Myers R E, Turner B, Weinberg D, Hauck W W, Hyslop T, Brigham T, Rothermel T, Grana J, Schlackman N
Division of Medical Oncology and Medical Genetics, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Prev Med. 2001 Oct;33(4):249-60. doi: 10.1006/pmed.2001.0878.
While indicated by guidelines, complete diagnostic evaluation, or CDE (i.e., colonoscopy or combined flexible sigmoidoscopy plus barium enema X ray), is often not recommended and performed for persons with an abnormal screening fecal occult blood test (FOBT) result. We initiated a randomized trial to assess the impact of a physician-oriented intervention on CDE rates in primary care practices.
In 1998, we identified 1,184 primary care physicians (PCPs) in 584 practices whose patients received FOBTs that are mailed annually by a managed care organization screening program. A total of 470 PCPs in 318 practices completed a baseline survey. Practices were randomly assigned either to a Control Group (N = 198) or to an Intervention Group (N = 120). Control Group practices received the screening program. Intervention Group practices received the screening program and the intervention (i.e., CDE reminder-feedback plus educational outreach). Practice CDE recommendation and performance rates are the primary outcomes to be measured in the study.
Baseline CDE recommendation and performance rates were low and were comparable in Control and Intervention Group practices (54 to 57% and 39 to 40%, respectively). PCPs in the practices tended to view FOBT screening and CDE favorably, but had concerns about screening efficacy, time involved in CDE, and patient discomfort and adherence. Control Group physicians were more likely than Intervention Group physicians to believe that a mail-out FOBT screening program helps in the practice of medicine.
We were able to enroll a high proportion of targeted primary care practices, measure practice characteristics and CDE rates at baseline, and develop and implement the intervention. Study outcome analyses will take into account baseline differences in practice characteristics.
虽然指南有所指示，但对于粪便潜血试验（FOBT）筛查结果异常的患者，通常不建议也不进行完整诊断评估（CDE，即结肠镜检查或柔性乙状结肠镜检查加钡剂灌肠X线检查）。我们开展了一项随机试验，以评估以医生为导向的干预措施对初级保健机构中CDE实施率的影响。
1998年，我们在584家机构中确定了1184名初级保健医生（PCP），这些机构的患者接受了由一家管理式医疗组织筛查项目每年邮寄的FOBT检查。318家机构中的470名PCP完成了基线调查。这些机构被随机分为对照组（N = 198）或干预组（N = 120）。对照组机构接受筛查项目。干预组机构接受筛查项目及干预措施（即CDE提醒 - 反馈加教育推广）。机构的CDE推荐率和实施率是本研究中要测量的主要结果。
基线时CDE推荐率和实施率较低，对照组和干预组机构相当（分别为54%至57%和39%至40%）。这些机构中的PCP倾向于对FOBT筛查和CDE持积极看法，但对筛查效果、CDE所需时间以及患者不适和依从性存在担忧。对照组医生比干预组医生更有可能认为邮寄式FOBT筛查项目有助于医疗实践。
我们能够纳入高比例的目标初级保健机构，在基线时测量机构特征和CDE率，并制定和实施干预措施。研究结果分析将考虑机构特征的基线差异。
