The Impact of the Coronavirus Disease-19 Pandemic on Access to Endoscopy Procedures in the VA Healthcare System

Gawron, Andrew J.; Kaltenbach, Tonya; Dominitz, Jason A.

doi:10.1053/j.gastro.2020.07.033

Cited by 25 publications

(30 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Organizations such as the US Department of Veterans Affairs suspended all screening colonoscopies, but continued FIT screening, reserving colonoscopies for individuals with positive tests who are more likely to have CRC. 43 COVID-19related screening delays may lead to a surge in late-stage CRC and CRC death. [44][45][46] Mailed FIT programs could mitigate this risk.…”

Section: Discussionmentioning

confidence: 99%

A Centralized Program with Stepped Support Increases Adherence to Colorectal Cancer Screening Over 9 Years: a Randomized Trial

et al. 2021

View full text Add to dashboard Cite

BACKGROUND: Screening over many years is required to optimize colorectal cancer (CRC) outcomes. OBJECTIVE: To evaluate the effect of a CRC screening intervention on adherence to CRC screening over 9 years. DESIGN: Randomized trial. SETTING: Integrated health care system in Washington state. PARTICIPANTS: Between August 2008 and November 2009, 4653 adults in a Washington state integrated health care system aged 50-74 due for CRC screening were randomized to usual care (UC; N =1163) or UC plus study interventions (interventions: N = 3490). INTERVENTIONS: Years 1 and 2: (arm 1) UC or this plus study interventions;(arm 2) mailed fecal tests or information on scheduling colonoscopy; (arm 3) mailings plus brief telephone assistance; or (arm 4) mailings and assistance plus nurse navigation. In year 3, stepped-intensity participants (arms 2, 3, and 4 combined) still eligible for screening were randomized to either stopped or continued interventions in years 3 and 5-9. MAIN MEASURES: Time in adherence to CRC testing over 9 years (covered time, primary outcome), and percent with no CRC testing in participants assigned to any intervention compared to UC only. Poisson regression models estimated incidence rate ratios for covered time, adjusting for patient characteristics and accounting for variable follow-up time. KEY RESULTS: Compared to UC, intervention participants had 21% more covered time over 9 years (57.5% vs. 69.1%; adjusted incidence rate ratio 1.21, 95% confidence interval 1.16-1.25, P<0.001). Fecal testing accounted for almost all additional covered time among intervention patients. Compared to UC, intervention participants were also more likely to have completed at least one CRC screening test over 9 years or until censorship (88.6% vs. 80.6%, P<0.001). CONCLUSIONS: An outreach program that included mailed fecal tests and phone follow-up led to increased adherence to CRC testing and fewer age-eligible individuals without any CRC testing over 9 years. TRIAL REGISTRATION: Systems of Support (SOS) to Increase Colon Cancer Screening and Follow-up (SOS),

show abstract

Section: Discussionmentioning

confidence: 99%

A Centralized Program with Stepped Support Increases Adherence to Colorectal Cancer Screening Over 9 Years: a Randomized Trial

et al. 2021

View full text Add to dashboard Cite

show abstract

“…This is particularly true within integrated health care delivery systems such as the Veterans Health Administration, which proactively has implemented a coordinated strategy favoring fecal immunochemical test (FIT)-based screening as a means to address pandemic-related procedural backlogs and enhance access. 6 Additional studies have shown that demand for endoscopic procedures could be moderated further by immediately implementing updated consensus recommendations for screening and surveillance that support longer intervals between procedures. Although some initial reluctance to adopting a new model can be expected, in the face of strong evidence that noninvasive testing is practical and useful it is critical that gastroenterologists take initiative in partnering with PCPs to encourage population-based screening and surveillance strategies that promote enhanced access and adherence whatever the modality.…”

Section: Access To Carementioning

confidence: 99%

An Impetus for Change: How COVID-19 Will Transform the Delivery of GI Health Care

Leiman

Weinstein

Adams

2021

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

“… 3 , 4 Esophagogastroduodenoscopy (EGD) and colonoscopy, routinely used in the evaluation of gastrointestinal (GI) disorders, are both known to produce aerosols, thus potentially exposing endoscopy personnel to SARS-CoV-2. 4 However, although many elective GI procedures can be deferred or canceled during surges of the pandemic, 5 the evaluation of acute GI bleeding is often urgent and as such cannot be deferred. Current guidelines recommend early EGD 6 and/or colonoscopy 7 within 24 hours as the first-line diagnostic and therapeutic modalities for acute GI bleeding.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Video Capsule Endoscopy in the Management of Acute Gastrointestinal Bleeding During the COVID-19 Pandemic

et al. 2021

View full text Add to dashboard Cite

Key Points Question Can video capsule endoscopy be safely used as an alternative to standard endoscopic procedures for the initial evaluation of gastrointestinal bleeding during the COVID-19 pandemic? Findings In this cohort study of 146 patients (74 with COVID-19), active bleeding was more frequently identified with video capsule endoscopy as the first strategy (59.5%) compared with conventional endoscopic evaluation (25.0%). The number of invasive procedures was significantly decreased with video capsule endoscopy without increased risk of rebleeding or compromising safety. Meaning The results of this study suggest that video capsule endoscopy can serve as a safe alternative to the standard endoscopic evaluation of gastrointestinal bleeding because it reduces the number of invasive procedures, personnel involved, and use of personal protective equipment.

show abstract

The Impact of the Coronavirus Disease-19 Pandemic on Access to Endoscopy Procedures in the VA Healthcare System

Cited by 25 publications

References 14 publications

A Centralized Program with Stepped Support Increases Adherence to Colorectal Cancer Screening Over 9 Years: a Randomized Trial

A Centralized Program with Stepped Support Increases Adherence to Colorectal Cancer Screening Over 9 Years: a Randomized Trial

An Impetus for Change: How COVID-19 Will Transform the Delivery of GI Health Care

Assessment of Video Capsule Endoscopy in the Management of Acute Gastrointestinal Bleeding During the COVID-19 Pandemic

Contact Info

Product

Resources

About