Working up rectal bleeding in adult primary care practices

Area of Science:

• Gastroenterology
• Primary Care Medicine
• Health Services Research

Background:

• Rectal bleeding workup variation can cause guideline-discordant care and delayed colorectal cancer diagnosis.
• Understanding primary care clinicians' initial evaluation of rectal bleeding is crucial.

Purpose of the Study:

• To characterize the initial evaluation of rectal bleeding by primary care clinicians.
• To identify factors associated with guideline-discordant rectal bleeding workups.

Main Methods:

• Retrospective medical record review of 438 patients across 10 primary care practices.
• Analysis of sociodemographic characteristics, symptoms, and workup components.
• Logistic regression models to examine factors associated with discordant care.

Main Results:

• Twenty-seven percent of rectal bleeding workups were inconsistent and discordant with guidelines.
• Failure to order imaging or diagnostic procedures was linked to discordant care.
• Patients at urban clinics had higher odds of incomplete workups compared to those at hospital-based sites.

Conclusions:

• Rectal bleeding workup in primary care is frequently inconsistent, incomplete, and discordant with established guidelines.
• Practice and provider variation necessitates targeted research and quality improvement strategies.