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Self-reported colorectal cancer screening of Medicare beneficiaries in family medicine vs. internal medicine practices in the United States: a cross-sectional study

DOI: 10.1186/1471-230x-12-23

Keywords: Colorectal cancer screening, Primary care physicians, Colonoscopy, Fecal occult blood test

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Abstract:

Nationally representative sample of non-institutionalized beneficiaries who received medical care from FPs or internists in 2006 (using Medicare Current Beneficiary Survey). The main outcome was the percentage of patients screened in 2007. We also examined the percentage of patients offered screening.Patients of FPs, compared to those of internists, were less likely to have received an FOBT kit or undergone home FOBT, even after accounting for patients' characteristics. Compared to internists, FPs' patients were more likely to have heard of colonoscopy, but were less likely to receive a screening colonoscopy recommendation (18% vs. 27%), or undergo a colonoscopy (43% vs. 46%, adjusted odds ratios [AOR], 95% confidence interval [CI]-- 0.65, 0.51-0.81) or any CRC screening (52% vs. 60%, AOR, CI--0.80, 0.68-0.94). Among subgroups examined, higher income beneficiaries receiving care from internists had the highest screening rate (68%), while disabled beneficiaries receiving care from FPs had the lowest screening rate (34%).Patients cared for by FPs had a lower rate of screening compared to those cared for by internists, despite equal or higher levels of awareness; a difference that remained statistically significant after accounting for socioeconomic status and access to healthcare. Both groups of patients remained below the national goal of 70 percent.Screening has been shown to decrease the risk of mortality for colorectal cancer (CRC) [1-4]. Although the use of CRC screening has increased in the US, particularly over the past decade [5,6], for many groups, screening rates are below the Healthy People goal of 70% [7]. Primary care physicians (PCPs) play an important role in the delivery of CRC screening services [6,8-12] by advising, recommending, performing and/or referring patients for screening [13]. It is therefore not surprising that studies have consistently reported a strong association between healthcare provider recommendations for and receipt of CRC screenin

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