Diagnostic colonoscopy completion after abnormal fecal immunochemical testing and quality of tests used at 8 Federally Qualified Health Centers in Southern California: Opportunities for improving screening outcomes

Abstract

Background The effectiveness of colorectal cancer screening with fecal immunochemical tests (FITs) of stool blood depends on high rates of colonoscopy follow‐up for abnormal FITs and the use of high‐quality tests. This study characterized colonoscopy referral and completion among patients with abnormal FITs and the types of FITs implemented in a sample of Southern California Federally Qualified Health Centers (FQHCs). Methods FQHCs in San Diego, Imperial, and Los Angeles Counties were invited to define a cohort of ≥150 consecutive patients with abnormal FITs in 2015‐2016 and to provide data on sex, insurance status, diagnostic colonoscopy referrals and completion within 6 months of abnormal FITs, and the types (brands) of FITs implemented. The primary outcomes were the proportions with colonoscopy referrals and completion for all patients at each FQHC and in aggregate. Results Eight FQHCs provided data for 1229 patients with abnormal FITs; 46% were male, and 20% were uninsured. Among patients with abnormal FITs, 89% (1091 of 1229; 95% confidence interval [CI], 0.87‐0.91) had a colonoscopy referral, and 44% (539 of 1229; 95% CI, 0.41‐0.47) had colonoscopy completion. Across FQHCs, the range for colonoscopy referral was 73% to 96%, and the range for completion was 18% to 57%. Six of the 8 FQHCs (75%) reported FIT brands with limited data to support their effectiveness. Conclusions In a sample of Southern California FQHCs, diagnostic colonoscopy completion after abnormal FITs was substantially below the nationally recommended benchmark to achieve 80% completion, and the use of FIT brands with limited data to support their effectiveness was high. These findings suggest a need for policies and multilevel interventions to promote diagnostic colonoscopy among individuals with abnormal FITs and the use of higher quality FITs.

Spatial Insights for Understanding Colorectal Cancer Screening in Disproportionately Affected Populations, Central Texas, 2019

“…The number of primary care visits remained a key factor after multivariate adjustment, suggesting that both access and use of care are key factors that affect screening for patients in this system. Overall screening rates in the system were generally low, a finding similar for other FQHC systems ( 14 – 16 ). Interventions that seek to increase screening in ways that do not require in-person visits or extended travel, such as mailed stool testing programs, may be effective in overcoming barriers ( 4 , 5 , 17 ).…”

Screening History and Comorbidities Help Refine Stop Ages for Colorectal Cancer Screening

“…Although these rates are based on observed data in Ontario, Canada 9 and considered near ideal, 10 real world adherence rates are lower, approximately 44%-56% in the United States. 11,12 The numerous steps between having an abnormal FIT and obtaining a successful diagnostic colonoscopy can be challenging to accomplish, especially in the setting of opportunistic rather than programmatic screening. 13 Notably, increasing age and comorbidity have been associated with lower rates of follow-up colonoscopy after abnormal FIT.…”

What You Don’t Know Might Hurt You: Cost Variations for Fecal Immunochemical Tests in Primary Care Practices

“…Evidence encourages health care practices to select FITs that are clinically effective and display patient preferred features, such as using a single sample and probe/vial collection tubes (17). However, we do not know what factors actually in uence primary care practices' choice of FIT, and some literature indicates community-based primary care practices use a wide variety of FITs, many of which do not have strong evidence of e cacy (17,18).…”