines (71.7% vs. 47.7%; OR=0.37). Compared to PCPs practicing in urban facilities, those in rural settings were more likely to follow the screening guidelines (49.8% vs. 57.4%, respectively; OR=1.36). Among all respondents, the two most frequently recommended CRC screening modalities for average risk patients were colonoscopy (61.7%) and fecal occult blood testing (FOBT) (21.1%). By practice setting, PCPs in CHCs had similar screening modality recommendations as the total (66.0% colonoscopy and 26.0% FOBT). However, clinicians in PH/IHS and rural practice settings were less likely to recommend colonoscopy (41.5% and 45.2%, respectively) but more likely to recommend FOBT (39.4% and 35.1%, respectively) as compared to the total group.

Conclusions: The results show differences in CRC screening practices for PCPs in key settings that serve populations with CRC health disparities (rural, CHC, PH/IHS). It is encouraging that physicians in PH/IHS settings are more likely to follow CRC screening guidelines than those in academic settings but discouraging the PCPs in CHCs are less likely to do so.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B102.