Table 3.
Multivariate Associations between Primary Care Physician and Practice Characteristics and Guideline-Consistent Colorectal Cancer Screening Recommendations
| Guideline-consistent screening recommendations* | p-value | ||||
|---|---|---|---|---|---|
| All guideline-consistent vs. none | Some guideline-consistent vs. none | ||||
| OR | (95% CI) | OR | (95% CI) | ||
| Physician background and experience | |||||
| Age | |||||
| <40 | 1.00 | 1.00 | <0.001 | ||
| 40-49 | 0.55 | (0.34, 0.88) | 0.82 | (0.52, 1.28) | |
| 50-59 | 0.39 | (0.23, 0.67) | 0.70 | (0.43, 1.15) | |
| ≥ 60 | 0.17 | (0.09, 0.35) | 0.41 | (0.24, 0.71) | |
| Gender | |||||
| Male | 1.00 | 1.00 | 0.002 | ||
| Female | 0.94 | (0.63, 1.41) | 1.63 | (1.20, 2.21) | |
| International medical school graduate | |||||
| Yes | 1.00 | 1.00 | 0.064 | ||
| No | 1.99 | (1.11, 3.58) | 1.23 | (0.87, 1.74) | |
| Board certification | |||||
| Yes | 1.95 | (1.12, 3.38) | 1.42 | (1.00, 2.03) | 0.030 |
| No | 1.00 | 1.00 | |||
| Medical school affiliation | |||||
| Yes | 1.27 | (0.90, 1.80) | 1.32 | (0.98, 1.80) | 0.151 |
| No | 1.00 | 1.00 | |||
| Specialty | |||||
| Family medicine/General practice | 1.00 | 1.00 | 0.132 | ||
| Internal medicine | 0.63 | (0.40, 0.99) | 0.75 | (0.53, 1.06) | |
| Obstetrics/Gynecology | 0.70 | (0.46, 1.05) | 0.68 | (0.45, 1.03) | |
| Practice environment and practice patterns | |||||
| Practice type | |||||
| Solo practice | 1.00 | 1.00 | <0.001 | ||
| Single specialty group | 3.09 | (1.67, 5.69) | 1.68 | (1.12, 2.52) | |
| Multi-specialty group | 4.71 | (2.54, 8.75) | 1.45 | (0.96, 2.19) | |
| Other | 1.93 | (0.47, 7.92) | 0.71 | (0.22, 2.26) | |
| Region | |||||
| Northeast | 0.67 | (0.42, 1.07) | 0.94 | (0.66, 1.35) | 0.014 |
| North central | 1.54 | (0.98, 2.42) | 1.45 | (1.03, 2.04) | |
| South | 1.00 | 1.00 | |||
| West | 1.05 | (0.69, 1.60) | 0.99 | (0.66, 1.47) | |
| Number of patients per week | |||||
| <76 | 1.00 | 1.00 | 0.008 | ||
| 76-100 | 0.76 | (0.48, 1.23) | 1.09 | (0.72, 1.64) | |
| ≥101 | 0.45 | (0.28, 0.72) | 0.98 | (0.66, 1.44) | |
| Record systems | |||||
| Paper charts | 1.00 | 1.00 | 0.007 | ||
| Partial EMR/transition to EMR | 1.47 | (0.92, 2.35) | 1.15 | (0.77, 1.71) | |
| Full EMR | 2.31 | (1.50, 3.56) | 1.44 | (0.97, 2.14) | |
| Number of CRC screening modalities recommended | |||||
| 1 or 2 | 1.00 | 1.00 | <0.001 | ||
| 3 or 4 | 0.99 | (0.57, 1.72) | 3.43 | (2.30, 5.12) | |
| Physician perceptions of colorectal cancer screening | |||||
| Availability of third party reimbursement | |||||
| Very influential | 1.70 | (0.97, 2.96) | 1.11 | (0.74, 1.68) | 0.101 |
| Somewhat influential | 1.37 | (0.95, 1.98) | 1.28 | (0.98, 1.68) | |
| Not influential | 1.00 | 1.00 | |||
| Patients preferences for CRC screening | |||||
| Very influential | 1.96 | (1.18, 3.24) | 1.92 | (1.17, 3.15) | 0.018 |
| Somewhat influential | 1.37 | (0.89, 2.11) | 1.72 | (1.14, 2.59) | |
| Not influential | 1.00 | 1.00 | |||
| Patient barriers to screening (composite measure) | |||||
| Low (<8) | 1.00 | 1.00 | 0.168 | ||
| Intermediate (8-9) | 1.56 | (0.98, 2.46) | 1.21 | (0.86, 1.70) | |
| High (≥10) | 0.91 | (0.57, 1.43) | 0.95 | (0.67, 1.34) | |
| Physician social support and influence | |||||
| Clinical evidence in published literature | |||||
| Very or somewhat influential | 3.25 | (0.82, 12.84) | 3.75 | (1.39, 10.10 | 0.028 |
| All other | 1.00 | 1.00 | |||
| Local CRC screening practice | |||||
| Very influential | 0.45 | (0.24, 0.82) | 0.53 | (0.35, 0.79) | 0.005 |
| Somewhat influential | 0.49 | (0.33, 0.73) | 0.76 | (0.56, 1.03) | |
| Not influential | 1.00 | 1.00 | |||
*Estimates are weighted for selection probability and non-response using survey design variables and SUDAAN statistical software
CRC=colorectal cancer screening EMR=electronic medical record FOBT=fecal occult blood test DCBE=double contrast barium enema USPSTF=U.S. Preventive Services Task Force ACS=American Cancer Society
National Survey of Primary Care Physicians’ Cancer Screening Recommendations and Practices, 2006-2007
Exact wording of all items is available at http://healthservices.cancer.gov/surveys/screening_rp/screening_rp_colo_lung_inst.pdf