TY - JOUR
T1 - Seniority of primary care physicians is associated with a decrease in PSA ordering habits in the years surrounding the United States Preventative Services Task Force recommendation against PSA screening
AU - Hutchinson, Ryan
AU - Singla, Nirmish
AU - Akhtar, Abdulhadi
AU - Haridas, Justin
AU - Bhat, Deepa
AU - Roehrborn, Claus
AU - Lotan, Yair
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/11
Y1 - 2018/11
N2 - Introduction: The United States Preventative Services Task Force recommendation against prostate-specific antigen (PSA) screening came in 2012, a time when many new primary care providers (PCPs) had been trained in the PSA screening era. We examined the differential effect of the recommendation on PCPs’ PSA screening by physician seniority and evaluated the impact of their individual stated opinions on their screening practices. Methods: We reviewed 54,684 PCP-directed PSA orders within a tertiary care academic institution from January 2010 to July 2015. Relative proportions of PSA orders per overall unique male ambulatory clinic volume were assessed for the periods of January 1, 2010 to December 31, 2011 (first period) and January 1, 2013 to July 31, 2015 (second period). A survey was subsequently sent to providers in the cohort assessing their attitudes toward the United States Preventative Services Task Force recommendation and responses were compared to physician seniority and actual PSA ordering habits. Results: Of 88 total PCPs assessed, 22 met criteria for inclusion. Overall unique male nononcology care patients were 88,558 for the first period and 140,173 for the second period. Overall proportion of unique male patients screened did not change and proportion of overall unique male patients screened vs. time since residency demonstrated a significant negative trend (R2 = 0.308, P = 0.007, slope of trend line −0.000005). A subsequent survey revealed no correlation of any aspect of the questionnaire with actual real-world screening practice but did note a paradoxical positive association between physician seniority and stated PSA use. Conclusion: From January 2010 to July 2015 PSA screening did not change greatly for providers in continuous practice throughout the period. Time since residency completion was significantly associated with screening proportionally fewer men. Provider opinion did not appear to have a strong influence on actual physician practice. These findings further inform future efforts to alter PSA screening.
AB - Introduction: The United States Preventative Services Task Force recommendation against prostate-specific antigen (PSA) screening came in 2012, a time when many new primary care providers (PCPs) had been trained in the PSA screening era. We examined the differential effect of the recommendation on PCPs’ PSA screening by physician seniority and evaluated the impact of their individual stated opinions on their screening practices. Methods: We reviewed 54,684 PCP-directed PSA orders within a tertiary care academic institution from January 2010 to July 2015. Relative proportions of PSA orders per overall unique male ambulatory clinic volume were assessed for the periods of January 1, 2010 to December 31, 2011 (first period) and January 1, 2013 to July 31, 2015 (second period). A survey was subsequently sent to providers in the cohort assessing their attitudes toward the United States Preventative Services Task Force recommendation and responses were compared to physician seniority and actual PSA ordering habits. Results: Of 88 total PCPs assessed, 22 met criteria for inclusion. Overall unique male nononcology care patients were 88,558 for the first period and 140,173 for the second period. Overall proportion of unique male patients screened did not change and proportion of overall unique male patients screened vs. time since residency demonstrated a significant negative trend (R2 = 0.308, P = 0.007, slope of trend line −0.000005). A subsequent survey revealed no correlation of any aspect of the questionnaire with actual real-world screening practice but did note a paradoxical positive association between physician seniority and stated PSA use. Conclusion: From January 2010 to July 2015 PSA screening did not change greatly for providers in continuous practice throughout the period. Time since residency completion was significantly associated with screening proportionally fewer men. Provider opinion did not appear to have a strong influence on actual physician practice. These findings further inform future efforts to alter PSA screening.
KW - PSA
KW - Primary care providers
KW - Prostate cancer
KW - Screening
KW - United States Preventative Services Task Force
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U2 - 10.1016/j.urolonc.2018.07.011
DO - 10.1016/j.urolonc.2018.07.011
M3 - Article
C2 - 30241954
AN - SCOPUS:85053692866
SN - 1078-1439
VL - 36
SP - 500.e21-500.e27
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 11
ER -