Predictors of Colorectal Cancer Screening: Does Rurality Play a Role?

Ojinnaka, Chinedum O.; Choi, Yong Won; Kum, Hye‐Chung; Bolin, Jane N.

doi:10.1111/jrh.12104

Cited by 38 publications

(40 citation statements)

References 40 publications

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“…MMC patients also are more likely to encounter barriers to screenings, such as low health literacy and limited English language competency, which can affect screening uptake. 18,19 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of patient‐focused interventions to promote colorectal cancer screening among New York State Medicaid managed care patients

Dacus

Wagner

Collins

et al. 2018

Cancer

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BACKGROUND: The objective of this study was to evaluate an ongoing initiative to improve colorectal cancer (CRC) screening uptake in the New York State (NYS) Medicaid managed care population. METHODS: Patients aged 50 to 75 years who were not up to date with CRC screening and resided in 2 NYS regions were randomly assigned to 1 of 3 cohorts: no mailed reminder, mailed reminder, and mailed reminder + incentive (in the form of a $25 cash card). Screening prevalence and the costs of the intervention were summarized. RESULTS: In total, 7123 individuals in the Adirondack Region and 10,943 in the Central Region (including the Syracuse metropolitan area) were included. Screening prevalence in the Adirondack Region was 7.2% in the mailed reminder + incentive cohort, 7.0% in the mailed reminder cohort, and 5.8% in the no mailed reminder cohort. In the Central Region, screening prevalence was 7.2% in the mailed reminder cohort, 6.9% in the mailed reminder + incentive cohort, and 6.5% in the no mailed reminder cohort. The cost of implementing interventions in the Central Region was approximately 53% lower than in the Adirondack Region. CONCLUSIONS: Screening uptake was low and did not differ significantly across the 2 regions or within the 3 cohorts. The incentive payment and mailed reminder did not appear to be effective in increasing CRC screening. The total cost of implementation was lower in the Central Region because of efficiencies generated from lessons learned during the first round of implementation in the Adirondack Region. More varied multicomponent interventions may be required to facilitate the completion of CRC screening among Medicaid beneficiaries.

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“…MMC patients also are more likely to encounter barriers to screenings, such as low health literacy and limited English language competency, which can affect screening uptake. 18,19 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of patient‐focused interventions to promote colorectal cancer screening among New York State Medicaid managed care patients

Dacus

Wagner

Collins

et al. 2018

Cancer

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“…9 Minority status, recent immigrant status, low income, low education, and residing in a non-urban area are all predictors of lower rates of colorectal cancer screening. [9][10][11] Access to services for genetic risk assessment and counseling is often limited to major metropolitan areas. Te border region of South Texas is a medically underserved area, especially with regard to cancer genetics.…”

mentioning

confidence: 99%

Reaching high-risk underserved individuals for cancer genetic counseling by video-teleconferencing

Mette¹,

Saldívar²,

Poullard³

et al. 2016

J Community Support Oncol

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Background Breast and colorectal cancers are common cancers for which genetic risk assessment and counseling are available. However, these services are often limited to metropolitan areas and are not readily accessible to underserved populations. Moreover, ethnic and racial disparities present additional obstacles to identifying and screening high-risk individuals and have a bearing on treatment outcomes. Objective To provide cancer genetic risk assessment and counseling through telemedicine to the remote, underserved primarily Hispanic population of the Texas-Mexico border region. Methods Program participants were mailed a questionnaire to assess their satisfaction with the program so that we could determine the acceptability of video-teleconferencing for cancer risk assessment. Results The overall level of satisfaction with the program was very high, demonstrating the acceptability of a cancer genetic risk assessment program that relied on telemedicine to reach and underserved minority community. Limitations Delivery model requires the availability of and access to communication technologies; trained staff are needed at remote sites for sample collection and patient handling. Conclusion Video-teleconferencing is an acceptable method of providing cancer risk assessment in a remote, underserved population.

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“…Importantly, a recent systematic review identified a notable lack of studies assessing who provides colonoscopy care in rural areas. 16 Lower rates of colorectal cancer screening in rural areas 17,18 suggest a need for increased provision of colonoscopy care in these regions.…”

Section: Discussionmentioning

confidence: 99%

“…15 In addition, residents of rural areas have been shown to have lower screening rates than urban residents [16][17][18] and a higher proportion of their colonoscopy procedures done by general surgeons. 15 Furthermore, the nature of the 2 professions differs and allows for varied roles in the delivery of endoscopy.…”

mentioning

confidence: 99%

Geographic variation in the provider of screening colonoscopy in Canada: a population-based cohort study

et al. 2018

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Background: Screening colonoscopy for the detection of colorectal carcinoma is provided by several specialties. Few studies have assessed geographic variation in the delivery of this care. Our objective was to investigate how geographic and socioeconomic factors affect who provides screening colonoscopy in Canada. Methods:This was a population-based cohort of all screening colonoscopy procedures performed at publicly funded Canadian health care facilities (excluding those in Quebec) between April 2008 and March 2015. The main outcome of interest was the proportion of colonoscopy procedures performed by surgeons versus gastroenterologists at the neighbourhood level. Predictors of interest included socioeconomic and geographic variables. We used spatial analysis to evaluate significant clustering of practitioner services and multinomial logistic regression to model predictors. Results:We identified 658 113 screening colonoscopy procedures performed by 1886 providers (1169 surgeons and 717 gastroenterologists) over the study period, of which 353 165 (53.7%) were performed by surgeons. A total of 24.2% of neighbourhoods were located within clusters predominantly served by gastroenterologists, and 19.5% were within surgeon clusters; the remainder were in mixed clusters. Rural neighbourhoods had a significantly increased relative risk of being within a surgeon cluster (relative risk [RR] 5.38, 95% confidence interval [CI] 3.48-8.01) compared to mixed clusters and nearly 100 times higher relative risk of being in a surgeon cluster compared to gastroenterologist clusters (RR 98.95,. Neighbourhoods with the highest socioeconomic status were 1.74 (95% CI 1.14-2.56) times likelier to be in gastroenterologist clusters than in mixed clusters.Interpretation: Surgeons provide a large proportion of colonoscopy procedures in Canada and are essential for access to care, particularly in rural regions. Most Canadians are served relatively equally by surgeons and gastroenterologists. This emphasizes the importance of both specialties to the delivery of colonoscopy care across the country. AbstractResearch OPEN CMAJ OPEN, 6(1) E127

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Predictors of Colorectal Cancer Screening: Does Rurality Play a Role?

Abstract: Effective development and implementation of strategies to improve screening rates should aim at improving access to health care, taking into account demographic characteristics such as rural versus urban residence.

Cited by 38 publications

References 40 publications

Evaluation of patient‐focused interventions to promote colorectal cancer screening among New York State Medicaid managed care patients

Evaluation of patient‐focused interventions to promote colorectal cancer screening among New York State Medicaid managed care patients

Reaching high-risk underserved individuals for cancer genetic counseling by video-teleconferencing

Geographic variation in the provider of screening colonoscopy in Canada: a population-based cohort study

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