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Flexible Sigmoidoscopy Training and Its Impact on Colorectal Cancer Screening by Primary Care Physicians
James D. Lewis, MD, MSCE;
Gregory G. Ginsberg, MD;
Timothy C. Hoops, MD;
Michael L. Kochman, MD;
Warren B. Bilker, PhD;
Brian L. Strom, MD, MPH
Arch Fam Med. 2000;9:420-425.
Background Colorectal cancer is an ideal disease for prevention with screening programs. Efforts to increase compliance with screening recommendations have included training primary care physicians to perform flexible sigmoidoscopy.
Objective To assess the impact of flexible sigmoidoscopy training on compliance with current screening recommendations.
Methods We performed a cross-sectional study of 232 patients cared for by physicians in a primary care network.
Main Outcome Measures Rates of screening for colorectal cancer and rates of undergoing flexible sigmoidoscopy were compared across patient groups according to the physician's training and whether the physician performs flexible sigmoidoscopy in his or her practice.
Results Among 217 patients included in the analysis, 122 (56%) were cared for by physicians who were trained in flexible sigmoidoscopy, of whom 79 (36%) were cared for by physicians who perform flexible sigmoidoscopy in their practice. Patients cared for by physicians trained in flexible sigmoidoscopy were not significantly more likely to receive any colorectal cancer screening than were patients cared for by physicians not trained in flexible sigmoidoscopy (odds ratio, 1.16; 95% confidence interval, 0.67-2.01). However, patients cared for by physicians who perform flexible sigmoidoscopy in their practice were more likely to have undergone any colorectal cancer screening (odds ratio, 1.73; 95% confidence interval, 1.02-2.95) and flexible sigmoidoscopy (odds ratio, 2.69; 95% confidence interval, 1.14-6.36).
Conclusion Performance of flexible sigmoidoscopy by primary care physicians has the potential to increase the rate of colorectal cancer screening with flexible sigmoidoscopy.
From the Division of Gastroenterology (Drs Lewis, Ginsberg, Hoops, and Kochman), the Center for Clinical Epidemiology and Biostatistics (Drs Lewis, Bilker, and Strom), the Division of General Internal Medicine (Dr Strom), and the Department of Biostatistics and Epidemiology (Drs Bilker and Strom), University of Pennsylvania, Philadelphia.
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