Université Paris Est (UPEC), Faculté de Médecine, Department of General Practice, Creteil, F-94000, France.
Prev Med. 2012 Nov;55(5):488-92. doi: 10.1016/j.ypmed.2012.08.004. Epub 2012 Aug 21.
Our aim was to determine whether physician-related factors influenced patient participation in colorectal cancer (CRC) screening programs and to identify patient characteristics associated with lower participation in order to facilitate the development of targeted actions to improve participation.
A retrospective cohort study was conducted in a French department during its first CRC screening campaign from June 2007 to May 2010. Data for 157,766 patients followed by 903 general practitioners (GPs) were analyzed. Patient participation was assessed using multilevel logistic modeling.
The overall participation rate was 30% (95% confidence interval [95% CI], 29.8-30.2) and varied across the 903 GPs from 0% to 75.5% (median, 30; interquartile range, 24-35). Inter-GP variance explained only 5.5% of the participation rate variance. Participation was significantly lower in males (odds ratio [OR], 0.79; 95% CI, 0.78-0.91), the youngest age group (55-59 years, OR, 0.61; 95% CI, 0.58-0.63), and patients living in socioeconomically deprived areas (OR, 0.82; 95% CI, 0.77-0.87).
Targeted actions to improve CRC screening participation should focus on patients younger than 60 years, males, and individuals living in deprived areas. Actions to enhance the influence of GPs on patient participation should be directed to the overall population of GPs.
本研究旨在确定与医生相关的因素是否会影响结直肠癌（CRC）筛查计划中患者的参与度，并确定与较低参与度相关的患者特征，以便制定有针对性的措施来提高参与度。
本研究为一项回顾性队列研究，于 2007 年 6 月至 2010 年 5 月期间在法国的一个部门进行，共纳入了 157766 例由 903 名全科医生（GP）随访的患者。采用多水平逻辑回归模型评估患者的参与度。
总体参与率为 30%（95%置信区间[95%CI]，29.8-30.2），903 名 GP 的参与率从 0%到 75.5%不等（中位数为 30；四分位距，24-35）。GP 间差异仅解释了参与率差异的 5.5%。男性（比值比[OR]，0.79；95%CI，0.78-0.91）、最年轻的年龄组（55-59 岁，OR，0.61；95%CI，0.58-0.63）和居住在社会经济条件较差地区的患者（OR，0.82；95%CI，0.77-0.87）的参与率显著较低。
提高 CRC 筛查参与度的针对性措施应针对 60 岁以下的患者、男性和生活在贫困地区的人群。提高 GP 对患者参与度的影响的措施应针对全科医生的总体人群。
