Primary care utilization associated with improved colorectal cancer outcomes

January 01, 0001

Primary care utilization associated with improved colorectal cancer outcomes

Primary medical care may improve colorectal cancer (CRC) outcomes through increased use of CRC screening tests and earlier diagnosis. These US authors examined the association between primary care utilization and CRC screening, stage at diagnosis, CRC mortality, and all-cause mortality in a retrospective cohort study of patients, aged 67 to 85 years, diagnosed as having CRC between 1994 and 2005 in the Surveillance, Epidemiology, and End Results-Medicare-linked database. Association of the number of visits to primary care physicians (PCPs) in the 3- to 27-month period before the CRC diagnosis and CRC screening, early-stage diagnosis, CRC mortality, and all- cause mortality were examined.

They found: "The odds of CRC screening and early-stage diagnosis increased with increasing number of PCP visits. Compared with persons having 0 or 1 PCP visit, patients with 5 to 10 visits had increased odds of ever receiving CRC screening at least 3 months before diagnosis (adjusted odds ratio, 2.60) and early-stage diagnosis (1.35). Persons with 5 to 10 visits had 16% lower CRC mortality (adjusted HR, 0.84) and 6% lower all-cause mortality (0.94) compared with persons with 0 or 1 visit."

The authors concluded: "Medicare beneficiaries with CRC have better outcomes if they have greater utilization of primary care before diagnosis. Revitalization of primary care in the United States may help strengthen the national efforts to reduce the burden of CRC."

Although the association does not prove causation, the dose- response gradient is supportive of a causal pathway.

For the full abstract, click here.

Arch Intern Med 171(19):1747-1757, 24 October 2011 © 2011 to the American Medical Association
Primary Care Utilization and Colorectal Cancer Outcomes Among Medicare Beneficiaries. Jeanne M. Ferrante, Ellen P. McCarthy, Eduardo C. Gonzalez, et al. Correspondence to Dr. Ferrante: ferranjm@umdnj.edu

Category: HSR. Health Services Research, D. Digestive. Keywords: colorectal cancer, older adults, primary care, screening, mortality, retrospective cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 8 November 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.