A National Survey of Primary Care Physicians' Methods for Screening for Fecal Occult Blood
Objective: To examine how FOBT and follow-up are conducted
in community practice across the United States.
Results: Although screening guidelines recommend home tests,
32.5% (95% CI, 29.8% to 35.3%) of physicians used only the
less accurate method of single-sample in-office testing; another
41.2% (CI, 38.3% to 44.0%) used both types of test. Follow-up
of positive test results showed considerable nonadherence to
guidelines, with 29.7% (CI, 27.1% to 32.4%) of physicians recommending
repeating FOBT. Furthermore, sigmoidoscopy, rather
than total colon examination, was commonly recommended to
work up abnormal findings. Nearly one third of adults who reported
having FOBT said they had only an in-office test, and
nearly one third of those who reported abnormal FOBT results
reported no follow-up diagnostic procedures.
Conclusions: Mortality reductions demonstrated with FOBT in
clinical trials may not be realized in community practice because
of the common use of in-office tests and inappropriate follow-up
of positive results. Education of providers and system-level interventions
are needed to improve the quality of screening implementation.
Reference: Nadel MR, Shapiro JA, Klabunde CN, Seeff LC, Uhler R, Smith RA, Ransohoff DF.
A national survey of primary care physicians' methods for screening for fecal occult blood.
Ann Intern Med 2005 Jan 18;142(2):86-94.
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