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A National Survey on physician's Acceptance of Colorectal Cancer Screening Recommendations
examining the results of upper endoscopy and colonoscopy in adults with dermatomyositis at an urban, university hospital over a ten year period was performed. Chart review of individual records was performed and the results were compared to a dermatomyositis database maintained by the rheumatology division. Findings on endoscopy were collected and statistical analyses stratified by age and presence of symptoms were performed. Results: Among 373 adult patients identified through a code based search strategy, only 163 patients had dermatomyositis confirmed by chart review; all patients were also in the dermatomyositis database. Of the 47 patients who underwent upper endoscopy, only two cases of Barrett's esophagus without dysplasia were identified and there were no cases of malignancy. Of the 67 patients who underwent colonoscopy, no cases of malignancy were identified and an adenoma was identified in 13% of cases. No significant differences were identified in the yield of endoscopy for pre-malignant conditions when stratified by age or presence of symptoms. Conclusion: The yield of endoscopy is low in patients with dermatomyositis and is likely similar to the general population; we identified no cases of malignancy. A code based search strategy is inaccurate for the diagnosis of dermatomyositis, calling into question the results of prior population-based studies. Larger studies with rigorously validated search strategies are necessary to understand the risk of gastrointestinal malignancy in patients with dermatomyositis. Yield of endoscopy stratified by age and symptoms
A NATIONAL SURVEY ON PHYSICIAN'S ACCEPTANCE OF COLORECTAL CANCER SCREENING RECOMMENDATIONS Pongkamon Tongpong, Nonthalee Pausawasdi, Phunchai Charatcharoenwitthaya, Somchai Leelakusolvong Background: The colorectal cancer (CRC) screening uptake is relatively low particularly in Asia Pacific despite the implementation of international guidelines. Studies suggest that physician recommendation may play a role in patient's screening behavior. Aim: To assess the physician's acceptance of CRC screening recommendations, the awareness and adherence of the guidelines. Methods: A paper-and-pencil questionnaire was developed based on the AGA CRC screening and surveillance guidelines and sent to practicing physicians throughout the country. The survey included physician demographics, questions assessing whether they offer CRC screening and their awareness of the guidelines. Among those who were aware of the guidelines, the knowledge and guidelines adherence were assessed using four clinical vignettes. Results: 47% (602/1,286) of potential respondents completed the survey (mean age 34, 60% male). 29.5% were internists, 23% were resident physicians, 17.5% were general surgeons, 13% were primary physicians, 13% were gastroenterologists, and 4% were colorectal surgeons. 58% of respondents offer CRC screening with no variation among different geographic areas and years of practice. Both colorectal surgeons (91%) and gastroenterologists (86%) were most likely to offer CRC screening followed by medicine residents (66%), general surgeons (58%), surgical residents (50%) and internists (49%), whereas primary physicians recommended screening at the lowest rate of 35%. Physicians in the community were less likely to offer screening compared with specialists practicing in referral or private hospitals. Using multivariate regression analysis, patient's age was the only significant factor influencing physician's decision (odds ratio, 2.95: 95% confidence interval, 1.72-5.06). Other patient characteristics (gender, family history of colorectal cancer and comorbidity), reimbursement policies and hospital facility have no impact on physician intention to order CRC screening. Colonoscopy was the most common test being recommended among specialists whereas primary care physicians preferred fecal occult blood test. Overall awareness of the CRC guidelines was 81% with the highest rates among gastroenterologists and colorectal surgeons. Gastroenterologists were more likely to adhere to the guidelines compared to surgeons (p<0.05) but both specialties preferred early surveillance colonoscopy than recommended in small hyperplastic rectal polyps. Conclusion: Recommendation for CRC screening and awareness of guidelines vary among different types of physicians. The data suggested that the necessity of CRC screening should be emphasized among primary care physicians whereas the factors influencing both surgeons and gastroenterologists in guidelines adherence should be explored and proper interval surveillance colonoscopy should be underscored.
Su1583 THE USE OF A POPULATION SPECIALIST TO INCREASE COLON CANCER SCREENING RATES: A COMPARATIVE ANALYSIS BETWEEN QUALITY IMPROVEMENT TECHNIQUES Kaivan Salehpour, Tyler Aasen, Scott McShane Background: Colon cancer represents the second leading cause of cancer-related deaths in the United States. There is strong evidence that colorectal cancer screening (CCS) reduces mortality from colon cancer. Despite this, adherence to CCS has been shown to be suboptimal. The rate of CCS amongst our internal medicine clinic (IMC) patient population has been well below the goal of 90% as outlined by current outpatient guidelines. An ongoing project at the IMC has completed two phases and evaluated the effectiveness of phone calls by nurses and by residents in increasing rates of CCS in patients who were deficient in screening. In 2015, a novel population specialist role was created at the IMC. This employee is a medical assistant (MA) that received specialized training regarding screening guidelines. The aim of this study was to evaluate the effectiveness of the population specialist in increasing CCS rates. Methods: Over a three year period, patients who were deficient in CCS were identified using query of the EMR and contacted by either the population specialist (PS), a nurse (LPN), a resident (Res), or were not called (NoCall) by staff. Charts were accessed three months after phone call to identify patients who completed CCS. The Fisher exact test was used to assess for statistical significance. Results: A total of 361 patients in need of CCS were contacted by IMC clinic staff (n, %): PS (71, 19.6%), LPN (76, 21.0%), Res (68, 18.8%), NoCall (146, 40.4%). Phone calls made by any IMC team member resulted in significant increase in CCS rates compared to no intervention (intervention vs. NoCall, p): PS (18.3% vs. 3.4%, p<0.001), LPN (18.4% vs 3.4%, p<0.001), Res (30.8% vs 3.4%, p<0.001). No significant difference was noted between PS and LPN (18.3% vs. 18.4%, p= 0.986), LPN and Res (18.4% vs. 30.8%, p=0.081), or between PS and Res (18.3% vs. 30.8%, p=0.084). Discussion: Our results indicate that phone calls made by any member of the IMC team resulted in statistically significant improvement in CCS rates. The specially trained MA population specialist intervention was not statistically different from an LPN or a resident calling patients. A resident calling patients led to a higher percentage of patients completing CCS; however, this finding was not statistically significant. Conclusion: Using clinic staff members to call patients regarding colon cancer screening is an effective way to increase colon cancer screening rates at our clinic. Additional information regarding the cost effectiveness of each intervention is needed. A specially trained MA with training emphasis on cancer screening may provide a lower cost alternative to interventions made by nurses or residents.
Listed as number of cases (%n)
Su1584 ENDOSCOPY IS OF LOW YIELD IN THE IDENTIFICATION OF GASTROINTESTINAL NEOPLASIA IN DERMATOMYOSITIS PATIENTS Trilokesh Kidambi, Jonathan P. Terdiman, Jeffrey K. Lee Background: Dermatomyositis is an inflammatory myopathy that, in large population-based studies, has been associated with an increased risk of gastrointestinal malignancy. However, no formal guidelines exist on malignancy screening in this patient population and there are no studies of the yield of endoscopy in dermatomyositis. Methods: A cross-sectional study
S-529
AGA Abstracts
AGA Abstracts
Su1582
A NATIONAL SURVEY ON PHYSICIAN'S ACCEPTANCE OF COLORECTAL CANCER SCREENING RECOMMENDATIONS Pongkamon Tongpong, Nonthalee Pausawasdi, Phunchai Charatcharoenwitthaya, Somchai Leelakusolvong Background: The colorectal cancer (CRC) screening uptake is relatively low particularly in Asia Pacific despite the implementation of international guidelines. Studies suggest that physician recommendation may play a role in patient's screening behavior. Aim: To assess the physician's acceptance of CRC screening recommendations, the awareness and adherence of the guidelines. Methods: A paper-and-pencil questionnaire was developed based on the AGA CRC screening and surveillance guidelines and sent to practicing physicians throughout the country. The survey included physician demographics, questions assessing whether they offer CRC screening and their awareness of the guidelines. Among those who were aware of the guidelines, the knowledge and guidelines adherence were assessed using four clinical vignettes. Results: 47% (602/1,286) of potential respondents completed the survey (mean age 34, 60% male). 29.5% were internists, 23% were resident physicians, 17.5% were general surgeons, 13% were primary physicians, 13% were gastroenterologists, and 4% were colorectal surgeons. 58% of respondents offer CRC screening with no variation among different geographic areas and years of practice. Both colorectal surgeons (91%) and gastroenterologists (86%) were most likely to offer CRC screening followed by medicine residents (66%), general surgeons (58%), surgical residents (50%) and internists (49%), whereas primary physicians recommended screening at the lowest rate of 35%. Physicians in the community were less likely to offer screening compared with specialists practicing in referral or private hospitals. Using multivariate regression analysis, patient's age was the only significant factor influencing physician's decision (odds ratio, 2.95: 95% confidence interval, 1.72-5.06). Other patient characteristics (gender, family history of colorectal cancer and comorbidity), reimbursement policies and hospital facility have no impact on physician intention to order CRC screening. Colonoscopy was the most common test being recommended among specialists whereas primary care physicians preferred fecal occult blood test. Overall awareness of the CRC guidelines was 81% with the highest rates among gastroenterologists and colorectal surgeons. Gastroenterologists were more likely to adhere to the guidelines compared to surgeons (p<0.05) but both specialties preferred early surveillance colonoscopy than recommended in small hyperplastic rectal polyps. Conclusion: Recommendation for CRC screening and awareness of guidelines vary among different types of physicians. The data suggested that the necessity of CRC screening should be emphasized among primary care physicians whereas the factors influencing both surgeons and gastroenterologists in guidelines adherence should be explored and proper interval surveillance colonoscopy should be underscored.
Su1583 THE USE OF A POPULATION SPECIALIST TO INCREASE COLON CANCER SCREENING RATES: A COMPARATIVE ANALYSIS BETWEEN QUALITY IMPROVEMENT TECHNIQUES Kaivan Salehpour, Tyler Aasen, Scott McShane Background: Colon cancer represents the second leading cause of cancer-related deaths in the United States. There is strong evidence that colorectal cancer screening (CCS) reduces mortality from colon cancer. Despite this, adherence to CCS has been shown to be suboptimal. The rate of CCS amongst our internal medicine clinic (IMC) patient population has been well below the goal of 90% as outlined by current outpatient guidelines. An ongoing project at the IMC has completed two phases and evaluated the effectiveness of phone calls by nurses and by residents in increasing rates of CCS in patients who were deficient in screening. In 2015, a novel population specialist role was created at the IMC. This employee is a medical assistant (MA) that received specialized training regarding screening guidelines. The aim of this study was to evaluate the effectiveness of the population specialist in increasing CCS rates. Methods: Over a three year period, patients who were deficient in CCS were identified using query of the EMR and contacted by either the population specialist (PS), a nurse (LPN), a resident (Res), or were not called (NoCall) by staff. Charts were accessed three months after phone call to identify patients who completed CCS. The Fisher exact test was used to assess for statistical significance. Results: A total of 361 patients in need of CCS were contacted by IMC clinic staff (n, %): PS (71, 19.6%), LPN (76, 21.0%), Res (68, 18.8%), NoCall (146, 40.4%). Phone calls made by any IMC team member resulted in significant increase in CCS rates compared to no intervention (intervention vs. NoCall, p): PS (18.3% vs. 3.4%, p<0.001), LPN (18.4% vs 3.4%, p<0.001), Res (30.8% vs 3.4%, p<0.001). No significant difference was noted between PS and LPN (18.3% vs. 18.4%, p= 0.986), LPN and Res (18.4% vs. 30.8%, p=0.081), or between PS and Res (18.3% vs. 30.8%, p=0.084). Discussion: Our results indicate that phone calls made by any member of the IMC team resulted in statistically significant improvement in CCS rates. The specially trained MA population specialist intervention was not statistically different from an LPN or a resident calling patients. A resident calling patients led to a higher percentage of patients completing CCS; however, this finding was not statistically significant. Conclusion: Using clinic staff members to call patients regarding colon cancer screening is an effective way to increase colon cancer screening rates at our clinic. Additional information regarding the cost effectiveness of each intervention is needed. A specially trained MA with training emphasis on cancer screening may provide a lower cost alternative to interventions made by nurses or residents.
Listed as number of cases (%n)
Su1584 ENDOSCOPY IS OF LOW YIELD IN THE IDENTIFICATION OF GASTROINTESTINAL NEOPLASIA IN DERMATOMYOSITIS PATIENTS Trilokesh Kidambi, Jonathan P. Terdiman, Jeffrey K. Lee Background: Dermatomyositis is an inflammatory myopathy that, in large population-based studies, has been associated with an increased risk of gastrointestinal malignancy. However, no formal guidelines exist on malignancy screening in this patient population and there are no studies of the yield of endoscopy in dermatomyositis. Methods: A cross-sectional study
S-529
AGA Abstracts
AGA Abstracts
Su1582