Working up rectal bleeding in adult primary care practices.

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Clinical Guidelines
Authored By
Weingart SN, Stoffel EM, Chung DC, Sequist TD, Lederman RI, Pelletier SR, Shields HM
Authored On
Interests
Gastroenterology
Emergency Medicine
Internal/Family Medicine
Speciality
Gastroenterology
Emergency Medicine
Internal/Family Medicine
Book Detail
volume
23
ISSN
1365-2753
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ISSN
1365-2753
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true
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Additional Info
["Weingart SN, Stoffel EM, Chung DC, Sequist TD, Lederman RI, Pelletier SR, Shields HM","Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 9609066 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2753 (Electronic) Linking ISSN: 13561294 NLM ISO Abbreviation: J Eval Clin Pract Subsets: MEDLINE","Journal Article","2017-04-01","Journal of evaluation in clinical practice [J Eval Clin Pract] 2017 Apr; Vol. 23 (2), pp. 279-287. Date of Electronic Publication: 2016 Jul 20.","English","1365-2753","Guideline Adherence* , Practice Guidelines as Topic*, Gastrointestinal Hemorrhage\/*etiology , Primary Health Care\/*organization & administration , Primary Health Care\/*statistics & numerical data, Community Health Centers\/statistics & numerical data ; Hospitals, Teaching\/statistics & numerical data ; Urban Health Services\/statistics & numerical data ; Adult ; Aged ; Aged, 80 and over ; Diagnostic Techniques and Procedures ; Female ; Humans ; Male ; Medical History Taking ; Middle Aged ; Physical Examination ; Socioeconomic Factors","Community Health Centers statistics & numerical data, Hospitals, Teaching statistics & numerical data, Urban Health Services statistics & numerical data, Adult, Aged, Aged, 80 and over, Diagnostic Techniques and Procedures, Female, Humans, Male, Medical History Taking, Middle Aged, Physical Examination, Socioeconomic Factors, Guideline Adherence, Practice Guidelines as Topic, Gastrointestinal Hemorrhage etiology, Primary Health Care organization & administration, Primary Health Care statistics & numerical data","Journal of evaluation in clinical practice","23"]
Description
Rationale, Aims and Objectives: Variation in the workup of rectal bleeding may result in guideline-discordant care and delayed diagnosis of colorectal cancer. Accordingly, we undertook this study to characterize primary care clinicians' initial rectal bleeding evaluation.<br />Methods: We studied 438 patients at 10 adult primary care practices affiliated with three Boston, Massachusetts, academic medical centres and a multispecialty group practice, performing medical record reviews of subjects with visit codes for rectal bleeding, haemorrhoids or bloody stool. Nurse reviewers abstracted patients' sociodemographic characteristics, rectal bleeding-related symptoms and components of the rectal bleeding workup. Bivariate and multivariable logistic regression models examined factors associated with guideline-discordant workups.<br />Results: Clinicians documented a family history of colorectal cancer or polyps at the index visit in 27% of cases and failed to document an abdominal or rectal examination in 21% and 29%. Failure to order imaging or a diagnostic procedure occurred in 32% of cases and was the only component of the workup associated with guideline-discordant care, which occurred in 27% of cases. Compared with patients at hospital-based teaching sites, patients at urban clinics or community health centres had 2.9 (95% confidence interval 1.3-6.3) times the odds of having had an incomplete workup. Network affiliation was also associated with guideline concordance.<br />Conclusion: Workup of rectal bleeding was inconsistent, incomplete and discordant with guidelines in one-quarter of cases. Research and improvements strategies are needed to understand and manage practice and provider variation.<br /> (© 2016 John Wiley & Sons, Ltd.)
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