Comparison of colorectal cancer screening in veterans based on the location of primary care clinic

Ashish Malhotra; Mary Vaughan-Sarrazin; Mary Elizabeth Charlton; Gary E Rosenthal

doi:10.1177/2150131913494842

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Comparison of colorectal cancer screening in veterans based on the location of primary care clinic

Journal article

Open access

Peer reviewed

Comparison of colorectal cancer screening in veterans based on the location of primary care clinic

Ashish Malhotra, Mary Vaughan-Sarrazin, Mary Elizabeth Charlton and Gary E Rosenthal

Journal of primary care & community health, Vol.5(1), pp.24-29

01/01/2014

DOI: 10.1177/2150131913494842

PMID: 24327586

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Abstract

To compare colorectal cancer screening rates in veterans receiving primary care (PC) in Veterans Administration (VA) community-based outpatient clinics (CBOCs) and VA medical centers (VAMCs). The VA Outpatient Care Files were used to identify 2 837 770 patients ≥ 50 years with ≥ 2 PC visits in 2010. Veterans undergoing screening/surveillance colonoscopy, sigmoidoscopy, fecal-occult-blood testing (FOBT), and double-contrast barium enema (DCBE) were identified from ICD-9-CM/CPT codes. Patients were categorized as VAMC (n = 1 403 273; 49.5%) or CBOC (1 434 497; 50.5%) based on where majority of PC encounters occurred and as high risk (n = 284 090) or average risk (n = 2 553 680) based on colorectal cancer risk factors and validated ICD-9-CM-based algorithms. CBOC patients were older than VAMC (mean ages 69.3 vs 67.4 years; P < .001), more likely (P < .001) to be male (96.5% vs 95.1%), and white (67.8% vs 64.2%), but less likely to be high-risk (9.4% vs 10.5%; P < .001). Rates of colonoscopy, sigmoidoscopy, and DCBE were all lower in CBOC (P < .001). Among high-risk veterans, rates in CBOC and VAMC, respectively, were 27.4% versus 36.8% for colonoscopy, 1.3% versus 0.8% for sigmoidoscopy, and 0.8% versus 0.5% for DCBE. Among average-risk veterans, these rates were 1.3% versus 1.9%, 0.2% versus 0.1%, and 0.2% versus 0.1%, respectively. The differences remained after adjusting for age/comorbidity. The adjusted odds of colonoscopy for CBOC were 0.73 (95% confidence interval = 0.64-0.82) for average risk and 0.76 (95% confidence interval = 0.67-0.87) for high risk. In contrast, the use of FOBT was relatively similar in CBOCs and VAMCs among both high risk (11.1% vs 11.2%) and average risk (14.3% vs 14.1%). Screening rates were similar between those younger than 65 years and older than 65 years. Veterans receiving PC in CBOCs are less likely to receive screening colonoscopy, sigmoidoscopy, and DCBE than VAMC according to VA records. The lower use in CBOC was not offset by higher use of FOBT, including the degree to which CBOC patients may be more reliant to use non-VA services. The clinical appropriateness of these differences merits further examination.

Veterans

Health Behavior

Multivariate Analysis

Outpatient Clinics, Hospital - statistics & numerical data

Age Factors

Primary Health Care - statistics & numerical data

Hospitals, Veterans - statistics & numerical data

Humans

Middle Aged

Risk Factors

Male

Patient Acceptance of Health Care - statistics & numerical data

Colorectal Neoplasms - diagnosis

Health Services Accessibility

Sex Factors

Female

Aged

Occult Blood

Sigmoidoscopy - statistics & numerical data

Details

Title: Subtitle: Comparison of colorectal cancer screening in veterans based on the location of primary care clinic
Creators: Ashish Malhotra - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, USA
Mary Vaughan-Sarrazin
Mary Elizabeth Charlton
Gary E Rosenthal
Resource Type: Journal article
Publication Details: Journal of primary care & community health, Vol.5(1), pp.24-29
DOI: 10.1177/2150131913494842
PMID: 24327586
NLM abbreviation: J Prim Care Community Health
ISSN: 2150-1327
eISSN: 2150-1327
Publisher: United States
Language: English
Date published: 01/01/2014
Academic Unit: Health Management and Policy; Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9983995006902771

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5 Times Cited - Web of Science