A Centrally Generated Primary Care Physician Audit Report Does Not Improve Colonoscopy Uptake After a Positive Result on a Fecal Occult Blood Test in Ontario’s Coloncancercheck Program

Stock, David; Rabeneck, Linda; Baxter, Nancy N.; Lf, Paszat; Sutradhar, Rinku; Yun, L; Tinmouth, Jill

doi:10.3747/co.24.3025

Cited by 7 publications

(11 citation statements)

References 8 publications

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“…The proportions of test-positive patients who had follow-up colonoscopy with and without the intervention were available for 17 studies; the 6 remaining studies either had no control group or reported only coefficients of change in colonoscopy completion rates (31, 33–35, 45, 48). The 17 studies with control and intervention proportions reported absolute differences of −7.4 percentage points (95% CI, −19 to 4.3 percentage points) to 25 percentage points (CI, 14 to 35 percentage points).…”

Section: Resultsmentioning

confidence: 99%

“…All 5 provider-level intervention studies used provider reminders or performance data (30, 35, 41, 49, 50). They used electronic algorithms to clearly identify ordering providers and remind those who had taken no initial action or inadequate action within 60 or 90 days of a positive fecal test result.…”

Section: Resultsmentioning

confidence: 99%

“…Four of the studies came from integrated systems in the United States and showed statistically significant, positive results with absolute improvements in colonoscopy completion of 9 to 25 percentage points (30, 41, 49, 50). The fifth study used centrally generated reports from a provincial screening program and did not show any difference in colonoscopy rates (hazard ratio, 0.95 [CI, 0.79 to 1.13]) (35). …”

Section: Resultsmentioning

confidence: 99%

“…Although 1 did not achieve statistical significance (39), it was underpowered and its point estimate of a 10% improvement in follow-up reached our threshold for clinical importance. Moderate evidence for the provision to providers of reminders or performance data was based on consistent, direct evidence for increases in colonoscopy completion across 4 studies, although 1 recent study failed to show an effect (35). All other categories, including all categories of system-level interventions, had low strength of evidence due to various problems with risk of bias, inconsistent effects on colonoscopy rates, and imprecise estimates of the effect on colonoscopy rates.…”

Section: Resultsmentioning

confidence: 99%

“…One study was excluded because it included symptomatic patients (28), and another because the intervention was unclear without additional information (29). One author provided additional results not available in the report (30); 4 authors of included studies either did not respond or no longer had access to the study data set (31–35). …”

Section: Methodsmentioning

confidence: 99%

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Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests

et al. 2017

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Background: Fecal immunochemical testing is the most commonly used method for colorectal cancer screening worldwide. However, its effectiveness is frequently undermined by failure to obtain follow-up colonoscopy after positive test results. Purpose: To evaluate interventions to improve rates of follow-up colonoscopy for adults after a positive result on a fecal test (guaiac or immunochemical). Data Sources: English-language studies from the Cochrane Central Register of Controlled Trials, PubMed, and Embase from database inception through June 2017. Study Selection: Randomized and nonrandomized studies reporting an intervention for colonoscopy follow-up of asymptomatic adults with positive fecal test results. Data Extraction: Two reviewers independently extracted data and ranked study quality; 3 rated overall strength of evidence for each category of study type. Data Synthesis: Twenty-three studies were eligible for analysis, including 7 randomized and 16 nonrandomized studies. Three were at low risk of bias. Eleven studies described patient-level interventions (changes to invitation, provision of results or follow-up appointments, and patient navigators), 5 provider-level interventions (reminders or performance data), and 7 system-level interventions (automated referral, precolonoscopy telephone calls, patient registries, and quality improvement efforts). Moderate evidence supported patient navigators and provider reminders or performance data. Evidence for system-level interventions was low. Seventeen studies reported the proportion of test-positive patients who completed colonoscopy compared with a control population, with absolute differences of −7.4 percentage points (95% CI, −19 to 4.3 percentage points) to 25 percentage points (CI, 14 to 35 percentage points). Limitation: More than half of studies were at high or very high risk of bias; heterogeneous study designs and characteristics precluded meta-analysis. Conclusion: Patient navigators and the provision to providers of reminders or performance data may help improve colonoscopy rates of asymptomatic adults with positive fecal blood test results. Current evidence about useful system-level interventions is scant and insufficient.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests

et al. 2017

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Clinical utility of a blood-based protein assay to increase screening of elevated-risk patients for colorectal cancer in the primary care setting

Peabody

Paculdo²,

Swagel³

et al. 2017

J Cancer Res Clin Oncol

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Over one-third of adults in the United States do not follow the recommended screening guidelines for CRC. The introduction of a blood-based protein assay significantly increased the likelihood that physicians would order diagnostic colonoscopies in elevated-risk patients compared to those without access to the assay results. The overall change in clinical utility observed here has the potential to significantly improve clinical care.

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What Multilevel Interventions Do We Need to Increase the Colorectal Cancer Screening Rate to 80%?

Inadomi

Issaka

Green

2021

Clinical Gastroenterology and Hepatology

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Screening reduces colorectal cancer mortality; however, this remains the second leading cause of cancer deaths in the United States and adherence to colorectal cancer screening falls far short of the National Colorectal Cancer Roundtable goal of 80%. Numerous studies have examined the effectiveness of interventions to increase colorectal cancer screening uptake. Outreach is the active dissemination of screening outside of the primary care setting, such as mailing fecal blood tests to individuals' homes. Navigation uses trained personnel to assist individuals through the screening process. Patient education may take the form of brochures, videos, or websites. Provider education can include feedback about screening rates of patient panels. Reminders to healthcare providers can be provided by dashboards of patients due for screening. Financial incentives provide monetary compensation to individuals when they complete screening tests, either as fixed payments or via a lottery. Individual preference for specific screening strategies has also been examined in several trials, with a choice of screening strategies yielding higher adherence than recommendation of a single strategy.

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A Centrally Generated Primary Care Physician Audit Report Does Not Improve Colonoscopy Uptake After a Positive Result on a Fecal Occult Blood Test in Ontario’s Coloncancercheck Program

Abstract: Background Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal

Cited by 7 publications

References 8 publications

Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests

Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests

Clinical utility of a blood-based protein assay to increase screening of elevated-risk patients for colorectal cancer in the primary care setting

What Multilevel Interventions Do We Need to Increase the Colorectal Cancer Screening Rate to 80%?

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