Prostate-Specific Antigen Testing among the Elderly in Community-Based Family Medicine Practices

Article Figures & Data

Table 1.

Community-Based Practice Characteristics (n =46)

Characteristic	Percent Mean (Range)
Practice size
Solo practice	26
Group practice	74
Payer mix
Medicare	23 (5–50)
Medicaid	8 (0–75)
Race/ethnicity of practice patients
Predominantly minority (>50% of patients)	19
Mixed (30% to 49% of patients)	14
White (>70% of patients)	67
Years in practice (average n)	10.43 (0–30)
Age of men in the practices (average)	55.73 (18–93)
Age of men included in chart audit (average)	65.05 (50–93)

Table 2.

Age Categories and Frequencies (%) of Those with Prostate-Specific Antigen Testing*

	Αge Category (years)
	50–54	55–59	60–64	65–69	70–74	75–79	80–84	85–89	≥90
Total	195	236	183	138	161	111	82	32	11
Screened during the past year (n [%])	152 (78)	188 (80)	134 (73)	106 (77)	125 (78)	81 (73)	62 (76)	24 (75)	9 (82)
Screened during the past 2 years (n [%])	178 (91)	222 (94)	168 (92)	131 (95)	146 (91)	100 (91)	77 (94)	29 (91)	10 (91)
Screened during the past 5 years (n [%])	194 (100)	235 (100)	183 (100)	135 (98)	160 (99)	110 (99)	81 (99)	32 (100)	11 (100)

* χ² testing for trend after stratifying by practice is 2.04 with 2-sided P = .15 for 1 year; 0.73 with P = .39 for 2 years; and 0.29 with P = .59 for 5 years. Percentages are rounded to the nearest whole percent.

Table 3.

Odds Ratios Derived from the Multivariate Hierarchical Model Describing the Odds of Prostate-Specific Antigen Testing during the Last Year*

	Odds Ratio (95% CI)	P
Patient level
Age (5-yr increments)	1.19 (0.80–1.76)	.38
Visits within last 2 years (n)	1.05 (0.98–1.12)	.17
Comorbid conditions^† (n)	0.74 (0.49–1.11)	.15
Cholesterol within last year^‡	2.42 (1.22–4.81)	.012
Practice level
Solo vs group	1.63 (0.37–7.24)	.52
Age of practice (5-yr increments)	0.91 (0.74–1.13)	.36
Average patient age (5-yr increments)	0.91 (0.68–1.23)	.55

* 236 patients, 41 practices.
† Count of whether patient has diabetes, hypertension, a heart condition, and/or asthma (score = 0, 1, . . 4).
‡ Unadjusted values for odds ratio, CI, and P are 2.10, 1.10–4.02, and .027, respectively.

Table 4.

Odds Ratios Derived from the Hierarchical Model Describing the Odds of Prostate-Specific Antigen Testing during the Last Year*

Practice-level Attributes	Practices (n)	Patients (n)	P
Office volume	38	229	.99
Minority Status	37	208	.20
Medicare	38	222	.84
Medicaid	34	194	.20
Communication^†	28	145	.022
Decision Making	28	145	.42
Stress/Busyness	28	145	.18
History of Change	28	145	.94

* After controlling for age, no. of visits within last 2 years, no. of comorbid conditions, whether cholesterol screening was done within the past year, solo versus group practice, and age of practice and average patient age.
† Comparing a practice at the 25^th and 75^th percentiles (a difference of 0.93 points), this has an odds ratio of 5.03 and a CI of 1.29–19.71. That is, the odds of prostate-specific antigen screening for a man 75 years of age or older in a practice at the 25^th percentile of “Communication” are 5.03 times the odds for a similar man in a practice at the 75^th percentile of “Communication.”