Systematic Review: Enhancing the Use and Quality of Colorectal Cancer Screening

Holden, Debra J; Jonas, Daniel E; Porterfield, Deborah S; Reuland, Daniel S.; Harris, Russell

doi:10.7326/0003-4819-152-10-201005180-00239

Cited by 273 publications

(277 citation statements)

References 114 publications

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“…Primary care providers play an important role in CRC screening; several studies have shown that lack of physician referral is a significant barrier to colonoscopy. 8,31 Our findings suggest that while provider referral and recommendation are clearly necessary for CRC screening, they are not sufficient for individuals to actually use screening tests. We found that whether or not individuals feel confident in their ability to obtain CRC screening was just as important as health insurance coverage.…”

Section: Discussionmentioning

confidence: 83%

Cultural, Economic, and Psychological Predictors of Colonoscopy in a National Sample

et al. 2011

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Section: Discussionmentioning

confidence: 83%

Cultural, Economic, and Psychological Predictors of Colonoscopy in a National Sample

et al. 2011

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“…The associations we report were robust after controlling for the likelihood of having a PCP visit, as well as in secondary analyses that adjusted for other patient factors known to influence screening and primary care utilization such as age, sex, race, ethnicity, education, and insurance. 4,30,31 Our study is limited by the observational nature of the data available for analysis. The majority of patients had commercial or Medicare insurance.…”

Section: Discussionmentioning

confidence: 99%

Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach

et al. 2016

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BACKGROUND: Population outreach strategies are increasingly used to improve colorectal cancer (CRC) screening. The influence of primary care on cancer screening in this context is unknown. OBJECTIVE: To assess associations between primary care provider (PCP) visits and receipt of CRC screening and colonoscopy after a positive fecal immunochemical (FIT) or fecal occult blood test (FOBT). DESIGN: Population-based cohort study. PARTICIPANTS: A total of 968,072 patients ages 50-74 years who were not up to date with CRC screening in 2011 in four integrated healthcare systems (three with screening outreach programs using FIT kits) in the PopulationBased Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. MEASURES: Demographic, clinical, PCP visit, and CRC screening data were obtained from electronic health records and administrative databases. We examined associations between PCP visits in 2011 and receipt of FIT/ FOBT, screening colonoscopy, or flexible sigmoidoscopy (CRC screening) in 2012 and follow-up colonoscopy within 3 months of a positive FIT/FOBT in 2012. We used multivariable logistic regression and propensity score models to adjust for confounding. RESULTS: Fifty-eight percent of eligible patients completed a CRC screening test in 2012, most by FIT. Those with a greater number of PCP visits had higher rates of CRC screening at all sites. Patients with ≥1 PCP visit had nearly twice the adjusted-odds of CRC screening (OR = 1.88, 95 % CI: 1.86-1.89). Overall, 79.6 % of patients with a positive FIT/FOBT completed colonoscopy within 3 months. Patients with ≥1 PCP visit had 30 % higher adjusted odds of completing colonoscopy after positive FIT/FOBT (OR = 1.30; 95 % CI: 1.22-1.40). CONCLUSIONS:Patients with a greater number of PCP visits had higher rates of both incident CRC screening and colonoscopy after positive FIT/FOBT, even in health systems with active population health outreach programs. In this era of virtual care and population outreach, primary care visits remain an important mechanism for engaging patients in cancer screening.KEY WORDS: primary care; colorectal cancer screening; population health outreach.

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“…Thus, the difference between the FIT outreach and usual care groups may overestimate the value of outreach compared to other evidence-based strategies. 25 Additionally, patients in the usual care group received a three-sample guaiac-based FOBT (gFOBT), while the intervention group received a FIT. Completion rates are higher with FIT than gFOBT, 26 , 27 preventing us from separating the effect of outreach from FIT usage.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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INTRODUCTION:Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care. METHODS: This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66 % were female, 62.1 % were Latino, and 70.7 % were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data. RESULTS: Patients who received outreach were more likely to complete FIT than those in usual care (36.7 % vs. 14.8 %; p<0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time. DISCUSSION: The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.KEY WORDS: health disparities; cancer prevention; care delivery system.

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Systematic Review: Enhancing the Use and Quality of Colorectal Cancer Screening

Abstract: Agency for Healthcare Research and Quality.

Cited by 273 publications

References 114 publications

Cultural, Economic, and Psychological Predictors of Colonoscopy in a National Sample

Cultural, Economic, and Psychological Predictors of Colonoscopy in a National Sample

Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach

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

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