Primary care provider perceptions of barriers to and facilitators of colorectal cancer screening in a managed care setting

Abstract

BACKGROUND Colorectal cancer (CRC) screening tests (e.g., fecal occult blood testing [FOBT], flexible sigmoidoscopy [FS], etc.) are underused. Primary care providers (PCPs) play a critical role in screening, but barriers to and facilitators of screening as perceived by PCPs in managed care settings are poorly understood. The objectives of the current study were to describe current CRC screening practices and to explore determinants of test use by PCPs in a managed care setting. METHODS In 2000, a self‐administered survey was mailed to a stratified, random sample of 1340 PCPs in a large, network model health maintenance organization in California. RESULTS The survey response rate was 67%. PCPs indicated that 79% of their standard‐risk patients were screened for CRC. PCP‐reported median rates of recommendation for the use of specific screening tests were 90% for FOBT and 70% for FS. In logistic regression models, perceived barriers to the use of FOBT and FS included patient characteristics (e.g., education) and PCP‐related barriers (e.g., failure to recall that patients were due for testing). Perceived facilitators of the use of FOBT and FS included interventions targeting certain aspects of the health care system (e.g., reimbursement) and interventions targeting certain aspects of the tests themselves (e.g., provision of evidence of a test's effectiveness). Assignment of high priority to screening, integrated medical group (as opposed to independent practice association) affiliation, and the proportion of patients receiving routine health maintenance examinations were positively associated with reported test use. CONCLUSIONS CRC screening tests appear to be underused in the managed care setting examined in the current study. The perceived barriers and facilitators that were identified can be used to guide interventions aimed at increasing recommendations for, as well as actual performance of, CRC screening. Cancer 2004. © 2004 American Cancer Society.

The effects of teamwork and system support on colorectal cancer screening in primary care practices

“…Most studies that examine preventive CRC screening do so aiming to find the problem -e.g., patient barriers, [25][26][27][28][29][30] physician barriers, [5][6][7]31,32] system barriers [14,23,24,33,34] -and implement targeted interventions that solely impact CRC screening. These approaches, while successful to varying degrees, may be limited in their usefulness in applied practice settings for a number of reasons.…”

“…[3,4] Appropriate testing could have saved more than half of the 55,170 people expected to die in 2006 from CRC. [1] A number of recent studies [5][6][7] aimed at improving CRC screening in primary care practices directly target physicians for CRC clinical interventions examining their attitudes [6,7] and whether physicians discuss CRC screening with their patients. [5] Although, primary care physician counseling of patients has been positively associated with CRC screening, [6,8] this approach is inadequate due to multiple competing demands and priorities.…”

Challenges Facing Primary Care Practices Aiming to Implement Patient-Centered Medical Homes

“…37 We were therefore not entirely surprised that VA PC directors reported the least amount of frustration with preventive care delivery, and even then, only with CRC screening, which requires iterative steps and specialty collaboration. 17,38 To date, medical home improvements in the delivery of preventive services, including cancer screening, has received limited attention, 39 suggesting VA's successes in these areas warrant attention.…”

A Public Health Approach to Winning the War Against Cancer

“…With 47 million people in the U.S. uninsured, nearly one sixth of the U.S. population lacks ready access to even the most basic preventive care [67]. Additionally, primary care physicians may be unaware of guidelines [68,69], may forget to recommend screening [70], or may not know when patients are due for screening [71]. Patients are also reluctant to undergo colonoscopy or sigmoidoscopy because it is a complex procedure that requires uncomfortable preparation [72,73].…”