BRIEF REPORT
Chris Gillette, PhD; Sarah Garvick, MS, MMS, PA-C; Nathan Bates, MMS, PA-C; Courtney M. Martin, BS, MMS Candidate; Amresh Hanchate, PhD; Daniel S. Reuland, MD, MPH
Corresponding Author: Chris Gillette, PhD; Wake Forest School of Medicine - Department of PA Studies.Email: cgillett@wakehealth.eduDOI: 10.3122/jabfm.2022.220185R1Keywords: Early Detection of Cancer, Geriatrics, Logistic Models, Men's Health, Primary Health Care, Prostate Cancer, Physicians, Prostate-Specific AntigenDates: Submitted: 05-18-2022; Revised: 08-22-2022; Accepted: 08-24-2022Status: Ahead of print: Available now. Final publication: February 2023
Ahead of Print: | HTML | | PDF | Final Publication: |TBD |
INTRODUCTION: There has been an increasing focus on improving value in health care and de-implementing the use of low-value services, such as prostate cancer (PC) screening for men aged >70 years. It is unclear whether utilization of low-value PC screening has changed over time nationally. The objectives of this study are to: (1) identify the proportion of primary care visits at which low-value PC screening is ordered, and (2) identify predisposing, enabling, and health care need characteristics that are associated with low-value PC screening in the United States.
METHODS: This was a secondary analysis of the National Ambulatory Medicare Care Survey (NAMCS) datasets from 2013-2016 and 2018. Andersen’s Behavioral Model of Health Services Use guided independent variable selection. Weighted multivariable logit models were used to analyze the data. Results from the regression models are presented with odds ratios (OR) and 99.5% confidence intervals (CI).
RESULTS: There were 6.71 low-value PSAs per 100 visits (95% CI=5.19-8.23) and 1.65 low-value DREs per 100 visits (95% CI=0.91-2.38). For each additional service ordered by PCPs, the odds of ordering a low-value PSA increased by 49% (OR=1.49, 99.5% CI=1.33, 1.67) and the odds of performing a low-value DRE increased by 37% (OR=1.37, 99.5%=1.15, 1.63). For each additional increase of number of previous visits, the odds of performing a low-value DRE decreased by 8% (OR=0.92, 95% CI=0.85-0.996).
CONCLUSIONS: The use of low-value PSA and DRE was sizable during the observed time period. Organizations who want to reduce low-value PSA and DRE may want to focus interventions on providers who order a high number of tests.