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. 2015 Apr;60(4):971-8.
doi: 10.1007/s10620-014-3403-0. Epub 2014 Nov 4.

Predictors of Poor Adherence of US Gastroenterologists with Colonoscopy Screening and Surveillance Guidelines

Heba Iskandar  1 , Yan Yan, Jill Elwing, Dayna Early, Graham A Colditz, Jean S Wang
Affiliations

Predictors of Poor Adherence of US Gastroenterologists with Colonoscopy Screening and Surveillance Guidelines

Heba Iskandar et al. Dig Dis Sci. 2015 Apr.

Abstract

Background: The US Multi-Society Task Force on Colorectal Cancer published guidelines for colonoscopy screening and surveillance in 2008 and affirmed them in 2012. Characteristics associated with guideline adherence among US gastroenterologists have not been assessed.

Aim: Assess awareness and adherence of US gastroenterologists with national guidelines for colonoscopy screening and surveillance and predictors of adherence to guidelines.

Methods: A Web-based survey was administered to gastroenterologists in various practice settings across the USA.

Results: A total of 306 gastroenterologists completed the survey; 86 % reported awareness of the guidelines. Low-volume colonoscopists (<20/month) were less likely to be aware of the guidelines (OR 0.26, p = 0.03) compared to high-volume colonoscopists (>100/month). Those completing training before 1990 were less likely to report following guidelines (OR 0.37, p = 0.01). Adherence with guidelines was then assessed via clinical scenarios. Compared to physicians finishing training in 1991-2010, less adherence was seen in those finishing before 1990 (OR 0.75, p < 0.001) or currently in training (OR 0.72, p = 0.004). Compared to the Western USA, less adherence was seen in the Midwest (OR 0.69, p = 0.001), Northeast (OR 0.63, p < 0.001), and South (OR 0.59, p < 0.001). Lower adherence was seen among non-academic physicians (OR 0.72, p = 0.001) and low-volume colonoscopists (OR 0.52, p < 0.001).

Conclusions: There is poor adherence with colonoscopy screening and surveillance guidelines among US gastroenterologists. Poor adherence was associated with being in training or finishing training before 1990, practicing in the South, non-academic settings, and low colonoscopy volume. These findings can target interventions for quality improvement in colorectal cancer screening and surveillance.

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Figures

Figure 1
Figure 1
Self-reported reasons for not following colonoscopy screening and surveillance guidelines (n=46). Respondents were only given this question if they answered “no” to the question “Do you follow these guidelines in your everyday clinical practice?” They were allowed to select more than one reason
Figure 2
Figure 2
Adherence of U.S. gastroenterologists to colonoscopy guidelines based on percentage of correct responses to clinical scenarios, using a common grading system
See this image and copyright information in PMC

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