Sigmoidoscopy use among primary care physicians.

BACKGROUND

Despite endorsement by a variety of professional societies, screening sigmoidoscopy is performed on a small minority of patients. We performed a survey of primary care physicians in Allegheny County to examine in detail their current practice and attitude toward screening sigmoidoscopy.

METHODS

Physicians were surveyed by mail or telephone. Eligible respondents were required to practice in the county and perform direct patients care.

RESULTS

Of 732 adult primary care physicians in Allegheny County, 400 were randomly selected for sampling and 279, or 70%, responded. Over 88% of physicians agreed completely or partly with current American Cancer Society recommendations for screening sigmoidoscopy, but only 34% (95% CI 29-39%) reported they regularly refer or schedule patients for screening. Physicians who screen were more likely to be from internal medicine or family practice (P < 0.001) and to be trained in (P < 0.001) or to personally perform (P < 0.001) sigmoidoscopy. The greater the number of barriers to screening cited by physicians, including cost, patient discomfort, equipment availability, low probability of finding a lesion, time it takes to do sigmoidoscopy, and the risk of the procedure, the lower the screening rate (P = 0.002).

CONCLUSION

(a) Although primary care physicians in Allegheny County report that they support screening sigmoidoscopy, only one-third regularly refer or schedule patients, (b) physicians who are trained in or who perform sigmoidoscopy are more likely to screen patients, and (c) further education and training of primary care physicians in sigmoidoscopy will be required to increase screening rates.