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Colonoscopy screening rates among patients of colonoscopy‐trained African American primary care physicians
Author(s) -
Xirasagar Sudha,
Hurley Thomas G.,
Burch James B.,
Mansaray Ali,
Hébert James R.
Publication year - 2011
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.26142
Subject(s) - medicine , colonoscopy , ambulatory , odds ratio , african american , demographics , retrospective cohort study , colorectal cancer , primary care , physical therapy , family medicine , cancer , demography , ethnology , sociology , history
BACKGROUND: When performed competently, colonoscopy screening can reduce colorectal cancer rates, especially in high‐risk groups such as African Americans. Training primary care physicians (PCPs) to perform colonoscopy may improve screening rates among underserved high‐risk populations. METHODS: The authors compared colonoscopy screening rates and computed adjusted odds ratios for colonoscopy‐eligible patients of trained African American PCPs (study group) versus untrained PCPs (comparison group), before and after initiating colonoscopy training. All colonoscopies were performed at a licensed ambulatory surgery center with specialist standby support. Retrospective chart review was conducted on 200 consecutive, established outpatients aged ≥50 years at each of 12 PCP offices (7 trained African American PCPs and 5 untrained PCPs, practicing in the same geographic region). There were a total of 1244 study group and 923 comparison group patients. RESULTS: Post‐training colonoscopy rates in both groups were higher than pretraining rates: 48.3% versus 9.3% in the study group, 29.6% versus 9.8% in the comparison group (both P < .001). African American patients in the study group showed a >5‐fold increase (8.9% pretraining vs 52.8% post‐training), with no change among whites (18.2% vs 25.0%). Corresponding pretraining and post‐training rates among comparison patients were 10.4%% and 38.7%, respectively, among African Americans ( P < .001), and 13.3% versus 13.2%, respectively, among whites. After adjusting for demographics, duration since becoming the PCP's patient, and health insurance, the study group had a 66% higher likelihood of colonoscopy in the post‐training period (odds ratio, 1.66; 95% confidence interval, 1.30‐2.13), and African Americans had a 5‐fold increased likelihood of colonoscopy relative to whites. CONCLUSIONS: Colonoscopy‐trained PCPs may help reduce colorectal cancer disparities. Cancer 2011;. © 2011 American Cancer Society.