Making the Case for the Benefits of Primary Care From Observational Studies: Does an Ounce of Prevention Take a Pound of Doctor Visits?
Authors: Barbara J. Turner, David S. Weinberg
Journal: Annals of Internal Medicine (2013)

EditorialsOctober 1, 2013Making the Case for the Benefits of Primary Care From Observational Studies: Does an Ounce of Prevention Take a Pound of Doctor Visits?Barbara J. Turner, MD, MSEd, MA and David S. Weinberg, MD, MScBarbara J. Turner, MD, MSEd, MAFrom University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Fox Chase Cancer Center, Philadelphia, Pennsylvania.Search for more papers by this author and David S. Weinberg, MD, MScFrom University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Fox Chase Cancer Center, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-7-201310010-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Despite slow improvement, colorectal cancer (CRC) screening rates continue to lag behind prevention efforts of other kinds of cancer, such as breast and cervical cancer. This deficit reflects a complex interplay of patient, provider, and system factors that ultimately contribute to CRC screening. For providers, one of the strongest reported predictors of patient adherence is an unambiguous physician recommendation to pursue screening (1). The study by Ferrante and colleagues in this issue (2) offers further evidence that contact between a patient and a primary care provider results in higher CRC screening rates. In a case–control study using the population-based 2008 ...References1. Weinberg DS. In the clinic. Colorectal cancer screening. Ann Intern Med. 2008;148:ITC2-1-ITC2-16 MedlineGoogle Scholar2. Ferrante JM, Lee JH, McCarthy EP, Fisher KJ, Chen R, Gonzalez EC, et al. Primary care utilization and colorectal cancer incidence and mortality among Medicare beneficiaries. A population-based, case-control study. Ann Intern Med. 2013;159:437-46. LinkGoogle Scholar3. Starfield B, Shi L, and Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457-502. [PMID: 16202000] CrossrefMedlineGoogle Scholar4. Campbell RJ, Ramirez AM, Perez K, and Roetzheim RG. Cervical cancer rates and the supply of primary care physicians in Florida. Fam Med. 2003;35:60-4. [PMID: 12564867] MedlineGoogle Scholar5. Fisher KJ, Lee JH, Ferrante JM, McCarthy EP, Gonzalez EC, Chen R, et al. The effects of primary care on breast cancer mortality and incidence among Medicare beneficiaries. Cancer. 2013;119:2964-72. [PMID: 23677482] CrossrefMedlineGoogle Scholar6. Weiss JM, Smith MA, Pickhardt PJ, Kraft SA, Flood GE, Kim DH, et al. Predictors of colorectal cancer screening variation among primary-care providers and clinics. Am J Gastroenterol. 2013;108:1159-67. [PMID: 23670114] CrossrefMedlineGoogle Scholar7. Turner BJ, Weiner M, Yang C, and TenHave T. Predicting adherence to colonoscopy or flexible sigmoidoscopy on the basis of physician appointment-keeping behavior. Ann Intern Med. 2004;140:528-32 LinkGoogle Scholar8. Turner BJ, Weiner M, Berry SD, Lillie K, Fosnocht K, and Hollenbeak CS. Overcoming poor attendance to first scheduled colonoscopy: a randomized trial of peer coach or brochure support. J Gen Intern Med. 2008;23:58-63. [PMID: 18030540] CrossrefMedlineGoogle Scholar9. Holden DJ, Jonas DE, Porterfield DS, Reuland D, and Harris R. Systematic review: enhancing the use and quality of colorectal cancer screening. Ann Intern Med. 2010;152:668-76 LinkGoogle Scholar10. Shrank WH, Patrick AR, and Brookhart MA. Healthy user and related biases in observational studies of preventive interventions: a primer for physicians. J Gen Intern Med. 2011;26:546-50. [PMID: 21203857] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Fox Chase Cancer Center, Philadelphia, Pennsylvania.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1896.Corresponding Author: Barbara J. Turner, MD, MSEd, MA, ReACH Center, 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229; e-mail, [email protected].Current Author Addresses: Dr. Turner: ReACH Center, 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229.Dr. Weinberg: Fox Chase Cancer Center, Department of Medicine, 333 Cottman Avenue, Philadelphia, PA 19111. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPrimary Care Utilization and Colorectal Cancer Incidence and Mortality Among Medicare Beneficiaries Jeanne M. Ferrante , Ji-Hyun Lee , Ellen P. McCarthy , Kate J. Fisher , Ren Chen , Eduardo C. Gonzalez , Kymia Love-Jackson , and Richard G. Roetzheim Metrics October 1, 2013Volume 159, Issue 7Page: 494-495KeywordsBehaviorBreast cancerCancer preventionCancer screeningCervical cancerCervical cancer screeningColonoscopyColorectal cancerElectronic medical recordsEpidemiologyFactor analysisInformation storage and retrievalMedical conditionsMorbidityObservational studiesPatientsPhysiciansPreventive medicine ePublished: 1 October 2013 Issue Published: October 1, 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...