Barriers to Colorectal Cancer Screening Among Medicare Consumers
Background
Few studies have examined lack of physician recommendation and other reasons for under-utilization of colorectal cancer (CRC) screening in the Medicare population.
Methods
Data from a telephone survey conducted in 2001 in a random sample of Medicare consumers residing in North and South Carolina were used to examine barriers to CRC screening, focusing on consumers’ reports of receiving a physician’s recommendation to obtain CRC screening and reasons for not being screened. Analyses were restricted to respondents with no history of CRC (n=1901). Descriptive statistics were used to characterize respondents’ CRC screening status, receipt of a physician’s recommendation for screening, and reasons for not being screened. Logistic regression modeling was used to examine factors associated with receiving a physician recommendation for fecal occult blood test, sigmoidoscopy, colonoscopy, any endoscopy, and any CRC test.
Results
Thirty-one percent of Medicare consumers had never been tested for CRC, and 18% had been tested but were not current with Medicare-covered intervals. Overall, 28% reported not receiving a physician recommendation for screening. Predictors of receiving a physician recommendation included sociodemographic (younger age, white race, more education), health status (increased CRC risk, comorbidity), and healthcare access (had a routine/preventive care visit in the past 12 months) factors. Lack of knowledge/awareness and the physician not ordering the test were commonly cited reasons for not having CRC tests.
Conclusions
Colorectal cancer screening was under-utilized by Medicare consumers in two states, and lack of physician recommendation was an important contributing factor. Providing a benefit under the Medicare program does not ensure its widespread use by consumers or their physicians.
aHealth Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
bMedical Review of North Carolina, Inc., Cary, North Carolina
cStatistical Research and Applications Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
Address correspondence and reprint requests to: Anna P. Schenck, PhD, Medical Review of North Carolina, Inc., 100 Regency Forest Drive, Suite 200, Cary NC 27511-8598
ABSTRACT