Making the case for the benefits of primary care from observational studies: Does an ounce of prevention take a pound of doctor visits?

摘要

Despite slow improvement, colorectal cancer (CRC) screening rates continue to lag behind prevention efforts of other kinds of cancer, such as breast and cervical cancer. This deficit reflects a complex interplay of patient, provider, and system factors that ultimately contribute to CRC screening. For providers, one of the strongest reported predictors of patient adherence is an unambiguous physician recommendation to pursue screening (1). The study by Ferrante and colleagues in this issue (2) offers further evidence that contact between a patient and a primary care provider results in higher CRC screening rates. In a case-control study using the population-based 2008 Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data set (available at http://seer.cancer .gov), the authors report that as primary care visits increased, CRC incidence decreased, mediated by greater screening rates. In addition, disease-specific and overall mortality were reduced. However, the authors found a similar protective association with increasing numbers of visits to any type of provider, raising the thorny, important question: "What is the unique role of the primary care provider in this process?