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Brief ReportBrief Report

The Prevalence of Low-Value Prostate Cancer Screening in Primary Care Clinics: A Study Using the National Ambulatory Medical Care Survey

Chris Gillette, Sarah Garvick, Nathan Bates, Courtney M. Martin, Amresh Hanchate and Daniel S. Reuland
The Journal of the American Board of Family Medicine January 2023, jabfm.2022.220185R1; DOI: https://doi.org/10.3122/jabfm.2022.220185R1
Chris Gillette
From Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC (CG, SG, NB, CMM); Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (CG); Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (AH); General Medicine, University of North Carolina School of Medicine, Chapel Hill (DSR).
PhD
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Sarah Garvick
From Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC (CG, SG, NB, CMM); Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (CG); Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (AH); General Medicine, University of North Carolina School of Medicine, Chapel Hill (DSR).
MS, MMS, PA-C
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Nathan Bates
From Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC (CG, SG, NB, CMM); Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (CG); Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (AH); General Medicine, University of North Carolina School of Medicine, Chapel Hill (DSR).
MMS, PA-C
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Courtney M. Martin
From Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC (CG, SG, NB, CMM); Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (CG); Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (AH); General Medicine, University of North Carolina School of Medicine, Chapel Hill (DSR).
BS
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Amresh Hanchate
From Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC (CG, SG, NB, CMM); Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (CG); Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (AH); General Medicine, University of North Carolina School of Medicine, Chapel Hill (DSR).
PhD
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Daniel S. Reuland
From Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, NC (CG, SG, NB, CMM); Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (CG); Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (AH); General Medicine, University of North Carolina School of Medicine, Chapel Hill (DSR).
MD, MPH
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Operationalization of Andersen’s Behavioral Model of Health Services Use. Abbreviations: PCP, primary care provider; PA, physician assistant; NP, nurse practitioner.

  • Figure 2.
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    Figure 2.

    Use of low-value prostate-specific antigen and digital rectal exam in primary care clinics during 2013 to 2018. Abbreviations: PSA, prostate-specific antigen; DRE, digital rectal exam; CI, confidence interval.

Tables

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    Table 1.

    Patient, Provider, and Visit Characteristics of National Ambulatory Medical Care Survey Sample (Unweighted n = 2,964, Weighted n = 121,633,833)

    FrequencyWeighted FrequencyPercent of Visits (Weighted)
    Race/ethnicity
     Non-Hispanic White247891,850,33075.51
     Non-Hispanic Black1647,532,3306.19
     Hispanic20613,372,04510.99
     Non-Hispanic other1168,879,1287.30
    Type of payment
     Private insurance40417,932,72414.74
     Medicare2497101,265,01783.25
     Medicaid/CHIP522,088,5101.72
     Other11347,5830.29
     Type of visit
     New problem89334,348,86928.24
     Chronic problem, routine120550,643,00641.64
     Chronic problem, flare-up2058,072,2686.64
     Preventive visit66128,569,69123.49
    Primary care provider—yes2668113,553,96793.36
    Established patient—yes2820116,606,88395.87
    “Does the patient now have: cancer?”
     Yes37813,879,47811.41
    Type of provider seen†
     Physician seen2926119,453,94898.21
     Physician assistant seen1143,178,1172.61
     Nurse practitioner/midwife seen833,528,7652.90
    Type of doctor seen
     MD—doctor of medicine2599110,605,83590.93
     DO—doctor of osteopathy36511,027,9989.12
    Type of practice (solo/nonsolo)
     Nonsolo195876,949,97063.26
    Rural—yes59319,335,18415.90
    Survey year
     2013120826,139,69021.49
     2014107924,881,46020.46
     201532926,557,92221.83
     201618818,515,87515.22
     201816025,538,88621.00
     MeanStandard Error of Mean
    Patient age—years77.950.23
     Total number of chronic conditions
     Total number of services ordered or provided during visit*
     Number of medications coded2.870.06
     Time spent with physician—minutes
     6.290.14
     5.780.28
     21.460.46
    • Abbreviation: CHIP, Children’s Health Insurance Program.

    • ↵* Total number of services reported as ordered or provided during the visit. Includes vital signs and write-in entries.

    • † Types of providers seen during visits are not mutually exclusive and do not add up to 100%; multiple provider types could have been included in the visit.

    • View popup
    Table 2.

    Multivariable Logistic Regression Results Predicting Low-Value Prostate-Specific Antigen Blood Test and Digital Rectal Exam (Unweighted n = 2,964, Weighted n = 121,633,833)

    Prostate-Specific Antigen (PSA)Digital Rectal Exam (DRE)
    VariableOdds Ratio99.5% Confidence LimitsPoint Estimate99.5% Confidence Limits
    Cancer—yes1.530.52–4.52––
    Age0.950.90, 1.00––
    Number of previous visits0.960.88, 1.040.92*0.85, 0.996*
    Number of services provided*1.49*1.33, 1.67*1.37*1.15, 1.63*
    Time spent with physician1.010.98, 1.041.020.98, 1.06
    Reason for visit—new problemRefRefRefRef
    Preventive visit1.010.30, 3.343.340.85, 13.18
    Chronic problem, routine0.640.20, 2.120.630.15, 2.62
    Chronic problem, flare-up0.370.07, 2.003.530.45, 27.92
    DRE—yes0.640.07, 5.57––
    Solo—yes––3.030.63, 14.61
    PSA—yes––0.720.10, 5.45
    Nurse practitioner included in visit—yes––3.950.31, 50.78
    • *Statistically significant at P < .005 level.

  • International Classification of Diseases–Ninth Revision Code (2013-2015)International Classification of Diseases–Tenth Revision Code (2016, 2018)Description
    185-C61Malignant neoplasm of prostate
    5990-N39.0Urinary tract infection
    600-N40Prostate diagnoses
    N41
    N42
    6089-N50.9Disorder of male genital organs, unspecified
    1539-C18Malignant neoplasm of colon
    2572-E29Testicular hypo-/hyperfunction
    60784-N52Erectile dysfunction
    1899C68.9Malignant neoplasm of urinary organ, unspecified
    1953C76.3Malignant neoplasm of pelvis
    1991C80.1Malignant (primary) neoplasm, unspecified
    2349D09.9Carcinoma in situ, unspecified
    2398D49.8Neoplasm of unspecified behavior of other specified sites
    7893R19.00Intra-abdominal and pelvic swelling, mass and lump
    V10-Z85.3Personal history of malignant neoplasm of breast
    V101Z85.0Personal history of malignant neoplasm of tongue
    V104Personal history of malignant neoplasm of stomach
    V102Z85.8Personal history of malignant neoplasms of organs and systems
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The Journal of the American Board of Family     Medicine: 38 (1)
The Journal of the American Board of Family Medicine
Vol. 38, Issue 1
January-February 2025
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The Prevalence of Low-Value Prostate Cancer Screening in Primary Care Clinics: A Study Using the National Ambulatory Medical Care Survey
Chris Gillette, Sarah Garvick, Nathan Bates, Courtney M. Martin, Amresh Hanchate, Daniel S. Reuland
The Journal of the American Board of Family Medicine Jan 2023, jabfm.2022.220185R1; DOI: 10.3122/jabfm.2022.220185R1

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The Prevalence of Low-Value Prostate Cancer Screening in Primary Care Clinics: A Study Using the National Ambulatory Medical Care Survey
Chris Gillette, Sarah Garvick, Nathan Bates, Courtney M. Martin, Amresh Hanchate, Daniel S. Reuland
The Journal of the American Board of Family Medicine Jan 2023, jabfm.2022.220185R1; DOI: 10.3122/jabfm.2022.220185R1
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Keywords

  • Early Detection of Cancer
  • Geriatrics
  • Logistic Models
  • Men's Health
  • NAMCS
  • Physicians
  • Primary Health Care
  • Prostate Cancer
  • Prostate-Specific Antigen

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