SIGMOIDOSCOPY USE AMONG PRIMARY-CARE PHYSICIANS

Background. Despite endorsement by a variety of professional societies , screening sigmoidoscopy is performed on a small minority of patients . We performed a survey of primary care physicians in Allegheny County to examine in detail their current practice and attitude toward scree ning sigmoidoscopy. Methods. Physicians were surveyed by mail or telep hone. Eligible respondents were required to practice in the county and perform direct patient care. Results. Of 732 adult primary care physi cians in Allegheny County, 400 were randomly selected for sampling and 279, or 70%, responded. Over 88% of physicians agreed completely or p artly with current American Cancer Society recommendations for screeni ng sigmoidoscopy, but only 34% (95% CI 29-39%) reported they regularly refer or schedule patients for screening. Physicians who screen were more likely to be from internal medicine or family practice (P < 0.001 ) and to be trained in (P < 0.001) or to personally perform (P < 0.001 ) sigmoidoscopy. The greater the number of barriers to screening cited by physicians, including cost, patient discomfort, equipment availabi lity, low probability of finding a lesion, time it takes to do sigmoid oscopy, and the risk of the procedure, the lower the screening rate (P = 0.002). Conclusion. (a) Although primary care physicians in Alleghe ny County report that they support screening sigmoidoscopy, only one-t hird regularly refer or schedule patients, (b) physicians who are trai ned in or who perform sigmoidoscopy are more likely to screen patients , and (c) further education and training of primary care physicians in sigmoidoscopy will be required to increase screening rates. (C) 1995 Academic Press, Inc.