Guidelines for early detection of colorectal cancer promote screening among average risk people beginning at age 50. In 1998, Medicare added coverage of four colorectal cancer screenings: fecal occult blood tests (FOBT); sigmoidoscopy; colonoscopy and barium enema. Medicare claims for diagnostic and screening colorectal cancer tests among North Carolina Medicare enrollees in 1998 were linked to physician data to determine specialty of the testing physician. Colorectal cancer test claims were analyzed by specialty of provider. Screening rates were examined among a sub-set of physicians for whom 100% of office visit data were available. Rate ratios (RRs) and 95 % confidence intervals (95% CIs) were used to assess differences in screening by type of physician. In 1998, 189,134 colorectal cancer tests were provided to NC Medicare enrollees, the majority of which (61%) were FOBTs. Type of test varied by specialty of provider. Internal medicine physicians provided the largest proportion of FOBTs and sigmoidoscopy tests (40%). Gasteroenterologists provided the largest percent of colonoscopy tests (52%). Radiologists conducted virtually all the barium enema tests (99%). Examination of screening rates revealed gasteroenterologists had the highest rate with 54% of patients screened. Among primary care providers, internal medicine physicians were twice as likely to provide screening to Medicare patients as family practice physicians (RR=2.1, 95% CI: 1.96-2.19). These data demonstrate considerable room for improvement in colorectal cancer testing among the Medicare population. The results also support the need for targeted efforts to increase test use among selected provider specialties.
Learning Objectives: 1. Participants will learn the Medicare colorectal cancer screening benefits. 2. Participants will understand use of screening and diagnostic tests in the Medicare popuation. 3. Participants will recognize differences in screening provided by different physicians.
Keywords: Cancer Screening, Providers
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