Colonoscopy screening rates among patients of colonoscopy‐trained African American primary care physicians

Abstract

Background When performed competently, colonoscopy screening can reduce colorectal cancer rates, especially in high-risk groups such as African Americans (AAs). Training primary care physicians (PCPs) to perform colonoscopy may improve screening rates among underserved high-risk populations. Methods We compared colonoscopy screening rates and computed adjusted odds ratios for colonoscopy-eligible patients of trained AA PCPs (study group) vs. untrained PCPs (comparison group), before and since 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 AA PCPs and 5 untrained PCPs, practicing in the same geographic region), total 1,244 study group and 923 comparison group patients. Results Post-training colonoscopy rates in both groups were higher than pre-training rates: 48.3% vs. 9.3% in the study group, 29.6% vs. 9.8% in the comparison group (both p<0.001). AA patients in the study group showed over 5-fold increase (8.9% pre-training vs. 52.8% post training), with no change among Whites (18.2% vs. 25.0%). Corresponding pre- and post-training rates among comparison patients were 10.4% and 38.7% respectively among AAs (p<0.001), and 13.3% vs. 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 (OR=1.66; CI, 1.30, 2.13), and AAs had a five-fold increased likelihood of colonoscopy relative to Whites. Conclusions Colonoscopy-trained PCPs may help reduce colorectal cancer disparities.

Loss of efficacy and cost‐effectiveness when screening colonoscopy is performed by nongastroenterologists

“…When also assuming in this scenario a 1.9 RR in interval CRC between non‐GI and GI endoscopists, as recently estimated,11 the absolute difference in the CRC prevention rate between the 2 specialists appeared to increase 4‐fold to nearly 40%. Conversely, our sensitivity analysis demonstrated that a potential advantage for non‐GI endoscopists may be represented by an eventual increase in the level of adherence to colonoscopy screening compared with the level among GI endoscopists, as recently suggested for African Americans 26…”

Expanding Access to Colorectal Cancer Screening: Benchmarking Quality Indicators in a Primary Care Colonoscopy Program

“…Endoscopy centers that serve more than 1 primary care practice could also reduce or eliminate the barrier of cost for physicians who cannot afford to purchase colonoscopy equipment. 46 Proactively increasing access to colonoscopy training among primary care physicians who belong to or serve minority groups should also be considered. This is highlighted in a study by Xirasagar et al, 46 which found that, following colonoscopy training of African American primary care physicians, colonoscopy screening rates among African American patients in their practice increased, compared with both practice screening rates before training and screening rates of African American patients of primary care physicians in the area who were not trained in colonoscopy.…”

Quality of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice‐Based Research Network

“…Offering colonoscopy in rural settings may improve rural screening rates. 30 These data suggest that colonoscopy can be performed with high quality in rural settings.…”