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Travel distance, rurality and area socioeconomic position as predictors of screening colonoscopy use among patients who get access to primary care practitioners.

机译：在可以与初级保健从业者接触的患者中，行进距离，农村地区和社会经济地位是结肠镜检查筛查的预测指标。

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摘要

Background. Colorectal cancer mortality ranks third among cancer-related cause of death in United States. Medical care is a tremendous burden for cancer patients. It is well established that colorectal cancer screening is cost effective and life saving. Recent guidelines by the American Cancer Society (ACS) recommend that adults aged over 50 years receive colorectal cancer screening. Colonoscopy is the most preferred method for colorectal cancer screening. However, little is known about the impacts of distance, rural residence and area socioeconomic status and the likelihood of colonoscopy utilization among patients of African American PCPs, particularly when the PCPs are trained in colonoscopy.;Data collection. The study used data collected for a project funded by the National Cancer Institute, through the South Carolina Cancer Disparities Community Network (one of 25 Cancer Network Programs). We conducted patient chart reviews at seven colonoscopy-trained and five untrained primary care physician offices (selected by convenience sampling) in South Carolina. Consecutive patient charts of patients aged ≥50 years were retrieved using the billing databases. We conducted chart reviews of 2,272 patients aged ≥50 years who were established patients of 12 primary care physicians. Based on inclusion and exclusion criteria, 677 patients of trained PCPs were eligible to study the distance's effect and 1196 patients of colonoscopy-trained and untrained PCPs for the rurality and area SES.;Data analysis. ARC GIS software was used to calculate distance between patients' zip code centroids and the endoscopy center where their PCP performed colonoscopy. Distance is analyzed as a continuous variable. The Rural Urban Commuting Areas (RUCA 2.0) classification system was used to classify patients' residence zip code into urban and rural. The U.S. Census 2000 was used to retrieve for each zip code the area-based SES data, including percent non-African American population, percent households above federal poverty level, percent households with any adult aged ≥ 25 years who have completed college, median housing value, percent households with dividend, rental or interest income, percent employed persons aged ≥ 16 years in non-blue collar occupations. A composite SES index was calculated as documented by Rosenberg et al. The composite scores were classified into four quartiles (highest=highest area SES). We controlled for patient demographics, insurance source, duration of patient-PCP relationship, and presence of serious co-morbidities.;Results. Distance is not a barrier for the colonoscopy use among patients of trained PCPs (OR=1.006; 95%CI: 0.997-1.016). Rural patients were more likely to use the procedure than the urban patients (OR=1.966; 95%CI: 1.438 -- 2.688). Area SES was adversely associated with colonoscopy utilization. As compared to the highest quartile, the OR was 0.649 for the first quartile (95%CI: 0.438 -- 0.961), 0.632 for the second quartile (95%CI: 0.417 -- 0.958), and 0.527 for the third quartile (95%CI: 0.352 -- 0.788).;Conclusion. A possible reason for the lack of association between distance and colonoscopy completion is motivational effects of PCPs trained in colonoscopy. A similar reason may be operating among rural patients' higher odds of colonoscopy relative to urban patients.
机译：背景。在美国，大肠癌的死亡率在与癌症相关的死亡原因中排名第三。医疗服务是癌症患者的巨大负担。众所周知，大肠癌筛查具有成本效益并可以挽救生命。美国癌症协会（ACS）最近的指南建议年龄超过50岁的成年人接受大肠癌筛查。结肠镜检查是结肠直肠癌筛查的最优选方法。但是，人们对非洲裔美国人PCP患者中距离，农村居民和地区社会经济地位的影响以及结肠镜检查利用的可能性知之甚少，特别是在对PCP进行结肠镜检查培训时。该研究使用了由国家癌症研究所通过南卡罗来纳州癌症差异社区网络（25个癌症网络计划之一）资助的项目收集的数据。我们在南卡罗来纳州的七个结肠镜检查培训和五个未经培训的初级保健医师办公室（通过方便抽样选择）进行了患者图表审查。使用计费数据库检索≥50岁患者的连续患者病历。我们对2272名年龄≥50岁的患者进行了图表审查，这些患者是由12位初级保健医生确定的患者。根据纳入和排除标准，有677名受过培训的PCP患者有资格研究该距离的影响，有1196例接受了结肠镜培训的和未经培训的PCP患者有农村和地区SES的资格。 ARC GIS软件用于计算患者的邮政编码质心与患者的PCP进行结肠镜检查的内窥镜检查中心之间的距离。距离被分析为连续变量。使用农村城市通勤区（RUCA 2.0）分类系统将患者的居住邮政编码分类为城市和农村。美国人口普查2000年用于每个邮政编码检索基于区域的SES数据，包括非裔美国人口百分比，联邦贫困线以上的家庭百分比，任何年龄≥25岁且已完成大学的家庭百分比，中位住房价值，有股息，租金或利息收入的家庭百分比，从事非蓝领工作且年龄≥16岁的就业人数百分比。如Rosenberg等人所述，计算了复合SES指数。综合得分分为四个四分位数（最高=最高面积SES）。我们控制了患者的人口统计学，保险来源，患者与PCP关系的持续时间以及严重的合并症的存在。在经过培训的PCP患者中，距离不是结肠镜检查使用的障碍（OR = 1.006； 95％CI：0.997-1.016）。农村患者比城市患者更可能使用该程序（OR = 1.966; 95％CI：1.438-2.688）。 SES面积与结肠镜检查的利用有不利关系。与最高四分位数相比，第一四分位数（95％CI：0.438-0.961）的OR为0.649，第二四分位数（95％CI：0.417-0.958）的OR为0.632，第三四分位数（95的OR）为0.527 ％CI：0.352-0.788）；结论。距离与结肠镜检查完成之间缺乏关联的可能原因是在结肠镜检查中训练的PCP的动机作用。与城市患者相比，农村患者结肠镜检查几率更高的原因可能与此类似。

著录项

  • 作者

    Sros, Lekhena.;

  • 作者单位

    University of South Carolina.;

  • 授予单位 University of South Carolina.;
  • 学科 Health Sciences Public Health.
  • 学位 Ph.D.
  • 年度 2010
  • 页码 137 p.
  • 总页数 137
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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