Kuo Nai-Wen, Lin Herng-Ching, Lee Hsin-Chien
Taipei Medical University, School of Health Care Administration, Taipei, Taiwan.
J Urol. 2008 Nov;180(5):1954-8; discussion 1958. doi: 10.1016/j.juro.2008.07.058. Epub 2008 Sep 17.
We investigated the relationship between physician clinical experience and inappropriate prostate specific antigen testing using a Taiwan nationwide population based data set. We used physician age as a surrogate for general practice experience and the frequency of ordered prostate specific antigen tests as a surrogate for procedure specific experience.
This study used data sourced from the 2005 Taiwan National Health Insurance Research Database. We extracted all patients who underwent prostate specific antigen tests in 2005 and their corresponding physicians. A total of 24,595 patients and 2,086 physicians were included. Physician age was categorized into 8 age groups of younger than 31, 31 to 35, 36 to 40, 41 to 45, 46 to 50, 51 to 55, 56 to 60 and 60 years or older. Physicians were divided into 4 groups according to the frequency of prostate specific antigen tests ordered in 40 to 75-year-old patients, including low frequency--less than 1 case per 3 months, medium-between 1 in 3 months and 1 per month, high--between 1 per month and 1 per week, and very high--greater than 1 per week.
In sampled physicians the mean +/- SD rate of inappropriate prostate specific antigen test use was 30.8% +/- 36.6%. Multiple regression analysis showed that after adjusting for other factors physicians who ordered fewer prostate specific antigen tests (those in the low and medium frequency groups) had a higher rate of inappropriate PSA test use than their counterparts who ordered prostate specific antigen tests with very high frequency (each p <0.001) Furthermore, physicians in the age groups 30 years or younger and 31 to 35 years had higher rates of inappropriate prostate specific antigen testing than their counterparts in the 41 to 45-year-old group (p = 0.019 and 0.010, respectively).
The likelihood of inappropriate prostate specific antigen screening was significantly and negatively associated with physician clinical experience.
我们使用台湾全国性基于人群的数据集，研究医生临床经验与不适当前列腺特异性抗原检测之间的关系。我们将医生年龄作为一般执业经验的替代指标，将前列腺特异性抗原检测的频率作为特定程序经验的替代指标。
本研究使用了来自2005年台湾国民健康保险研究数据库的数据。我们提取了2005年接受前列腺特异性抗原检测的所有患者及其相应的医生。共纳入24,595名患者和2,086名医生。医生年龄分为8个年龄组，分别为31岁以下、31至35岁、36至40岁、41至45岁、46至50岁、51至55岁、56至60岁以及60岁及以上。根据40至75岁患者中前列腺特异性抗原检测的频率，医生被分为4组，包括低频率（每3个月少于1例）、中频率（每3个月1例至每月1例）、高频率（每月1例至每周1例）和非常高频率（每周多于1例）。
在抽样医生中，不适当前列腺特异性抗原检测使用的平均±标准差率为30.8%±36.6%。多元回归分析显示，在调整其他因素后，开具前列腺特异性抗原检测较少的医生（低频率和中频率组）与开具非常高频率前列腺特异性抗原检测的医生相比，不适当PSA检测的使用率更高（各p<0.001）。此外，30岁及以下年龄组和31至35岁年龄组的医生与41至45岁年龄组的医生相比，不适当前列腺特异性抗原检测的发生率更高（分别为p = 0.019和0.010）。
不适当前列腺特异性抗原筛查的可能性与医生临床经验显著负相关。
