Comparative trial of a short workshop designed to enhance appropriate use of screening tests by family physicians

Anestis Karakatsanis, George Alexiou, Dimitrios Kalogerakis, Davide Mauri

Panhellenic Association for Continual Medical Research: PACMeR Public Health, Athens (Greece). pacmer_science@yahoo.com

Screening among asymptomatic individuals represents a great development in medical practice and many tests are actually widely employed in primary care. However only a few tests are proven to be cost- effective screening procedures. Screening chest radiography has been identified as a key avoidable test even if it is commonly prescribed from Australian, Canadian, USA, and European primary care physicians [1,2,3,4,5] with prescriptions being more frequent among smokers than non-smokers [3] and thus evidencing that tobacco use may trig physicians to screening activities. Since economical resources’ abuse is a major public health issue, screening practice monitoring of Primary Care Physicians is generally utilized to point out possible sources of useless screening costs. Anyway, although there is an undoubtedly strict correlation between screening costs and prescriptions, the overall screening cost of a certain test among the population represent the result of both prescription and opportunistic practice (screening activities directly correlated to the individual’ s will). For example, in a cancer economics study, screening chest x-ray practice among a subgroup of the Hellenic population aged 50-80 was found to range between 164.000,00 – 224.400,00 € / 100.000 individuals [6], but we do not know anything about the proportion of the cost due to tests prescribed by physicians as opposed to the cost of opportunistic screening activities. Thus, taking also into account that tobacco use is the major cause of lung cancer, and that opportunistic screening activities may be driven by cancer fear related to no-smoking campaigns, the solely analysis of medical prescriptions habits may represent a considerable bias of the chest radiography screening para-economics. We therefore searched medical literature in order to evaluate the rate of opportunistic chest radiography screening practice and whether it is triggered by smoking habits. MEDLINE was systematically searched with the following algorithm: (lung AND cancer AND screening AND smok*). No year or language restrictions were set. Last search was conducted on the 16th of September 2004, and 2601 hits were found. Eligible papers were selected by abstract or title. Two investigators independently analyzed the retrieved hits (MEDLINE reports) and agreement for eligible paper was reached for each eligible trial. Despite the extended investigation of MEDLINE library we found no suitable paper dealing with screening chest radiography opportunistic activities and smoking habits. We conclude that the phenomenon of chest screening radiography among the general population is largely underestimated in medical literature both in terms of opportunistic activities and in terms of overall costs. Due to tobacco related cancer fear (induced by anti-smoking campaigns), opportunistic screening activities may in fact represent a large part of screening radiography related costs. Further investigation should be done towards this direction in order to provide a comprehensive analysis of screening chest radiography “para- economics”.

References

1. Sladden MJ, Ward JE. Do Australian family physicians screen smokers for lung cancer? Chest. 1999 Mar;115(3):725-8.

2. Beaulieu MD, Rivard M, Hudon E, Beaudoin C, Saucier D, Remondin M. Comparative trial of a short workshop designed to enhance appropriate use of screening tests by family physicians. CMAJ. 2002 Nov 26;167(11):1241-6.

3. Ashford A, Gemson D, Sheinfeld Gorin SN, Bloch S, Lantigua R, Ahsan H,Neugut AI. Cancer screening and prevention practices of inner-city physicians. Am J Prev Med. 2000 Jul;19(1):59-62

4. Montano DE, Phillips WR. Cancer screening by primary care physicians: a comparison of rates obtained from physician self-report, patient survey, and chart audit. Am J Public Health. 1995 Jun;85(6):795- 800

5. Alevizaki P, Mauri D, Pavlidou C, et al. Avoidable screening tests : role of primary care physician in chest radiography prescriptions for lung cancer early diagnosis. Eur J Cancer 2001; 37(Suppl 6):s243

6. Priskos A, Mauri D, Peponi C, et al. Time for lung cancer screening: spiral CT costs coverage by redistribution of funds usually invested on screening chest-radiography Eur J Cancer 2003; Suppl 1(3):S15

Conflict of Interest:

None declared