Iskandar Heba, Yan Yan, Elwing Jill, Early Dayna, Colditz Graham A, Wang Jean S
Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, 1365 Clifton Road, Building B, Suite 1200, Atlanta, GA, 30322, USA,
Dig Dis Sci. 2015 Apr;60(4):971-8. doi: 10.1007/s10620-014-3403-0. Epub 2014 Nov 4.
The US Multi-Society Task Force on Colorectal Cancer published guidelines for colonoscopy screening and surveillance in 2008 and affirmed them in 2012. Characteristics associated with guideline adherence among US gastroenterologists have not been assessed.
Assess awareness and adherence of US gastroenterologists with national guidelines for colonoscopy screening and surveillance and predictors of adherence to guidelines.
A Web-based survey was administered to gastroenterologists in various practice settings across the USA.
A total of 306 gastroenterologists completed the survey; 86 % reported awareness of the guidelines. Low-volume colonoscopists (<20/month) were less likely to be aware of the guidelines (OR 0.26, p = 0.03) compared to high-volume colonoscopists (>100/month). Those completing training before 1990 were less likely to report following guidelines (OR 0.37, p = 0.01). Adherence with guidelines was then assessed via clinical scenarios. Compared to physicians finishing training in 1991-2010, less adherence was seen in those finishing before 1990 (OR 0.75, p < 0.001) or currently in training (OR 0.72, p = 0.004). Compared to the Western USA, less adherence was seen in the Midwest (OR 0.69, p = 0.001), Northeast (OR 0.63, p < 0.001), and South (OR 0.59, p < 0.001). Lower adherence was seen among non-academic physicians (OR 0.72, p = 0.001) and low-volume colonoscopists (OR 0.52, p < 0.001).
There is poor adherence with colonoscopy screening and surveillance guidelines among US gastroenterologists. Poor adherence was associated with being in training or finishing training before 1990, practicing in the South, non-academic settings, and low colonoscopy volume. These findings can target interventions for quality improvement in colorectal cancer screening and surveillance.
美国结直肠癌多学会特别工作组于2008年发布了结肠镜检查筛查及监测指南，并于2012年予以确认。美国胃肠病学家中与遵循该指南相关的特征尚未得到评估。
评估美国胃肠病学家对结肠镜检查筛查及监测国家指南的知晓情况与遵循情况，以及遵循指南的预测因素。
对美国各地不同执业环境的胃肠病学家进行了一项基于网络的调查。
共有306名胃肠病学家完成了调查；86%报告知晓该指南。与高工作量结肠镜检查医师（每月>100例）相比，低工作量结肠镜检查医师（每月<20例）知晓该指南的可能性较小（比值比0.26，p = 0.03）。1990年之前完成培训的医师报告遵循指南的可能性较小（比值比0.37，p = 0.01）。随后通过临床病例评估对指南的遵循情况。与1991 - 2010年完成培训的医师相比，1990年之前完成培训的医师（比值比0.75，p < 0.001）或目前仍在培训的医师（比值比0.72，p = 0.004）的遵循情况较差。与美国西部相比，中西部（比值比0.69，p = 0.001）、东北部（比值比0.63，p < 0.001）和南部（比值比0.59，p < 0.001）的遵循情况较差。非学术型医师（比值比0.72，p = 0.001）和低工作量结肠镜检查医师（比值比0.52，p < 0.001）的遵循情况较低。
美国胃肠病学家对结肠镜检查筛查及监测指南的遵循情况较差。较差的遵循情况与1990年之前接受培训或完成培训、在南部执业、非学术环境以及结肠镜检查工作量低有关。这些发现可为改善结直肠癌筛查及监测质量的干预措施提供目标。
