Blog | Thursday, October 17, 2013

QD: News Every Day--Primary care provider a primary influence on who gets a PSA screen after 75

Which primary care provider a man saw had a nearly 7-fold difference in who underwent a prostate-specific antigen screening after age 75, a study found.

Researchers reviewed Medicare Part A and B data for the year 2010 in the state of Texas to find primary care providers whose patient panels included at least 20 men who were 75 years or older and did not have a prior diagnosis of prostate cancer. There were nearly 2,000 providers with a total of more than 61,000 men.

Results appeared in a research letter by first author Elizabeth A Jaramillo, MD, ACP Resident/Fellow Member, and colleagues that appeared in the Oct. 16 issue of The Journal of the American Medical Association.

Overall, 28.8% of men underwent PSA screening ordered by their primary care providers (41.1% of all men underwent PSA screening). There were 474 primary care providers (24.2%) who had rates significantly greater than the mean, and they had a mean rate of 49.8% (95% CI, 48.8% to 50.8%). There were 314 primary care providers (16.0%) who had significantly lower rates, and they had a mean rate of 6.1% (95% CI, 5.9% to 6.3%).

27% of the variance in whether a man received a PSA screening was explained by which primary care provider he saw, compared to patient characteristics such as age or comorbidity, which explained only 3.7% of the variance—a nearly 7-fold difference, the researchers noted. And, there was a 10-fold difference in rates between the highest and lowest deciles of primary care providers.

While there was a 27% variance for PSA screening that was attributable to which primary care provider the man saw, there was a 10% variance for mammography depending on the provider, and a 9% variance for colorectal cancer screening by provider, the authors noted.