Colorectal Cancer Screening among Users of County Health Centers and Users of Private Physician Practices

Abstract

Objective. We examined use of colorectal cancer (CRC) screening exam modalities among county health centers and private physician offices, where both were located in the same geographic area. Methods. We surveyed 500 county health center registrants and 570 private physician patients, aged 52–75 years. We administered telephone surveys during 2004 to examine relationships among sociodemographic characteristics; perceived barriers to screening with fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy; and self-reported receipt of each exam. Results. FOBT was more frequent among county health center registrants; sigmoidoscopy and colonoscopy were more frequent among private physician patients ( p<0.001). County health center registrants less frequently cited no physician recommendation as a barrier to FOBT, but more frequently cited no recommendation as a barrier to sigmoidoscopy and colonoscopy, compared with private physician patients ( p ≤0.02). Among county health center registrants, better health insurance coverage was associated with lower odds of FOBT and higher odds of screening endoscopy; perceived barriers were associated with lower odds of screening ( p<0.02). Among private physician patients, we noted an association between perceived barriers to screening and lower odds of any screening ( p<0.001). Conclusions. Overall, CRC screening among county health center and private physician patient samples compared favorably with overall New York and U.S. rates. Although prior studies using national data suggested that screening rates were equivalent in county health center and private physician primary care settings, we found exam-specific differences in patient-reported screening endoscopy among our two patient samples. Understanding factors that contribute to differences in CRC screening between primary care settings is important for ensuring equal access to CRC screening options for all patients.