In the Journals

PCPs order significantly fewer cancer screening tests later in the day

The rate at which primary care clinicians order breast and colorectal cancer screening tests decreases significantly over the course of the day, according to a recent study published in JAMA Network Open.

“The US Preventive Services Task Force guidelines recommend that primary care physicians (PCPs) offer breast and colorectal cancer screening to eligible patients during clinic visits,” Esther Y. Hsiang, MD-MBA candidate at the School of Medicine at Johns Hopkins University, and the Wharton School at the University of Pennsylvania, and colleagues wrote. “However, as the clinic day progresses, PCPs may fall behind schedule and this may result in shorter and more rushed interactions with patients scheduled later in the day.”

Previous studies found that PCPs have higher rates of inappropriate antibiotic prescription and opioid prescription in patients with back pain later in the day, according to the researchers.

To determine if appointment time was associated with clinician ordering of colorectal and breast cancer screenings, researchers conducted a retrospective, quality improvement study of 33 primary care practices in Pennsylvania and New Jersey from Sept. 1, 2014, to Aug. 31, 2016. The primary outcome of the study was clinicians ordering cancer screening tests during the initial visit, and the secondary outcome was patient completion of the screening test within a year of the visit.

Data were collected from electric health records for up to 10 years prior to each patient’s visit to determine which patients were due for breast or colorectal cancer screenings based on U.S. Preventative Task Force Service guidelines. Breast cancer screening guidelines included women aged 50 to 74 years and colorectal screening guidelines included adults aged 50 to 75 years.

A total of 19,254 patients with a median age of 60.2 years were eligible for breast cancer screening. The screening test order rate was highest at 8 a.m. with a 67% rate, which decreased to 48.7% in the 11 a.m. group. The rate increased to 56.5% at 12 p.m. and decreased to 47.8% at 5 p.m. (adjusted OR = 0.94; 95% CI, 0.93-0.96).

The study included 33,468 patients with a mean age of 59.6 years who were eligible for colorectal cancer screening. Screening test order rates were at 36.5% at 8 a.m. and decreased to 31.3% by 11 a.m., followed by an increase to 34.4% at 12 p.m. and a decrease to 23.4% at 5 p.m. (adjusted OR = 0.94; 95% CI, 0.93-0.95).

The rate of screening completion at the 1-year follow-up was also associated with appointment time. For those who were eligible for breast cancer screening, the rate of completion started at 33.2% among patients with an appointment at 8 a.m. and decreased to 17.8% in those with appointments at 5 p.m. (adjusted OR = 0.95; 95% CI, 0.94-0.97). In patients eligible for colorectal cancer screening, the rate was 28% in patients with at 8 a.m. appointments and decreased to 17.8% among patients with appointments at 5 p.m. (adjusted OR = 0.97; 95% CI, 0.96-0.98).

The researchers explained that a number of factors, including clinician fatigue, spending less time with each patient to stay on schedule and previous patient behavior, may impact the rate of screening tests ordered by PCPs throughout the day.

“Future work could be conducted to further understand the existing behaviors identified in this study such as evaluating the relative contributions of clinician vs patient factors on variations in ordering of cancer screening tests, as well as other factors associated with patient completion of screening tests,” Hsiang and colleagues wrote. – by Erin Michael

Disclosures: Hsiang reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

The rate at which primary care clinicians order breast and colorectal cancer screening tests decreases significantly over the course of the day, according to a recent study published in JAMA Network Open.

“The US Preventive Services Task Force guidelines recommend that primary care physicians (PCPs) offer breast and colorectal cancer screening to eligible patients during clinic visits,” Esther Y. Hsiang, MD-MBA candidate at the School of Medicine at Johns Hopkins University, and the Wharton School at the University of Pennsylvania, and colleagues wrote. “However, as the clinic day progresses, PCPs may fall behind schedule and this may result in shorter and more rushed interactions with patients scheduled later in the day.”

Previous studies found that PCPs have higher rates of inappropriate antibiotic prescription and opioid prescription in patients with back pain later in the day, according to the researchers.

To determine if appointment time was associated with clinician ordering of colorectal and breast cancer screenings, researchers conducted a retrospective, quality improvement study of 33 primary care practices in Pennsylvania and New Jersey from Sept. 1, 2014, to Aug. 31, 2016. The primary outcome of the study was clinicians ordering cancer screening tests during the initial visit, and the secondary outcome was patient completion of the screening test within a year of the visit.

Data were collected from electric health records for up to 10 years prior to each patient’s visit to determine which patients were due for breast or colorectal cancer screenings based on U.S. Preventative Task Force Service guidelines. Breast cancer screening guidelines included women aged 50 to 74 years and colorectal screening guidelines included adults aged 50 to 75 years.

A total of 19,254 patients with a median age of 60.2 years were eligible for breast cancer screening. The screening test order rate was highest at 8 a.m. with a 67% rate, which decreased to 48.7% in the 11 a.m. group. The rate increased to 56.5% at 12 p.m. and decreased to 47.8% at 5 p.m. (adjusted OR = 0.94; 95% CI, 0.93-0.96).

The study included 33,468 patients with a mean age of 59.6 years who were eligible for colorectal cancer screening. Screening test order rates were at 36.5% at 8 a.m. and decreased to 31.3% by 11 a.m., followed by an increase to 34.4% at 12 p.m. and a decrease to 23.4% at 5 p.m. (adjusted OR = 0.94; 95% CI, 0.93-0.95).

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The rate of screening completion at the 1-year follow-up was also associated with appointment time. For those who were eligible for breast cancer screening, the rate of completion started at 33.2% among patients with an appointment at 8 a.m. and decreased to 17.8% in those with appointments at 5 p.m. (adjusted OR = 0.95; 95% CI, 0.94-0.97). In patients eligible for colorectal cancer screening, the rate was 28% in patients with at 8 a.m. appointments and decreased to 17.8% among patients with appointments at 5 p.m. (adjusted OR = 0.97; 95% CI, 0.96-0.98).

The researchers explained that a number of factors, including clinician fatigue, spending less time with each patient to stay on schedule and previous patient behavior, may impact the rate of screening tests ordered by PCPs throughout the day.

“Future work could be conducted to further understand the existing behaviors identified in this study such as evaluating the relative contributions of clinician vs patient factors on variations in ordering of cancer screening tests, as well as other factors associated with patient completion of screening tests,” Hsiang and colleagues wrote. – by Erin Michael

Disclosures: Hsiang reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

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