Screening colonoscopies by primary care physicians: A meta-analysis

Thad Wilkins, Bruce Leclair, Mark Smolkin, Kathy Davies, Andria Thomas, Marcia L. Taylor, Scott Strayer

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

PURPOSE There is currently too few endoscopists to enact a national colorectal cancer screening program with colonoscopy. Primary care physicians could play an important role in filling this shortage by offering screening colonoscopy in their practice. The purpose of this study was to examine the safety and effectiveness of colonoscopies performed by primary care physicians. METHODS We identified relevant articles through searches of MEDLINE and EMBASE bibliographic databases to December 2007 and through manual searches of bibliographies of each citation. We found 590 articles, 12 of which met inclusion criteria. Two authors independently abstracted data on study and patient characteristics. Descriptive statistics were performed. For each outcome measure, a random effects model was used to determine estimated means and confidence intervals. RESULTS We analyzed 12 studies of colonoscopies performed by primary care physicians, which included 18,292 patients (mean age 59 years, 50.5% women). The mean estimated adenoma and adenocarcinoma detection rates were 28.9% (95% confidence interval [CI], 20.4%-39.3%) and 1.7% (95% CI, 0.9%-3.0%), respectively. The mean estimated reach-the-cecum rate was 89.2% (95% CI, 80.1%-94.4%). The major complication rate was 0.04% (95% CI, 0.01%-0.07%); no deaths were reported. CONCLUSIONS Colonoscopies performed by primary care physicians have quality, safety, and efficacy indicators that are comparable to those recommended by the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology, and the Society of American Gastrointestinal Endoscopic Surgeons. Based on these results, colonoscopy screening by primary care physicians appears to be safe and effective.

Original languageEnglish (US)
Pages (from-to)56-62
Number of pages7
JournalAnnals of family medicine
Volume7
Issue number1
DOIs
StatePublished - Jan 1 2009

Fingerprint

Primary Care Physicians
Colonoscopy
Meta-Analysis
Confidence Intervals
Bibliographic Databases
Safety
Gastrointestinal Endoscopy
Cecum
Bibliography
Early Detection of Cancer
MEDLINE
Adenoma
Colorectal Neoplasms
Adenocarcinoma
Outcome Assessment (Health Care)

Keywords

  • Colonoscopy
  • Colorectal cancer
  • General practitioners
  • Internist
  • Mass screening
  • Physicians, family
  • Primary care physicians
  • Primary health care

ASJC Scopus subject areas

  • Family Practice

Cite this

Screening colonoscopies by primary care physicians : A meta-analysis. / Wilkins, Thad; Leclair, Bruce; Smolkin, Mark; Davies, Kathy; Thomas, Andria; Taylor, Marcia L.; Strayer, Scott.

In: Annals of family medicine, Vol. 7, No. 1, 01.01.2009, p. 56-62.

Research output: Contribution to journalArticle

@article{f42e86d73f0f4642b8b324a71ad79765,
title = "Screening colonoscopies by primary care physicians: A meta-analysis",
abstract = "PURPOSE There is currently too few endoscopists to enact a national colorectal cancer screening program with colonoscopy. Primary care physicians could play an important role in filling this shortage by offering screening colonoscopy in their practice. The purpose of this study was to examine the safety and effectiveness of colonoscopies performed by primary care physicians. METHODS We identified relevant articles through searches of MEDLINE and EMBASE bibliographic databases to December 2007 and through manual searches of bibliographies of each citation. We found 590 articles, 12 of which met inclusion criteria. Two authors independently abstracted data on study and patient characteristics. Descriptive statistics were performed. For each outcome measure, a random effects model was used to determine estimated means and confidence intervals. RESULTS We analyzed 12 studies of colonoscopies performed by primary care physicians, which included 18,292 patients (mean age 59 years, 50.5{\%} women). The mean estimated adenoma and adenocarcinoma detection rates were 28.9{\%} (95{\%} confidence interval [CI], 20.4{\%}-39.3{\%}) and 1.7{\%} (95{\%} CI, 0.9{\%}-3.0{\%}), respectively. The mean estimated reach-the-cecum rate was 89.2{\%} (95{\%} CI, 80.1{\%}-94.4{\%}). The major complication rate was 0.04{\%} (95{\%} CI, 0.01{\%}-0.07{\%}); no deaths were reported. CONCLUSIONS Colonoscopies performed by primary care physicians have quality, safety, and efficacy indicators that are comparable to those recommended by the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology, and the Society of American Gastrointestinal Endoscopic Surgeons. Based on these results, colonoscopy screening by primary care physicians appears to be safe and effective.",
keywords = "Colonoscopy, Colorectal cancer, General practitioners, Internist, Mass screening, Physicians, family, Primary care physicians, Primary health care",
author = "Thad Wilkins and Bruce Leclair and Mark Smolkin and Kathy Davies and Andria Thomas and Taylor, {Marcia L.} and Scott Strayer",
year = "2009",
month = "1",
day = "1",
doi = "10.1370/afm.939",
language = "English (US)",
volume = "7",
pages = "56--62",
journal = "Annals of Family Medicine",
issn = "1544-1709",
publisher = "Annals of Family Medicine, Inc",
number = "1",

}

TY - JOUR

T1 - Screening colonoscopies by primary care physicians

T2 - A meta-analysis

AU - Wilkins, Thad

AU - Leclair, Bruce

AU - Smolkin, Mark

AU - Davies, Kathy

AU - Thomas, Andria

AU - Taylor, Marcia L.

AU - Strayer, Scott

PY - 2009/1/1

Y1 - 2009/1/1

N2 - PURPOSE There is currently too few endoscopists to enact a national colorectal cancer screening program with colonoscopy. Primary care physicians could play an important role in filling this shortage by offering screening colonoscopy in their practice. The purpose of this study was to examine the safety and effectiveness of colonoscopies performed by primary care physicians. METHODS We identified relevant articles through searches of MEDLINE and EMBASE bibliographic databases to December 2007 and through manual searches of bibliographies of each citation. We found 590 articles, 12 of which met inclusion criteria. Two authors independently abstracted data on study and patient characteristics. Descriptive statistics were performed. For each outcome measure, a random effects model was used to determine estimated means and confidence intervals. RESULTS We analyzed 12 studies of colonoscopies performed by primary care physicians, which included 18,292 patients (mean age 59 years, 50.5% women). The mean estimated adenoma and adenocarcinoma detection rates were 28.9% (95% confidence interval [CI], 20.4%-39.3%) and 1.7% (95% CI, 0.9%-3.0%), respectively. The mean estimated reach-the-cecum rate was 89.2% (95% CI, 80.1%-94.4%). The major complication rate was 0.04% (95% CI, 0.01%-0.07%); no deaths were reported. CONCLUSIONS Colonoscopies performed by primary care physicians have quality, safety, and efficacy indicators that are comparable to those recommended by the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology, and the Society of American Gastrointestinal Endoscopic Surgeons. Based on these results, colonoscopy screening by primary care physicians appears to be safe and effective.

AB - PURPOSE There is currently too few endoscopists to enact a national colorectal cancer screening program with colonoscopy. Primary care physicians could play an important role in filling this shortage by offering screening colonoscopy in their practice. The purpose of this study was to examine the safety and effectiveness of colonoscopies performed by primary care physicians. METHODS We identified relevant articles through searches of MEDLINE and EMBASE bibliographic databases to December 2007 and through manual searches of bibliographies of each citation. We found 590 articles, 12 of which met inclusion criteria. Two authors independently abstracted data on study and patient characteristics. Descriptive statistics were performed. For each outcome measure, a random effects model was used to determine estimated means and confidence intervals. RESULTS We analyzed 12 studies of colonoscopies performed by primary care physicians, which included 18,292 patients (mean age 59 years, 50.5% women). The mean estimated adenoma and adenocarcinoma detection rates were 28.9% (95% confidence interval [CI], 20.4%-39.3%) and 1.7% (95% CI, 0.9%-3.0%), respectively. The mean estimated reach-the-cecum rate was 89.2% (95% CI, 80.1%-94.4%). The major complication rate was 0.04% (95% CI, 0.01%-0.07%); no deaths were reported. CONCLUSIONS Colonoscopies performed by primary care physicians have quality, safety, and efficacy indicators that are comparable to those recommended by the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology, and the Society of American Gastrointestinal Endoscopic Surgeons. Based on these results, colonoscopy screening by primary care physicians appears to be safe and effective.

KW - Colonoscopy

KW - Colorectal cancer

KW - General practitioners

KW - Internist

KW - Mass screening

KW - Physicians, family

KW - Primary care physicians

KW - Primary health care

UR - http://www.scopus.com/inward/record.url?scp=61449195110&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=61449195110&partnerID=8YFLogxK

U2 - 10.1370/afm.939

DO - 10.1370/afm.939

M3 - Article

C2 - 19139450

AN - SCOPUS:61449195110

VL - 7

SP - 56

EP - 62

JO - Annals of Family Medicine

JF - Annals of Family Medicine

SN - 1544-1709

IS - 1

ER -