Effectiveness of a clinic‐based colorectal cancer screening promotion program for underserved Hispanics

Abstract

BACKGROUND: Hispanics in the United States are less likely than other groups to receive screening services for colorectal cancer. METHODS: The authors conducted a clinic-based individual randomized trial that enrolled Hispanic patients ages 50 to 79 years who had been seen in the Seattle-based community clinic in the past 5 years. A total of 501 patients met the eligibility criteria and were randomized to 1 of 3 conditions: 1) usual care; 2) mailed fecal occult blood test (FOBT) card and instructions on how to complete the test (mailed FOBT only); and 3) mailed FOBT card and instructions on how to complete the test, telephone reminders, and home visits (mailed FOBT and outreach). The authors assessed postintervention differences in rates of FOBT screening in intervention and usual care groups using computerized medical records reviewed from June 2007 to March 2008. RESULTS: Data analysis occurred between November 2008 and September 2009. Nine-month postintervention screening rates were 26% among patients who received the mailed packet only intervention (P < .001 compared with usual care) and 31% in the group that received the mailed packet and outreach intervention (P < .001 compared with usual care). This compared with 2% in the group that received usual care. Screening rates in the mailed FOBT only group and in the mailed FOBT and outreach group were not significantly different (P ¼ .28). CONCLUSIONS: Culturally appropriate clinic-based interventions may increase colorectal cancer screening among underserved Hispanics.

Program to Improve Colorectal Cancer Screening in a Low-Income, Racially Diverse Population: A Randomized Controlled Trial

“…Those that have evaluated this intervention in more vulnerable populations have tended to focus on just 1 or 2 ethnic groups. 12,20 Our study adds to this existing literature by demonstrating that this outreach strategy can significantly improve colorectal cancer screening rates even among economically disadvantaged patients from a wide range of racial, ethnic, and cultural backgrounds.…”

“…Those that have evaluated this intervention in more vulnerable populations have tended to focus on just 1 or 2 ethnic groups. 12,20 Our study adds to this existing literature by demonstrating that this outreach strategy can significantly improve colorectal cancer screening rates even among economically disadvantaged patients from a wide range of racial, ethnic, and cultural backgrounds.Especially in settings with an EHR system to facilitate the ready identifi cation of patients who are eligible and overdue for colorectal cancer screening, the direct mailing of FOBT kits to eligible patients with some additional phone outreach to initial nonresponders may be a sustainable strategy to promote colorectal cancer screening, particularly under a patient-centered medical home payment model that reimburses practices for population health management activities.21 Although our study did not include formal cost or cost-effectiveness analyses, very similar outreach interventions have been found to be cost-effective in other studies. 15,16 Our study demonstrated that the direct-to-patient outreach intervention was effi cacious even in a health care setting that had already implemented point-ofcare clinician-directed electronic clinical reminders to promote appropriate colorectal cancer screening.…”

“…The direct mailing of FOBT kits to patients who are due for colorectal cancer screening has been shown to be both clinically effective [9][10][11][12][13][14] and cost-effective 15,16 for increasing colorectal cancer screening rates. The vast majority of studies assessing the effi cacy of this strategy have not included sizable numbers of patients with lower socioeconomic status or from racial or ethnic minority groups, however.…”

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

“…13 Several randomized trials have reported that outreach with FOBT can improve CRC screening rates. [14][15][16][17][18][19][20] However, most were conducted in integrated health plans. 15 , 16 , 18 , 19 Few targeted vulnerable populations cared for in community health centers (CHCs) and other safety net settings.…”

“…[14][15][16][17][18][19][20] However, most were conducted in integrated health plans. 15 , 16 , 18 , 19 Few targeted vulnerable populations cared for in community health centers (CHCs) and other safety net settings. [21][22][23][24] We previously reported that a multifaceted outreach and reminder intervention using mailed FITs increased adherence to annual screening, compared to point-of-care strategies that maximize FIT distribution at clinic visits, for patients due for repeat screening.…”