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

Abstract

When performed competently, colonoscopy screening can reduce colorectal cancer rates, especially in high-risk groups such as African Americans. Training primary care physicians (PCPs) to perform colonoscopy may improve screening rates among underserved high-risk populations. The authors compared colonoscopy screening rates and computed adjusted odds ratios for colonoscopy-eligible patients of trained African American PCPs (study group) versus untrained PCPs (comparison group), before and after 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 African American PCPs and 5 untrained PCPs, practicing in the same geographic region). There were a total of 1244 study group and 923 comparison group patients. Post-training colonoscopy rates in both groups were higher than pretraining rates: 48.3% versus 9.3% in the study group, 29.6% versus 9.8% in the comparison group (both P < .001). African American patients in the study group showed a >5-fold increase (8.9% pretraining vs 52.8% post-training), with no change among whites (18.2% vs 25.0%). Corresponding pretraining and post-training rates among comparison patients were 10.4%% and 38.7%, respectively, among African Americans (P < .001), and 13.3% versus 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 (odds ratio, 1.66; 95% confidence interval, 1.30-2.13), and African Americans had a 5-fold increased likelihood of colonoscopy relative to whites. Colonoscopy-trained PCPs may help reduce colorectal cancer disparities.