Colorectal Cancer Screening among the Medically Underserved

Abstract

Prevalence of physician recommendation and patient completion of colorectal cancer screening was investigated among Federally Qualified Health Centers (FQHC) serving low-income neighborhoods in Chicago. Medical records of 3,416 patients receiving primary care services at 1 of 31 FQHCs were randomly chosen for review. In all, 642 patients were identified by age and family history as eligible for colorectal cancer screening and included in this study. Patient demographic information and colorectal cancer screening history were collected. The physician screening recommendation rate was 9.2% (n=59); 7.0% (n=45) of patients were determined to have been appropriately screened for colorectal cancer, primarily by Fecal Occult Blood Test (94.1%, n=43). Among patients who received a recommendation from their physician, 76.2% had completed a screening test. Older patients were more likely than their younger counterparts to have received a recommendation from their physician (p<.05) and to have been screened (p<.01). Organizational interventions are needed to support physicians in medically underserved areas and to promote recommended screening practices.

Expanding Access to Colorectal Cancer Screening: Benchmarking Quality Indicators in a Primary Care Colonoscopy Program

“…Incorporating colonoscopy into primary care practices may have the added benefit of ensuring continuity of care, decreasing costs to patients, and decreasing transportation barriers (including travel time). 40 Because a personal physician's recommendation is a strong predictor of CRC screening, [41][42][43][44] and trust in a primary care physician is also associated with CRC screening compliance, 13 primary care colonoscopy has great potential for decreasing CRC incidence and mortality. However, relatively few primary care physicians perform colonoscopies, 23 and only a fraction of family medicine residencies train residents to conduct colonoscopies.…”

Improving Colorectal Cancer Screening Among the Medically Underserved: A Pilot Study within a Federally Qualified Health Center

“…This is much lower than what was anticipated based on our prior research among FQHCs, and what had been achieved among veterans. 10 It is possible that the emphasis on colonoscopy as the practice standard in this intervention led to a lower uptake of recommended screening. However, the increase in recommendation rates alone was enough to increase screening completion rates, reinforcing the importance of the physician's role in screening adherence.…”

“…However, our inclusion of patients who were more frequent users of care at the FQHC, and their limited economic resources suggest the patients included in our study are not as likely to be dual users of a preventive care service like colonoscopy or FOBT. 10,22 Third, several other patient-level characteristics have been previously proposed as influencing screening adherence, but were not captured in the current research activities. 22 Fourth, we recognize the value of the support of a community hospital to provide charitable care to patients with financial restrictions was crucial for the implementation of this intervention.…”

“…In particular, the African-American population has the highest morbidity and mortality rate owing to colorectal cancer, and the Hispanic population has the lowest screening rates, putting this group at greater risk for late-stage presentation of the disease. [6][7][8][9][10] Our research team recently investigated screening completion rates among a network of 31 federally qualified health centers (FQHCs) whose mission is to provide comprehensive primary care in areas where there are large volumes of low-income and medically underserved populations. 10,11 The screening rates among these predominantly African-American and Hispanic communities were the lowest recorded in the literature to date; only 7% of eligible patients were found to be compliant with colorectal cancer screening (predominantly FOBT).…”

“…[6][7][8][9][10] Our research team recently investigated screening completion rates among a network of 31 federally qualified health centers (FQHCs) whose mission is to provide comprehensive primary care in areas where there are large volumes of low-income and medically underserved populations. 10,11 The screening rates among these predominantly African-American and Hispanic communities were the lowest recorded in the literature to date; only 7% of eligible patients were found to be compliant with colorectal cancer screening (predominantly FOBT). Most nota-ble was the remarkably low rate of physician recommendation of colorectal cancer screening for these patients (9%), coupled with the high completion rate among those who actually did receive a recommendation (76%).…”