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Effect of Guidelines on Primary Care Physician Use of PSA Screening: Results from the Community Tracking Study Physician Survey

Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, carmen.guerra{at}uphs.upenn.edu, Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia, Abramson Cancer Center, University of Pennsylvania, Philadelphia

Phyllis A. Gimotty, PhD

Department of Biostatistics, University of Pennsylvania School of Medicine, Philadelphia

Judy A. Shea, PhD

Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia

José A. Pagán, PhD

Department of Economics and Finance and the Institute for Population Health Policy, University of Texas–Pan American, Edinburg, Texas

J. Sanford Schwartz, MD

Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia, Abramson Cancer Center, University of Pennsylvania, Philadelphia

Katrina Armstrong, MD, MSCE

Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia, Abramson Cancer Center, University of Pennsylvania, Philadelphia

Background. Little is known about the effect of guidelines that recommend shared decision making on physician practice patterns. The objective of this study was to determine the association between physicians' perceived effect of guidelines on clinical practice and self-reported prostate-specific antigen (PSA) screening patterns. Methods. This was a cross-sectional study using a nationally representative sample of 3914 primary care physicians participating in the 1998—1999 Community Tracking Study Physician Survey. Responses to a case vignette that asked physicians what proportion of asymptomatic 60-year-old white men they would screen with a PSA were divided into 3 distinct groups: consistent PSA screeners (screen all), variable screeners (screen 1%— 99%), and consistent nonscreeners (screen none). Logistic regression was used to determine the association between PSA screening patterns and physician-reported effect of guidelines (no effect v. any magnitude effect). Results. Only 27% of physicians were variable PSA screeners; the rest were consistent screeners (60%) and consistent nonscreeners (13%). Only 8% of physicians perceived guidelines to have no effect on their practice. After adjustment for demographic and practice characteristics, variable screeners were more likely to report any magnitude effect of guidelines on their practice when compared with physicians in the other 2 groups (adjusted odds ratio= 1.73; 95% confidence interval=1:25–2:38;P=0:001). Conclusions. Physicians who perceive an effect of guidelines on their practice are almost twice as likely to exhibit screening PSA practice variability, whereas physicians who do not perceive an effect of guidelines on their practice are more likely to be consistent PSA screeners or consistent PSA nonscreeners.

Key Words: Key words: prostate-specific antigen • mass screening • guidelines • physicians' practice patterns.

This version was published on September 1, 2008

Medical Decision Making, Vol. 28, No. 5, 681-689 (2008)
DOI: 10.1177/0272989X08315243


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