Table 4.
Factors Associated With Primary Care Physicians’ Confidence and Preferences in Pulmonary Nodule Management
| Variable | Confidence Managing Pulmonary Nodules |
Prefers to Self-manage |
||
|---|---|---|---|---|
| N (%) | OR (95% CI) | N (%) | OR (95% CI) | |
| Age | ||||
| <40 | 15 (7.2) | 1.00 (reference) | 13 (6.5) | 1.00 (reference) |
| 40-49 | 61 (29.3) | 2.03 (0.65-6.34) | 55 (27.4) | 0.70 (0.18-2.64) |
| 50-59 | 63 (30.3) | 3.36 (1.05-10.73)* | 68 (33.8) | 1.08 (0.30-3.88) |
| 60-69 | 56 (26.9) | 1.77 (0.56-5.56) | 50 (24.9) | 0.49 (0.12-1.97) |
| 70 + | 13 (6.3) | 1.83 (0.40-8.27) | 15 (7.5) | 0.56 (0.10-3.17) |
| Sex | ||||
| Male | 135 (64.9) | 1.00 (reference) | 123 (61.2) | 1.00 (reference) |
| Female | 73 (35.1) | 0.88 (0.49-1.59) | 78 (38.8) | 0.34 (0.16-0.71)* |
| Years in practice | ||||
| 0-4 | 3 (1.4) | Undetermined | 3 (1.5) | 5.69 (0.48-68.13) |
| 5-10 | 26 (12.5) | 0.42 (0.16-1.11) | 22 (10.9) | 1.07 (0.34-3.31) |
| 11-20 | 69 (33.2) | 0.89 (0.41-1.96) | 68 (33.8) | 0.88 (0.38-2.04) |
| 21-30 | 58 (27.9) | 0.63 (0.28-1.41) | 57 (28.4) | 0.93 (0.39-2.22) |
| >30 | 51 (24.5) | 1.00 (reference) | 50 (24.9) | 1.00 (reference) |
| Specialty | ||||
| Family practice | 91 (43.8) | 1.00 (reference) | 89 (44.3) | 1.00 (reference) |
| Internal medicine | 115 (55.3) | 1.95 (1.09-3.48)* | 110 (54.7) | 1.55 (0.80-3.00) |
| Primary practice arrangement | ||||
| Full or part owner of practice | 104 (50.0) | 1.00 (reference) | 103 (51.2) | 1.00 (reference) |
| Employee of physician-owned practice | 12 (5.8) | 0.35 (0.10-1.17) | 14 (7.0) | 2.47 (0.78-7.82) |
| Employee of large medical group or health-care system | 38 (18.3) | 1.57 (0.67-3.67) | 31 (15.4) | 1.81 (0.76-4.30) |
| Employee of staff or group model HMO | 21 (10.1) | 0.79 (0.30-2.08) | 18 (9.0) | 1.65 (0.56-4.85) |
| Employee of university hospital or clinic | 21 (10.1) | 0.53 (0.21-1.38) | 22 (10.9) | 0.52 (0.14-1.91) |
| Employee of non–university affiliated hospital or clinic | 11 (5.3) | 0.58 (0.17-2.05) | 12 (6.0) | 0.30 (0.04-2.44) |
| Practice specialty mix | ||||
| Single specialty | 124 (59.6) | 1.00 (reference) | 124 (61.7) | 1.00 (reference) |
| Multi-specialty | 81 (38.9) | 1.55 (0.85-2.82) | 73 (36.3) | 1.01 (0.52-1.96) |
| Practice size | ||||
| 1 | 57 (27.4) | 1.00 (reference) | 52 (25.9) | 1.00 (reference) |
| 2-5 | 64 (30.8) | 0.69 (0.33-1.44) | 73 (36.3) | 1.41 (0.61-3.26) |
| 6-15 | 37 (17.8) | 1.35 (0.54-3.36) | 29 (14.4) | 1.68 (0.60-4.70) |
| 16-49 | 29 (13.9) | 0.82 (0.32-2.07) | 27 (13.4) | 1.06 (0.35-3.28) |
| 50-99 | 10 (4.8) | 2.00 (0.39-10.36) | 8 (4.0) | 0.53 (0.06-4.80) |
| 100 + | 10 (4.8) | 0.75 (0.19-2.98) | 11 (5.5) | 2.13 (0.53-8.61) |
| Type of health record system used | ||||
| Paper charts | 30 (14.4) | 1.00 (reference) | 28 (13.9) | 1.00 (reference) |
| Partial EHR | 10 (4.8) | 0.75 (0.17-3.28) | 10 (5.0) | 4.00 (0.77-20.82) |
| Transitioning from paper to full EHR | 29 (13.9) | 0.71 (0.25-2.04) | 36 (17.9) | 0.75 (0.17-3.31) |
| Full EHR | 136 (65.4) | 1.01 (0.44-2.34) | 124 (61.7) | 2.75 (0.89-8.47) |
| Percent uninsured patients | ||||
| 0-5 | 135 (64.9) | 1.00 (reference) | 128 (63.7) | 1.00 (reference) |
| 6-25 | 49 (23.6) | 0.71 (0.37-1.39) | 49 (24.4) | 0.71 (0.32-1.57) |
| 26-50 | 6 (2.9) | Undetermined | 6 (3.0) | 0.55 (0.06-4.90) |
| 76-100 | 4 (1.9) | 1.60 (0.16-15.83) | 3 (1.5) | 1.38 (0.12-15.74) |
| Percent of Medi-Cal insured patients | ||||
| 0-5 | 97 (46.6) | 1.00 (reference) | 89 (44.3) | 1.00 (reference) |
| 6-25 | 56 (26.9) | 1.61 (0.78-3.32) | 54 (26.9) | 1.08 (0.51-2.27) |
| 26-50 | 21 (10.1) | 0.44 (0.17-1.15) | 24 (11.9) | 0.37 (0.10-1.34) |
| 51-75 | 19 (9.1) | 1.28 (0.45-3.66) | 20 (10.0) | 0.45 (0.12-1.68) |
| 76-100 | 6 (2.9) | 2.95 (0.33-26.26) | 6 (3.0) | 0.51 (0.06-4.60) |
| Patient volume (weekly) | ||||
| ≤25 | 18 (8.7) | 1.00 (reference) | 20 (10.0) | 1.00 (reference) |
| 26-50 | 30 (14.4) | 1.31 (0.40-4.22) | 32 (15.9) | 1.59 (0.36-7.01) |
| 51-75 | 56 (26.9) | 1.80 (0.62-5.27) | 50 (24.9) | 2.20 (0.56-8.71) |
| 76-100 | 60 (28.8) | 2.00 (0.69-5.82) | 55 (27.4) | 1.93 (0.49-7.61) |
| 101-125 | 24 (11.5) | 2.43 (0.68-8.70) | 25 (12.4) | 1.42 (0.29-6.81) |
| 126+ | 15 (7.2) | 4.00 (0.84-19.16) | 13 (6.5) | 6.61 (1.28-34.1)* |
| Feels confident in managing workup when pulmonary nodule is detected | ||||
| Agree | – | – | 104 (51.7) | 1.00 (reference) |
| Disagree | – | – | 70 (34.8) | 0.14 (0.06-0.36)* |
| Neutral | – | – | 25 (12.4) | 0.29 (0.09-0.91)* |
*
P < 0.05.
“Agree” includes all somewhat agree and strongly agree responses.
“Disagree” includes all somewhat disagree and strongly disagree responses.
Undetermined–value unable to be calculated due to the small sample size.