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, Adult ; Aged ; Aged, 80 and over ; Community Health Centers\/statistics & numerical data ; Diagnostic Techniques and Procedures ; Female ; Hospitals, Teaching\/statistics & numerical data ; Humans ; Male ; Medical History Taking ; Middle Aged ; Physical Examination ; Socioeconomic Factors ; Urban Health Services\/statistics & numerical data","Adult, Aged, Aged, 80 and over, Community Health Centers statistics & numerical data, Diagnostic Techniques and Procedures, Female, Hospitals, Teaching statistics & numerical data, Humans, Male, Medical History Taking, Middle Aged, Physical Examination, Socioeconomic Factors, Urban Health Services statistics & numerical data, Gastrointestinal Hemorrhage etiology, Guideline Adherence, Practice Guidelines as Topic, 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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