The Prevalence of Low-Value Prostate Cancer Screening in Primary Care Clinics: A Study Using the National Ambulatory Medical Care Survey

Abstract

Introduction: There has been an increasing focus on improving value in health care and deimplementing the use of low-value services, such as prostate cancer (PC) screening for men aged >70 years. The objectives of this study are to (1) identify the proportion of primary care visits at which low-value PC screening is ordered, and (2) identify predisposing, enabling, and health care need characteristics associated with low-value PC screening in the United States.Methods: This was a secondary analysis of the National Ambulatory Medicare Care Survey datasets from 2013 to 2016 and 2018. Andersen's Behavioral Model of Health Services Use guided independent variable selection. Weighted multivariable logit models were used to analyze data.Results: There were 6.71 low-value prostate-specific antigens (PSAs) per 100 visits and 1.65 lowvalue digital rectal exams (DREs) per 100 visits. For each additional service ordered by primary care providers, the odds of ordering a low-value PSA increased by 49%, and the odds of performing a lowvalue DRE increased by 37%.Conclusions: The use of low-value PSAs and DREs was sizable during the observed time period. Organizations who want to reduce low-value PSAs and DREs may want to focus interventions on providers who order a high number of tests.

Family Physicians Can/Should Do: What? Where? And How?

“…Screening for prostate cancer is common but has been increasingly recognized as of low value in men older than 70 without other specific indications. Gillette et al 7 provide updated data on the rate of such screening and quantify other tests ordered concurrently with prostate-specific antigen testing.…”