Department of Internal Medicine, University of Michigan, Ann Arbor.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
JAMA Netw Open. 2021 Oct 1;4(10):e2127827. doi: 10.1001/jamanetworkopen.2021.27827.
Recognition of iron deficiency anemia (IDA) is important to initiate timely evaluation for gastrointestinal tract cancer. Retrospective studies have reported delays in diagnostic evaluation of IDA as a common factor associated with delayed diagnosis of colorectal cancer.
To assess how US primary care physicians (PCPs) approach testing for anemia, interpret iron laboratory studies, and refer patients with IDA for gastrointestinal endoscopy.
DESIGN, SETTING, AND PARTICIPANTS: This survey study, conducted in August 2019, included members of the American College of Physicians Internal Medicine Insiders Panel, a nationally representative group of American College of Physicians membership, who self-identified as PCPs. Participants completed a vignette-based survey to assess practices related to screening for anemia, interpretation of laboratory-based iron studies, and appropriate diagnostic evaluation of IDA.
Descriptive statistics based on survey responses were evaluated for frequency of anemia screening, correct interpretation of iron laboratory studies, and proportion of patients with new-onset IDA referred for gastrointestinal tract evaluation.
Of 631 PCPs who received an invitation to participate in the survey, 356 (56.4%) responded and 31 (4.9%) were excluded, for an adjusted eligible sample size of 600, yielding 325 completed surveys (response rate, 54.2%). Of the 325 participants who completed surveys, 180 (55.4%) were men; age of participants was not assessed. The mean (SD) duration of clinical experience was 19.8 (11.2) years (range, 1.0-45.0 years). A total of 250 participants (76.9%) screened at least some patients for anemia. Interpretation of iron studies was least accurate in a scenario of a borderline low ferritin level (40 ng/mL) with low transferrin saturation (2%); 86 participants (26.5%) incorrectly responded that this scenario did not indicate IDA, and 239 (73.5%) correctly identified this scenario as IDA. Of 312 participants, 170 (54.5%) recommended bidirectional endoscopy (upper endoscopy and colonoscopy) for new IDA for women aged 65 years; of 305 respondents, 168 (55.1%) recommended bidirectional endoscopy for men aged 65 years.
In this survey study, US PCPs' self-reported testing practices for anemia suggest overuse of screening laboratory tests, misinterpretation of iron studies, and underuse of bidirectional endoscopy for evaluation of new-onset IDA. Both misinterpretation of iron studies and underuse of bidirectional endoscopy can lead to delayed diagnosis of gastrointestinal tract cancers and warrant additional interventions.
识别缺铁性贫血（IDA）很重要，可及时评估胃肠道肿瘤。回顾性研究报告称，IDA 的诊断评估延迟是与结直肠癌诊断延迟相关的常见因素。
评估美国初级保健医生（PCP）如何进行贫血检测、解读铁实验室研究结果以及将 IDA 患者转介至胃肠内镜检查。
设计、地点和参与者：这项调查研究于 2019 年 8 月进行，参与者为美国内科医师学院内科内幕小组的成员，这是一个具有全国代表性的美国内科医师学院会员群体，他们自认为是 PCP。参与者完成了基于病例的调查，以评估与贫血筛查、基于实验室的铁研究解读以及 IDA 新发病例的适当诊断评估相关的实践。
根据调查结果的描述性统计数据评估了贫血筛查的频率、铁实验室研究的正确解读以及新发生 IDA 患者接受胃肠道评估的比例。
在收到调查邀请的 631 名 PCP 中，有 356 名（56.4%）做出回应，31 名（4.9%）被排除在外，调整后的合格样本量为 600 名，产生了 325 份完成的调查（回应率为 54.2%）。在 325 名完成调查的参与者中，有 180 名（55.4%）为男性；参与者的年龄未评估。临床经验的平均（SD）持续时间为 19.8（11.2）年（范围，1.0-45.0 年）。共有 250 名参与者（76.9%）至少对一些患者进行了贫血筛查。在边缘低铁蛋白水平（40ng/mL）伴低转铁蛋白饱和度（2%）的情况下，铁研究的解读最不准确；86 名参与者（26.5%）错误地表示这种情况不表示 IDA，239 名参与者（73.5%）正确地将这种情况识别为 IDA。在 312 名参与者中，170 名（54.5%）建议对 65 岁女性的新 IDA 进行双向内镜检查（上消化道内镜检查和结肠镜检查）；在 305 名回答者中，168 名（55.1%）建议对 65 岁男性进行双向内镜检查。
在这项调查研究中，美国 PCP 自我报告的贫血检测实践表明，过度使用筛查实验室检测、铁研究解读错误以及对新发生 IDA 的双向内镜检查不足。铁研究解读错误和双向内镜检查不足都可能导致胃肠道癌的诊断延迟，需要采取额外的干预措施。
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