Having a Personal Health Care Provider and Receipt of Colorectal Cancer Testing

Abstract

PURPOSE We wanted to assess the relationship between having a personal health care provider and receiving colorectal cancer testing.METHODS Self-reported data were obtained from the United States 2004 Behavioral Risk Factor Surveillance System. Men and women aged 50 years and older were included, and associations of having a personal health care provider, age, sex, race/ethnicity, education, income, and health insurance status with colorectal cancer testing were examined. Multiple logistic regression was performed on a fi nal sample of 120,221 individuals. RESULTSHaving at least 1 personal health care provider signifi cantly predicted up-to-date colorectal cancer testing in both the univariate (odds ratio [OR] = 3.96; 95% confi dence interval [CI] 3.56-4.41) and multiple regression models (OR = 2.91; 95% CI 2.58-3.28). Age, sex, race/ethnicity, education, income, and health insurance were also signifi cantly associated with up-to-date colorectal cancer testing.CONCLUSIONS Having a personal health care provider was associated with up-todate colorectal cancer testing. Efforts to increase and support the primary care workforce are needed to improve up-to-date colorectal cancer screening rates. INTRODUCTIOND ebate in the United States over health care reform is rampant, with many advocates claiming reform is a necessary step to revitalize a current nonfunctional health care system. 1 This debate has been a central focus for many Americans since reports ranked the US health care system last, or close to last, in satisfaction, health equity, access to care, and various health indicators, even though the United States is among the highest of all industrialized nations in spending for health care.2 One component being promoted is universal health coverage in which a primary care workforce provides fi rst-line health care services.That primary care has a positive effect on population health has been shown in a landmark study by Starfi eld et al, 3 who found access to primary care prevents illness and death and results in more equitable health. In a preventive health care delivery system that some believe is fragmented and fundamentally fl awed, 4 the Starfi eld et al fi ndings lend support to improving rates of preventive health care screening. One such preventive screening test is for colorectal cancer. Colorectal cancer has garnered particular attention because it has low screening rates among men and women (approximately 50% in the United States) and accounts for 1 of the top 3 causes of cancer deaths. [5][6][7] Moreover, persistent colorectal cancer disparities exist, with African Americans suffering 15% and 40% higher incidence of and mortality from colorectal cancer, respectively, than whites. [8][9][10][11][12][13] Further studies with a sample representative of the US population are needed to assess whether access to primary care clinicians improves colorecRoberto Cardarelli, DO PER S ONA L CL INICIA N A ND COLOR EC TA L C A NC ER T ES T INGtal cancer screening rates beyond changes in socioeconomic fac...

Health Insurance Is Associated With Preventive Care but Not Personal Health Behaviors

“…We employed conditional logistic regression analyses 19,20 to model within-individual changes in preventive care and health behaviors associated with within-individual changes in health insurance status. One set of models was unadjusted, while a second set was adjusted for factors that may both change year to year and influence preventive care and health behaviors: income level, 21,22 employment status, 23 total health care expenditures, 24 the number of office visits to health care providers, 25,26 the number of medication prescriptions, 24 availability of a usual source of care, [27][28][29][30] and health status. 31 An advantage of conditional logistic regression in this context is that it simultaneously models individual increases or decreases in preventive care and health behaviors associated with individual gain or loss of insurance, providing a more robust estimate of the effects of insurance change (approximately doubling the sample size of those changing insurance status) and yielding an average of the effects of insurance gain and loss.…”

Non-Visit-Based Cancer Screening Using a Novel Population Management System

“…However, similar screening rates were achieved with significantly fewer reminder letters in intervention practices where PCPs reviewed their overdue patients, and intervention PCPs reported spending less time during clinic hours on cancer screening tasks. Studies have shown that involvement of a PCP [23][24][25][26][27][28] and non-visit-based reminder systems 10,[12][13][14][15][16][17]36,37 can increase rates of preventive cancer screening. The current study demonstrates that an automated reminder IT application without physician input led to similar screening rates for patients who seemed to be overdue for up to 3 widely recommended cancers: breast, cervical, and colorectal.…”

“…We implemented this application as part of a practice-randomized trial that compared involving PCPs in the screening process to customize outreach with a fully automated outreach process. Although higher cancer screening rates are associated with having a PCP 23,24 and the PCP recommending screening, [25][26][27][28] the role of the PCP in non-visit-based outreach efforts is unclear. We hypothesized that having PCPs determine whether contact was needed-and, if needed, how best to provide it-would lead to an increase in cancer screening rates.…”

Alerts in electronic medical records to promote a colorectal cancer screening programme: a cluster randomised controlled trial in primary care

“…16 Data obtained in Catalonia indicated that 88.9% of individuals would agree to participate in a colorectal cancer screening programme if their primary care professional suggested it; 17 this figure, however, is far from the actual participation rates. In Catalonia, public primary care is organised through primary care centres that each cover a specific population area.…”