Barriers associated with inadequate follow-up of abnormal fecal immunochemical test results in a safety-net system: A mixed-methods analysis

Performance of OC-Auto Micro 80 Fecal Immunochemical Test in an Integrated Academic-Community Health System

“…In other studies focused on safety-net health systems and federally qualified health care centers, follow-up colonoscopy completion rates have varied from 33% to 56% 10,18,19 . In these settings, inadequate follow-up has been attributed to barriers at multiple levels of care, including patient fear of colonoscopy and findings, lack of transportation and/or chaperone, lack of referral to gastroenterology, lack of documentation after referral to gastroenterology, abnormal result attributed to another cause and lack of health insurance 10,20,21 . The lower colonoscopy completion rate in the present study likely reflects a combination of these factors and incomplete access to endoscopy reports from some UW Medicine non–safety-net clinics that were acquired through a health system merger in 2020.…”

“…10,18,19 In these settings, inadequate follow-up has been attributed to barriers at multiple levels of care, including patient fear of colonoscopy and findings, lack of transportation and/or chaperone, lack of referral to gastroenterology, lack of documentation after referral to gastroenterology, abnormal result attributed to another cause and lack of health insurance. 10,20,21 The lower colonoscopy completion rate in the present study likely reflects a combination of these factors and incomplete access to endoscopy reports from some UW Medicine non-safety-net clinics that were acquired through a health system merger in 2020. Although this highlights the importance of complete EHR records in assessing the quality of stool-based CRC screening efforts, ultimately, there is room to improve follow-up of abnormal FIT results across clinical practice sites to reach the US Multi-Society Task Force on CRC follow-up goal of 80%.…”

Implementing an Organized Colorectal Cancer Screening Program: Lessons Learned From an Academic–Community Practice

“…Inadequate follow-up colonoscopy completion after abnormal FIT results is well described in the literature. 48 , 49 Barriers include but are not limited to lack of comprehensive health insurance, competing health issues, and logistical barriers such as lack of transportation. 48 Despite a 2021 Centers for Medicare and Medicaid Services rule that eliminates cost sharing for colonoscopy after an abnormal FIT result, 50 many patients continue to face insurance barriers to screening and follow-up.…”

“… 48 , 49 Barriers include but are not limited to lack of comprehensive health insurance, competing health issues, and logistical barriers such as lack of transportation. 48 Despite a 2021 Centers for Medicare and Medicaid Services rule that eliminates cost sharing for colonoscopy after an abnormal FIT result, 50 many patients continue to face insurance barriers to screening and follow-up. In our program, navigators connected patients with insurance barriers to financial assistance resources.…”

Socioeconomic differences in discrepancies between expected and experienced discomfort from colonoscopy and colon capsule endoscopy

“…It has proven difficult to reduce inequalities between socioeconomic subgroups as most interventions targeted at the entire population, are less efficient in the less privileged subgroups [ [12] , [13] , [14] , [15] , [16] , [17] , [18] ]. Previous research have identified barriers to screening participation such as perceived risk of disease, fear of the result, the faecal collection, expected discomfort, and invasiveness of the procedures [ [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] ]. These barriers are very unlikely to be of equal relevance to all individuals.…”