Changing Physician PSA Ordering Patterns Through Education

Skelton, Nadine Khouzam

doi:10.1001/archinte.1994.00420070149021

Cited by 4 publications

(2 citation statements)

References 2 publications

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“…Unfortunately, little has been published to date on educational interventions to improve practitioners' PSA screening knowledge and practice patterns. 26 Systems-level changes may also be an effective method by which to improve PSA screening practices. For example, a computerized ordering system could alert practitioners when they attempt to order a PSA test on an ageinappropriate patient.…”

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confidence: 99%

Practitioner-Level Determinants of Inappropriate Prostate-Specific Antigen Screening

Kerfoot

Holmberg²,

Lawler³

et al. 2007

Arch Intern Med

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Background: None of the major clinical practice guidelines recommend that prostate-specific antigen (PSA) screening be routinely performed in asymptomatic men older than 75 years or younger than 40 years. We investigated the practitioner-level determinants of inappropriate PSA screening in 7 Veterans Health Administration (VHA) hospitals. Methods: Data on PSA test use from 1997 to 2004 were obtained from VHA databases for 181 139 male patients and the 4823 health care providers who ordered their tests. Patients were excluded from the study population if they underwent PSA testing for nonscreening reasons, as indicated by prostate cancer-specific medications, diagnoses, and procedures. Inappropriate PSA test use was defined as PSA screening in patients older than 75 years or younger than 40 years. Univariate and multivariate Poisson regressions were performed. Results: The mean±SD percentage of inappropriate tests by health care provider was 19.3% ± 15.0%, with 18.4% ± 14.9% in patients older than 75 years and 0.8% ± 3.0% in patients younger than 40 years. Practitioners who were urology specialists, male, infrequent PSA test orderers, and affiliated with specific hospitals had significantly higher levels of inappropriate PSA screening. Compared with attending physicians, nurses and physician assistants had significantly lower levels of inappropriate screening. Under multivariate modeling, infrequent PSA test ordering and hospital affiliation retained statistical significance. The percentage of inappropriate PSA screening increased significantly with the age of male health care providers (PϽ.001). Conclusions: This study elucidates several important provider-level determinants of PSA screening misuse and substantiates that PSA screening is frequently performed counter to evidence-based guidelines. Further work is needed to determine the degree to which "prostatempathy" contributes to PSA misuse by older male providers.

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confidence: 99%

Practitioner-Level Determinants of Inappropriate Prostate-Specific Antigen Screening

Kerfoot

Holmberg²,

Lawler³

et al. 2007

Arch Intern Med

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“…Trends in testing and cancer occurrence continue to be monitored. A similar effort has been reported in a fee-for-service setting (134). However, the experience at GHC contrasts with that of other health maintenance organizations that report rising rates ofPSA screening in the absence of an internal evaluation program (A Glass, J Thompson, S Van Den Eeden personal communications).…”

Section: A Managed Care System's Approach To Psa Screeningmentioning

confidence: 77%

PSA Screening: A Public Health Dilemma

Mandelson

Wagner²,

Thompson³

1995

Annu. Rev. Public Health

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Screening for prostate cancer with serum prostate specific antigen (PSA) is one of the most controversial practices in health care today and guidelines from professional and policy organizations are contradictory. Prostate cancer is unique because of a wide discrepancy between prevalent asymptomatic cancer and clinical disease and an uncertain natural history. Proponents and critics of mass screening agree that PSA can detect early cancer and that definitive data that PSA reduces prostat cancer mortality are not available. Differences in screening recommendations reflect distinct viewpoints regarding what constitutes screening benefit and what level of evidence is needed to endorse a screening practice. This review describes what is known about the areas most relevant to the conflicting perspectives: the epidemiology and natural history of prostate cancer, the ability of PSA to detect disease and operational characteristics of PSA as a screening test, and the efficacy of treatment of early disease.

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Australian general practitioners' views and use of tests to detect early prostate cancer

Ward

Young

Sladden

1998

Australian and New Zealand Journal of Public Health

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To describe general practitioners' current beliefs, knowledge and self-reported practices in prostate cancer screening, we conducted a national survey of 1,271 general practitioners, obtaining 855 completed questionnaires (67% response rate). Available tests for prostate cancer screening, namely DRE and PSA alone and in combination, were indicated to be effective by 49%, 43% and 68% of respondents respectively, with older GPs significantly more likely to hold these views. Michael SaddenDepartment of General Practice, University of Tasmania rostate cancer screening has been the subject of considerable controversy, P as witnessed in this Journal! and Two tests -digital rectal examination (DRE) and prostate-specific antigen (PSA) -have been advocated, either alone or in combination, to screen asymptomatic men for early prostate cancer. In 1994, Parkes and Killers first raised the concern that Australian general practitioners (GPs) were ordering PSA assays to screen for prostate cancer. They reported that 12% of the male veteran population had had PSA estimations in a 12-month period but that only 2.2% had follow-up investigation. This finding suggested that PSA assays were being ordered in a population with a low pre-test probability of prostate cancer and hence for screening, not diagnostic, purposes.h A subsequent survey of Tasmanian GPs (n=83) found that one-third thought they should screen for prostate cancer with PSA.' Furthermore, routine rectal examination for adults 50 years and over was recommended by approximately three-quarters of GPs in NSW surveyed about preventive care in 1994 (11=363).~ In a 1995 survey, 39% of 286 GPs indicated that guidelines about screening for prostate cancer would be either 'extremely' or 'very' useful. ' TheAustralian Cancer Society (ACS) was the first national organisation to release a public position against screening.1° A multidisciplinary committee convened by the Australian Health Technology Advisory Committee (AHTAC) subsequently comrnissioned the Cochrane Collaboration to review the scientific evidence about prostate cancer screening. The ensuing report, launched in August 1996 by the Commonwealth Minister for Health, provided an unequivocal statement that PSA assays should not be used to screen for prostate cancer." In the 3rd edition of 'Guidelines for preventive activities in general practice',I2 current at the time of this study, the Royal Australian College of General Practitioners (RACGP) recommended against screening with either DRE or PSA assay. As no national studies had been conducted to assess GPs' views, we undertook this study in May 1996 before the AHTAC guidelines were launched in anticipation of providing a baseline against which effective dissemination of the policy could be compared. Method Questionnaire con ten 1As part of a 20-page questionnaire, respondents first were asked to indicate whether DRE, PSA or a combination of the two were effective in reducing premature mortality from prostate cancer. For each intervention, respondents next...

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Changing Physician PSA Ordering Patterns Through Education

Cited by 4 publications

References 2 publications

Practitioner-Level Determinants of Inappropriate Prostate-Specific Antigen Screening

Practitioner-Level Determinants of Inappropriate Prostate-Specific Antigen Screening

PSA Screening: A Public Health Dilemma

Australian general practitioners' views and use of tests to detect early prostate cancer

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