Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, 13th floor Blockley Hall, Philadelphia, PA 19104, USA.
J Gen Intern Med. 2012 Aug;27(8):940-4. doi: 10.1007/s11606-012-2010-z. Epub 2012 Feb 28.
As HIV positive patients live longer, they become susceptible to the development of non-AIDS defining malignancies. Little is known about routine cancer screening practices in that population and the factors associated with cancer screening.
Evaluate 1) the proportion of patients with HIV who had any type of colorectal cancer (CRC) screening and 2) whether having a primary care physician (PCP) or seeking care in an integrated care practice is associated with higher CRC screening.
A cross-sectional chart abstraction study of patients with HIV enrolled in the Philadelphia Medical Monitoring Project (MMP).
MMP participants age 50 and older.
CRC screening defined as having a documented colonoscopy, sigmoidoscopy, barium enema, or fecal occult blood test after the age of 50.
Out of 123 chart abstractions performed, 115 had a complete clinical record from MMP. The majority of the population was male (71.3%), Black/Hispanic (73.8%) and between the age of 50 and 59 (71.3%). 45.2% of patients did not have a PCP. The overall proportion of patients who received CRC screening was 46.9%. Having a documented PCP was the only factor strongly associated with CRC screening. Rates of screening were 66.7% among those with a PCP versus 28.5% among those without a PCP (χ(2) p < 0.001). After adjusting for race, socioeconomic status, substance and alcohol abuse, the odds of getting CRC screening in those with a PCP was 4.59 (95% CI 2.01-10.48, p < 0.001). The type of practice where patients were enrolled into care was not associated with CRC screening.
Having a PCP significantly increases the likelihood of receiving CRC screening in patients with HIV. Competency in addressing primary care needs in HIV clinics will only become more important as patients with HIV age.
随着 HIV 阳性患者寿命的延长，他们易患非艾滋病定义的恶性肿瘤。人们对该人群的常规癌症筛查实践以及与癌症筛查相关的因素知之甚少。
评估 1）HIV 患者中进行任何类型结直肠癌（CRC）筛查的比例，2）是否有初级保健医生（PCP）或在综合护理实践中就诊与更高的 CRC 筛查相关。
对费城医疗监测项目（MMP）中登记的 HIV 患者进行横断面图表提取研究。
年龄在 50 岁及以上的 MMP 参与者。
CRC 筛查定义为 50 岁以后有记录的结肠镜检查、乙状结肠镜检查、钡灌肠或粪便潜血检查。
在进行的 123 次图表提取中，有 115 次从 MMP 获得了完整的临床记录。该人群的大多数为男性（71.3%）、黑人和西班牙裔（73.8%）和 50 至 59 岁之间（71.3%）。45.2%的患者没有 PCP。接受 CRC 筛查的患者总体比例为 46.9%。有记录的 PCP 是唯一与 CRC 筛查密切相关的因素。有 PCP 的患者的筛查率为 66.7%，而没有 PCP 的患者为 28.5%（χ(2) p<0.001）。在调整种族、社会经济地位、物质和酒精滥用后，有 PCP 的患者接受 CRC 筛查的几率为 4.59（95%CI 2.01-10.48，p<0.001）。患者入组护理的实践类型与 CRC 筛查无关。
有 PCP 可显著增加 HIV 患者接受 CRC 筛查的可能性。随着 HIV 患者年龄的增长，在 HIV 诊所中解决基本医疗需求的能力将变得更加重要。
