Walsh Judith M E, Posner Samuel F, Perez-Stable Eliseo J
Division of General Internal Medicine, University of California San Francisco, Box 1732, 1701 Divisadero, San Francisco, CA 94115, USA.
Prev Med. 2002 Sep;35(3):209-18. doi: 10.1006/pmed.2002.1059.
Despite evidence of decreased mortality, recommendations for colon cancer screening have not been widely implemented by physicians. The objective of this study was to determine patient and clinician factors associated with screening for colon cancer.
A retrospective review of computerized medical records from primary care practices in an academic medical center was performed. Patients comprised men and women aged 50-74 with at least one visit between July 1, 1995 and June 30, 1997. Measurements included Fecal occult blood testing in the past 1 or 2 years, sigmoidoscopy in the previous 5 or 10 years, or colonoscopy in the past 10 years.
A total of 6,039 patients were included in the analysis. Fecal occult blood testing had been performed in 44% of patients and sigmoidoscopy in 26%. Fifty-three percent of patients had undergone some type of colon cancer screening. In multivariate analysis, patient factors predictive of fecal occult blood testing included age (odds ratio (OR) per 5 years 1.05; 95% confidence interval 1.04, 1.06), Asian ethnicity (OR 1.23; 1.08, 1.41), number of visits during the study period (OR 1.05; 1.04, 1.06), recency of the last visit (OR 1.03; 1.02, 1.04), and having private insurance (OR 1.65; 1.04, 2.62). Predictors of sigmoidoscopy were similar except that patients with a family history of colon cancer and those with managed care insurance were also more likely to undergo sigmoidoscopy. Patients of nurse practitioners were less likely to receive fecal occult blood testing than were patients of physicians (OR 0.78; 0.65, 0.93). Patients of residents were less likely to undergo sigmoidoscopy than were patients of faculty (OR 0.79; 0.66, 0.94).
Among patients seen in primary care practices, rates of colon cancer screening remain low, especially in patients who are younger, who have been seen less frequently, who are uninsured, or who do not have managed care insurance. Future research should explore these differences and should focus on increasing screening in all patient groups, especially in those who are underscreened.
尽管有证据表明结肠癌筛查可降低死亡率，但医生对结肠癌筛查的建议尚未得到广泛实施。本研究的目的是确定与结肠癌筛查相关的患者和临床医生因素。
对一所学术医疗中心基层医疗诊所的计算机化病历进行回顾性研究。患者包括年龄在50 - 74岁之间，在1995年7月1日至1997年6月30日期间至少就诊过一次的男性和女性。测量指标包括过去1或2年的粪便潜血试验、过去5或10年的乙状结肠镜检查，或过去10年的结肠镜检查。
共有6039名患者纳入分析。44%的患者进行了粪便潜血试验，26%的患者进行了乙状结肠镜检查。53%的患者接受了某种类型的结肠癌筛查。在多因素分析中，预测粪便潜血试验的患者因素包括年龄（每5岁的优势比（OR）为1.05；95%置信区间为1.04，1.06）、亚裔种族（OR为1.23；1.08，1.41）、研究期间的就诊次数（OR为1.05；1.04，1.06）、上次就诊的近期程度（OR为1.03；1.02，1.04）以及拥有私人保险（OR为1.65；1.04，2.62）。乙状结肠镜检查的预测因素与之相似，只是有结肠癌家族史的患者和拥有管理式医疗保险的患者也更有可能接受乙状结肠镜检查。执业护士的患者比医生的患者接受粪便潜血试验的可能性更小（OR为0.78；0.65，0.93）。住院医生的患者比教员的患者接受乙状结肠镜检查的可能性更小（OR为0.79；0.66，0.94）。
在基层医疗诊所就诊的患者中，结肠癌筛查率仍然较低，尤其是在年龄较小、就诊频率较低、未参保或没有管理式医疗保险的患者中。未来的研究应探索这些差异，并应专注于提高所有患者群体的筛查率，特别是那些筛查不足的患者群体。
