%0 Journal Article
%T A study of prescriptions for prostate specific antigen (PSA) testing
%A Cros L
%A Germanaud J
%A Charlon R
%J Revue M¨¦dicale de l'Assurance Maladie
%D 2005
%I 
%X Aim: To assess prescriptions for prostate specific antigen (PSA) with respect to the guidelines of the National Agency for Accreditation and Evaluation in Health (ANAES). Method: We analyzed the French national healthfund¡¯s reimbursement data for the Centre region of France during 12 consecutive months (from March 1, 2000 to February 28, 2001). Results: In the Centre region, 61,547 PSA determinations were reimbursed during the twelve month study period for 49,836 patients. Among affiliates of the general scheme of the national healthfund, PSA determinations were performed in 21 % of patients older than 75 years, in 17 % of patients aged between 50 and 74 years and in 1 % of patients aged between 40 and 50 years. In 72 % of the PSA determinations, PSA levels had never been determined before. Among these first determinations, seven out of ten exclusively ordered PSA. 27 % of the patients who had their PSA tested were younger than 50 years or older than 75 years. PSA determinations are not recommended for individuals in these age groups. Only 1 % of the patients who had PSA tests were exonerated from co-payments due to the long-term disorder, cancer of the prostate, during the two-year period following the test. 83 % of the tests were prescribed by general practitioners and 10 % by urologists. There were important differences in the frequency with which the tests were prescribed within the same specialty. When prescriptions included a PSA index, the ANAES guidelines were poorly followed: 40 % were prescribed without asking for the total reference PSA and when the index was prescribed, it was appropriately prescribed in only 40 % of the cases. Conclusion: Individual screening with PSA determinations were routinely performed in contradiction to the ANAES guidelines. There is an enormous disparity in how often physicians prescribe PSA tests. In addition, these tests do not target patients very well.
%K prostate cancer
%K screening
%K prostate specific antigen
%K practice guidelines
%K unnecessary procedures.
%U http://www.ameli.fr/fileadmin/user_upload/documents/Dosage_PSA.pdf