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Baskar S, Schoeneich R, Baskar A, Grewal US. Leveraging Patient Education to Amplify Colorectal Cancer Screening in the United States: Strategies and Implications. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02482-1. [PMID: 39060864 DOI: 10.1007/s13187-024-02482-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
Despite several available screening modalities, colorectal cancer (CRC) remains a leading cause of cancer deaths, especially among populations with lower screening rates. Barriers to screening include cost, access, awareness, and education disparities, with interventions such as patient education programs and mailed screening kits showing promise in increasing participation rates. The current review elucidates the correlation between patient awareness/knowledge and screening rates in the United States, highlighting the pivotal role of education in mitigating these deficiencies. Different educational models, including online resources, mailed information, community programs, direct provider-based interventions, and narratives, are explored in terms of their effectiveness and limitations. We also offer a blueprint for primary care providers (PCPs) that highlights the importance of tailored education, barrier identification, and utilization of available resources to enhance CRC screening uptake. Large-scale adoption of educational strategies has the potential to significantly increase CRC screening rates and consequently reduce mortality associated with this preventable malignancy.
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Affiliation(s)
- Suriya Baskar
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Robert Schoeneich
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Adhithya Baskar
- St. Matthew's University School of Medicine, George Town, Cayman Islands
| | - Udhayvir Singh Grewal
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
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Zheng S, Zhang X, Greuter MJW, de Bock GH, Lu W. Willingness of healthcare providers to perform population-based cancer screening: a cross-sectional study in primary healthcare institutions in Tianjin, China. BMJ Open 2024; 14:e075604. [PMID: 38569674 PMCID: PMC10989173 DOI: 10.1136/bmjopen-2023-075604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 03/17/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To evaluate the willingness of healthcare providers to perform population-based screening in primary healthcare institutions in China. METHODS Healthcare providers of 262 primary healthcare institutions in Tianjin were invited to fill out a questionnaire consisting of demographic characteristics, workload, and knowledge of, attitude towards and willingness to perform breast, cervical and colorectal cancer screening. Willingness to screen was the primary outcome. Multilevel logistic regression models were conducted to analyse the determinants of healthcare providers' willingness to screen. ORs and 95% CIs were estimated. RESULTS A total of 554 healthcare providers from 244 institutions answered the questionnaire. 67.2%, 72.1% and 74.3% were willing to perform breast, cervical and colorectal cancer screening, respectively. A negative attitude towards screening was associated with a low willingness for cervical (OR=0.27; 95% CI 0.08, 0.94) and colorectal (OR=0.08; 95% CI 0.02, 0.30) cancer screening, while this was not statistically significant for breast cancer screening (OR=0.30; 95% CI 0.08, 1.12). For breast, cervical and colorectal cancer screening, 70.1%, 63.8% and 59.0% of healthcare providers reported a shortage of staff dedicated to screening. A perceived reasonable manpower allocation was a determinant of increased willingness to perform breast (OR=2.86; 95% CI 1.03, 7.88) and colorectal (OR=2.70; 95% CI 1.22, 5.99) cancer screening. However, this was not significant for cervical cancer screening (OR=1.76; 95% CI 0.74, 4.18). CONCLUSIONS In China, healthcare providers with a positive attitude towards screening have a stronger willingness to contribute to cancer screening, and therefore healthcare providers' attitude, recognition of the importance of screening and acceptable workload should be optimised to improve the uptake of cancer screening.
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Affiliation(s)
- Senshuang Zheng
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Xiaorui Zhang
- Department of Epidemiology and Health Statistics, Capital Medical University, Beijing, China
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
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Heider AK, Mang H. Effects of Non-monetary Incentives in Physician Groups-A Systematic Review. Am J Health Behav 2023; 47:458-470. [PMID: 37596755 DOI: 10.5993/ajhb.47.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Objectives: Healthcare expenditures in western countries have been rising for many years. This leads many countries to develop and test new reimbursement systems. A systematic review about monetary incentives in group settings indicated that a sole focus on monetary aspects does not necessarily result in better care at lower costs. Hence, this systematic review aims to describe the effects of non- monetary incentives in physician groups. Methods: We searched the databases MEDLINE (PubMed), The Cochrane Library, CINAHL, PsycINFO, EconLit, and ISI Web of Science. Grey literature search, reference lists, and authors' personal collection provided additional sources. Results: Overall, we included 36 studies. We identified 4 categories of interventions related to non-monetary incentives. In particular, the category of decision support achieved promising results. However, design features vary among different decision support systems. To enable effective design, we provide an overview of the features applied by the studies included. Conclusions: Not every type of non-monetary incentive has a positive impact on quality of care in physician group settings. Thus, creating awareness among decision-makers regarding this matter and extending research on this topic can contribute to preventing implementation of ineffective incentives, and consequently, allocate resources towards tools that add value.
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Affiliation(s)
- Ann-Kathrin Heider
- Faculty of Medicine, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
| | - Harald Mang
- Master Program Medical Process Management, Universitätsklinikum Erlangen, Germany
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Ahmed AM, Bacchus MW, Beal SG, Huber KN, Lee JH, Zhao J, George TJ, Sattari M. Colorectal cancer screening completion by patients due or overdue for screening after reminders: a retrospective study. BMC Cancer 2023; 23:391. [PMID: 37127588 PMCID: PMC10152700 DOI: 10.1186/s12885-023-10837-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Patient and clinician reminders were implemented as part of an adherence improvement project at University of Florida (UF) Internal Medicine Clinics. We sought to assess colorectal cancer (CRC) screening completion rates among patients not up-to-date with screening following distribution of reminders and to identify characteristics correlated with screening outcomes. METHODS Retrospective chart review was performed for patients not up-to-date with CRC screening for whom at least one reminder (patient and/or clinician) was issued in June 2018. The primary endpoint, the completion of a CRC screening test, is characterized as the ratio of completed screening tests to the number of patients not up-to-date with screening. All analyses were performed using R 4.0 software. RESULTS Of the 926 patients included, 403 (44%; 95% CI, 0.40-0.47) completed a CRC screening test within 24 months following a reminder. Family history of CRC (relative risk (RR) 1.33; P = 0.007), flu immunization within two years of the reminder (RR 1.23; P = 0.019), and receiving a patient reminder either alone (RR 1.62; P < 0.001) or in combination with a clinician reminder (RR 1.55; P = 0.006) were positively associated with CRC screening completion. Reporting being divorced, separated, or widowed was negatively associated with screening completion (RR 0.70; P = 0.004). CONCLUSION Reminders, in particular patient reminders, seem to be an effective method to enhance screening among patients not up-to-date with CRC screening. This study suggests that reminder efforts should be focused at the level of the patients and provides insight on target populations for practical interventions to further increase CRC screening adherence.
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Affiliation(s)
| | | | - Stacy G Beal
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Katherine N Huber
- Division of General Internal Medicine, University of Florida College of Medicine, 1329 SW 16Th Street, Suite 5140, PO Box 103204, Gainesville, FL, 32610, USA
| | - Ji-Hyun Lee
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Jing Zhao
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Thomas J George
- Division of Hematology-Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Maryam Sattari
- Division of General Internal Medicine, University of Florida College of Medicine, 1329 SW 16Th Street, Suite 5140, PO Box 103204, Gainesville, FL, 32610, USA.
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Huguet N, Ezekiel-Herrera D, Gunn R, Pierce A, O'Malley J, Jones M, Marino M, Gold R. Uptake of a Cervical Cancer Clinical Decision Support Tool: A Mixed-Methods Study. Appl Clin Inform 2023; 14:594-599. [PMID: 37532232 PMCID: PMC10411153 DOI: 10.1055/s-0043-1769913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/26/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES Clinical decision support (CDS) tools that provide point-of-care reminders of patients' care needs may improve rates of guideline-concordant cervical cancer screening. However, uptake of such electronic health record (EHR)-based tools in primary care practices is often low. This study describes the frequency of factors associated with, and barriers and facilitators to adoption of a cervical cancer screening CDS tool (CC-tool) implemented in a network of community health centers. METHODS This mixed-methods sequential explanatory study reports on CC-tool use among 480 community-based clinics, located across 18 states. Adoption of the CC-tool was measured as any instance of tool use (i.e., entry of cervical cancer screening results or follow-up plan) and as monthly tool use rates from November 1, 2018 (tool release date) to December 31, 2020. Adjusted odds and rates of tool use were evaluated using logistic and negative-binomial regression. Feedback from nine clinic staff representing six clinics during user-centered design sessions and semi-structured interviews with eight clinic staff from two additional clinics were conducted to assess barriers and facilitators to tool adoption. RESULTS The CC-tool was used ≥1 time in 41% of study clinics during the analysis period. Clinics that ever used the tool and those with greater monthly tool use had, on average, more encounters, more patients from households at >138% federal poverty level, fewer pediatric encounters, higher up-to-date cervical cancer screening rates, and higher rates of abnormal cervical cancer screening results. Qualitative data indicated barriers to tool adoption, including lack of knowledge of the tool's existence, understanding of its functionalities, and training on its use. CONCLUSION Without effective systems for informing users about new EHR functions, new or updated EHR tools are unlikely to be widely adopted, reducing their potential to improve health care quality and outcomes.
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Affiliation(s)
- Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - David Ezekiel-Herrera
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - Rose Gunn
- OCHIN Inc., Portland, Oregon, United States
| | | | | | | | - Miguel Marino
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - Rachel Gold
- OCHIN Inc., Portland, Oregon, United States
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, United States
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Kruse-Diehr AJ, Dignan M, Cromo M, Carman AL, Rogers M, Gross D, Russell S. Building Cancer Prevention and Control Research Capacity in Rural Appalachian Kentucky Primary Care Clinics During COVID-19: Development and Adaptation of a Multilevel Colorectal Cancer Screening Project. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1407-1413. [PMID: 33599967 PMCID: PMC7890393 DOI: 10.1007/s13187-021-01972-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 06/12/2023]
Abstract
This study describes the development of a colorectal cancer (CRC) screening multilevel intervention with four primary care clinics in rural Appalachian Kentucky. We also discuss barriers experienced by the clinics during COVID-19 and how clinic limitations and needs informed project modifications. Four primary care clinics were recruited, key informant interviews with clinic providers were conducted, electronic health record (EHR) capacity to collect data related to CRC screening and follow-up was assessed, and a series of meetings were held with clinic champions to discuss implementation of strategies to impact clinic CRC screening rates. Analysis of interviews revealed multilevel barriers to CRC screening. Patient-level barriers included fatalism, competing priorities, and financial and literacy concerns. The main provider- and clinic-level barriers were provider preference for colonoscopy over stool-based testing and EHR tracking concerns. Clinics selected strategies to address barriers, but the onset of COVID-19 necessitated modifications to these strategies. Due to COVID-19, changes in clinic staffing and workflow occurred, including provider furloughs, a state-mandated pause in elective procedures, and an increase in telehealth. Clinics adapted screening strategies to match changing needs, including shifting from paper to digital educational tools and using telehealth to increase annual wellness visits for screening promotion. While significant delays persist for scheduling colonoscopies, clinics were encouraged to promote stool-based tests as a primary screening modality for average-risk patients.
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Affiliation(s)
- Aaron J Kruse-Diehr
- University of Kentucky College of Public Health, 151 Washington Avenue, Bowman Hall 345, Lexington, KY, 40536, USA.
- Markey Cancer Center, Lexington, KY, USA.
| | - Mark Dignan
- Markey Cancer Center, Lexington, KY, USA
- University of Kentucky College of Medicine, Prevention Research Center, Lexington, KY, USA
| | - Mark Cromo
- University of Kentucky College of Medicine, Prevention Research Center, Lexington, KY, USA
| | - Angela L Carman
- University of Kentucky College of Public Health, 151 Washington Avenue, Bowman Hall 345, Lexington, KY, 40536, USA
| | | | - David Gross
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Sue Russell
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
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Gocuk SA, McKendrick AM, Downie LE. Point‐of‐care tools to support optometric care provision to people with age‐related macular degeneration: A randomised, placebo‐controlled trial. Ophthalmic Physiol Opt 2022; 42:814-827. [PMID: 35285531 PMCID: PMC9543223 DOI: 10.1111/opo.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
Purpose Age‐related macular degeneration (AMD) is a leading cause of vision impairment. This randomised placebo‐controlled trial investigated whether point‐of‐care tools can improve optometrists' AMD knowledge and/or care provision. Methods Australian optometrists (n = 31) completed a demographics survey and theoretical AMD case study multiple‐choice questions (MCQs) to assess their confidence in AMD care provision and AMD knowledge. Participants were then randomly assigned to one of three point‐of‐care tools (online ‘Classification of Age‐related macular degeneration and Risk Assessment Tool’ (CARAT), paper CARAT, or ‘placebo’) to use when providing care to their subsequent 5–10 AMD patients. Participants self‐audited the compliance of their AMD care to best practice for these patients, and a similar number of consecutive patients seen prior to enrolment. Post‐intervention, participants retook the AMD knowledge MCQs and confidence survey. Results A total of 29 participants completed the study. At the study endpoint, clinical confidence relative to baseline improved with the paper CARAT, relative to placebo, for knowledge of AMD risk factors, asking patients about these factors and referring for medical retinal sub‐specialist care. There were no between‐group differences for the change in AMD knowledge scores. Considering record documentation for patients with any AMD severity, there were no significant between‐group differences for documenting patient risk factors, AMD severity, clinical examination techniques or management. In a sub‐analysis, the change from baseline in compliance for documenting discussions about patient smoking behaviours for early AMD patients was higher with use of the online CARAT relative to placebo (p = 0.04). For patients with intermediate AMD, the change from baseline in documenting the risk of progression to late AMD was greater among practitioners who used the paper CARAT, relative to placebo (p = 0.04). Conclusions This study demonstrates that point‐of‐care clinical tools can improve practitioner confidence and aspects of the documentation of AMD clinical care by optometrists as assessed by self‐audit.
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Affiliation(s)
- Sena A Gocuk
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Victoria Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Victoria Australia
| | - Laura E Downie
- Department of Optometry and Vision Sciences The University of Melbourne Parkville Victoria Australia
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Coronado GD, Nyongesa DB, Petrik AF, Thompson JH, Escaron AL, Younger B, Harbison S, Leo MC. Randomized Controlled Trial of Advance Notification Phone Calls vs Text Messages Prior to Mailed Fecal Test Outreach. Clin Gastroenterol Hepatol 2021; 19:2353-2360.e2. [PMID: 32739569 PMCID: PMC9285860 DOI: 10.1016/j.cgh.2020.07.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Mailing fecal immunochemical test (FITs) to individuals who are due for screening (mailed FIT outreach) increases colorectal cancer (CRC) screening. Little is known about how phone-based advance notifications (primers) affect the effectiveness of mailed FIT outreach programs. METHODS We performed a prospective study of patients at a large urban health center, 50-75 years old and due for screening, with no record of a prior FIT. Participants were randomly assigned to groups that received a live phone call primer (n = 1203) or a text message primer (n = 1622), from June through December 2018. The participants were then mailed a FIT kit, followed by 2 automated calls, and live reminder calls delivered by the care team. The main outcome was completion of FIT within 3 months of assignment to the live phone call or text message group. RESULTS Participants had a FIT completion rate of 16.8%, a mean age of 58 years, and 80% were Latino. In adjusted intention to treat analyses (n = 2825), FIT completion rates were higher in the patients assigned to receive a live phone call vs text message primer (percentage point difference, 3.3%; 95% CI, 0.4%-6.2%). Between-group differences increased to 7.3% points (95% CI, 3.6%-11.0%) in the per-protocol analysis of 2144 participants reached by the text message (1320/1622, 81%), live call (438/1203, 36%), or voice message (386/1203, 32%). This rate increased to 14.9% points (95% CI; 9.6%-20.1%) in the per-protocol analysis of 1758 participants reached by the text message or reached by the live call. CONCLUSIONS In a randomized trial, advance notification live phone calls outperformed text messages in prompting health center patients who had not previously completed a FIT to complete a mailed FIT. Clinicaltrials.gov no: NCT03167125.
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Affiliation(s)
- Gloria D. Coronado
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Denis B. Nyongesa
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Amanda F. Petrik
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jamie H. Thompson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | | | | | - Michael C. Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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Sharma KP, DeGroff A, Maxwell AE, Cole AM, Escoffery NC, Hannon PA. Evidence-Based Interventions and Colorectal Cancer Screening Rates: The Colorectal Cancer Screening Program, 2015-2017. Am J Prev Med 2021; 61:402-409. [PMID: 33994253 PMCID: PMC11008572 DOI: 10.1016/j.amepre.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/09/2021] [Accepted: 03/01/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The Centers for Disease Control and Prevention administers the Colorectal Cancer Control Program to increase colorectal cancer screening rates among people aged 50-75 years in areas where rates are lower than state or national levels. The aim of this study is to better understand the effectiveness of specific Colorectal Cancer Control Program components. METHODS The study population included clinics enrolled in the Colorectal Cancer Control Program during Years 1 and 2. Clinic data collected by the Centers for Disease Control and Prevention annually from 2015 to 2017 for program evaluation were used. The outcome variable was screening rate change through Program Year 2, and predictor variables were a new implementation or enhancement of evidence-based interventions and other program components. The analysis, conducted in 2020, used ordinary least square and generalized estimating equations regressions and first difference models to estimate the associations of independent variables with the outcome. RESULTS Of the total 336 clinics, 50%-70% newly implemented or enhanced different evidence-based interventions. Among these, client reminders were most highly associated with the increase in screening rates (8.0 percentage points). Provider reminder was not significantly associated with any change in screening rates. Among all program components, having a colorectal cancer screening champion was most highly (8.4 percentage points) associated with screening rate change. Results from different models were slightly different but in agreement. CONCLUSIONS Client reminders, provider assessment and feedback, and colorectal cancer screening champions were associated with increased clinic-level colorectal cancer screening rates. Universal implementation of these strategies can substantially increase colorectal cancer screening rates in the U.S.
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Affiliation(s)
- Krishna P Sharma
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Amy DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Annette E Maxwell
- UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Allison M Cole
- School of Medicine, University of Washington, Seattle, Washington
| | | | - Peggy A Hannon
- School of Public Health, University of Washington, Seattle, Washington
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Coury JK, Schneider JL, Green BB, Baldwin LM, Petrik AF, Rivelli JS, Schwartz MR, Coronado GD. Two Medicaid health plans' models and motivations for improving colorectal cancer screening rates. Transl Behav Med 2021; 10:68-77. [PMID: 30445511 DOI: 10.1093/tbm/iby094] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Screening rates for colorectal cancer (CRC) remain low, especially among certain populations. Mailed fecal immunochemical testing (FIT) outreach initiated by U.S. health plans could reach underserved individuals, while solving CRC screening data and implementation challenges faced by health clinics. We report the models and motivations of two health insurance plans implementing a mailed FIT program for age-eligible U.S. Medicaid and Medicare populations. One health plan operates in a single state with ~220,000 enrollees; the other operates in multiple states with ~2 million enrollees. We conducted in-depth qualitative interviews with key stakeholders and observed leadership and clinic staff planning during program development and implementation. Interviews were transcribed and coded using a content analysis approach; coded interview reports and meeting minutes were iteratively reviewed and summarized for themes. Between June and September 2016, nine participants were identified, and all agreed to the interview. Interviews revealed that organizational context was important to both organizations and helped shape program design. Both organizations were hoping this program would address barriers to their prior CRC screening improvement efforts and saw CRC screening as a priority. Despite similar motivations to participate in a mailed FIT intervention, contextual features of the health plans led them to develop distinct implementation models: a collaborative model using some health clinic staffing versus a centralized model operationalizing outreach primarily at the health plan. Data are not yet available on the models' effectiveness. Our findings might help inform the design of programs to deliver mailed FIT outreach.
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Affiliation(s)
| | - Jennifer L Schneider
- Kaiser Permanente, Center for Health Research, Science Department, Portland, OR, USA
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Science Department, Seattle, WA, USA
| | - Laura-Mae Baldwin
- University of Washington, Department of Family Medicine, Seattle, WA, USA
| | - Amanda F Petrik
- Kaiser Permanente, Center for Health Research, Science Department, Portland, OR, USA
| | - Jennifer S Rivelli
- Kaiser Permanente, Center for Health Research, Science Department, Portland, OR, USA
| | - Malaika R Schwartz
- University of Washington, Department of Family Medicine, Seattle, WA, USA
| | - Gloria D Coronado
- Kaiser Permanente, Center for Health Research, Science Department, Portland, OR, USA
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Clinical Decision Support Systems for Diagnosis in Primary Care: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168435. [PMID: 34444182 PMCID: PMC8391274 DOI: 10.3390/ijerph18168435] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 01/18/2023]
Abstract
Diagnosis is one of the crucial tasks performed by primary care physicians; however, primary care is at high risk of diagnostic errors due to the characteristics and uncertainties associated with the field. Prevention of diagnostic errors in primary care requires urgent action, and one of the possible methods is the use of health information technology. Its modes such as clinical decision support systems (CDSS) have been demonstrated to improve the quality of care in a variety of medical settings, including hospitals and primary care centers, though its usefulness in the diagnostic domain is still unknown. We conducted a scoping review to confirm the usefulness of the CDSS in the diagnostic domain in primary care and to identify areas that need to be explored. Search terms were chosen to cover the three dimensions of interest: decision support systems, diagnosis, and primary care. A total of 26 studies were included in the review. As a result, we found that the CDSS and reminder tools have significant effects on screening for common chronic diseases; however, the CDSS has not yet been fully validated for the diagnosis of acute and uncommon chronic diseases. Moreover, there were few studies involving non-physicians.
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12
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Martellucci CA, Flacco ME, Morettini M, Giacomini G, Palmer M, Fraboni S, Pasqualini F. Wide variability in colorectal cancer screening uptake by general practitioner: Cross-sectional study. J Med Screen 2021; 29:21-25. [PMID: 34369814 DOI: 10.1177/09691413211035795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Despite several interventions, colorectal cancer (CRC) screening uptake remains below acceptable levels in Italy. Among the potential determinants of screening uptake, only a few studies analysed the role of general practitioners (GPs). The aim was to evaluate the variation in screening uptake of the clusters of subjects assisted by single GPs. SETTING Ancona province, Central Italy. METHODS Cross-sectional study, including all residents aged 50-69 years, who were offered the public screening programme with biannual faecal immunochemical tests. Demographic (of all GPs) and screening data (of all eligible residents) for years 2018-2019 were collected from the official electronic datasets of the Ancona Local Health Unit. The potential predictors of acceptable screening uptake, including GP's gender, age, and number of registered subjects, were evaluated using random-effect logistic regression, with geographical area as the cluster unit. RESULTS The final sample consisted of 332 GP clusters, including 120,178 eligible subjects. The overall province uptake was 38.0% ± 10.7%. The uptake was lower than 30% in one-fifth of the GP clusters, and higher than 45% in another fifth. At multivariable analysis, the significant predictors of uptake were younger GP age (p = 0.010) and lower number of registered subjects (p < 0.001). None of the GP clusters with 500 subjects or more showed an uptake ≥45%. CONCLUSIONS The wide variation across GPs suggests they might substantially influence screening uptake, highlighting a potential need to increase their commitment to CRC screening. Further research is needed to confirm the role of the number of registered subjects.
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Affiliation(s)
| | - Maria E Flacco
- Department of Medical Sciences, 9299University of Ferrara, University of Ferrara, Ferrara, Italy
| | - Margherita Morettini
- Oncologic Screening Department, Hygiene and Public Health Service, Area 2 of the Regional Health Agency of the Marche Region, Italy
| | - Giusi Giacomini
- Oncologic Screening Department, Hygiene and Public Health Service, Area 2 of the Regional Health Agency of the Marche Region, Italy
| | - Matthew Palmer
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Stefania Fraboni
- Oncologic Screening Department, Hygiene and Public Health Service, Area 2 of the Regional Health Agency of the Marche Region, Italy
| | - Francesca Pasqualini
- Oncologic Screening Department, Hygiene and Public Health Service, Area 2 of the Regional Health Agency of the Marche Region, Italy
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13
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Kelsey EA, Njeru JW, Chaudhry R, Fischer KM, Schroeder DR, Croghan IT. Understanding User Acceptance of Clinical Decision Support Systems to Promote Increased Cancer Screening Rates in a Primary Care Practice. J Prim Care Community Health 2021; 11:2150132720958832. [PMID: 33016170 PMCID: PMC7543103 DOI: 10.1177/2150132720958832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Clinical decision support systems (CDDSs) in the electronic medical record (EMR) have been implemented in primary care settings to identify patients due for cancer screening tests, while functioning as a real time reminder system. There is little known about primary care providers (PCPs) perspective or user acceptance of CDSS. The purpose of this study was to investigate primary care provider perceptions of utilizing CDSS alerts in the EMR to promote increased screening rates for breast cancer, cervical cancer, and colorectal cancer. METHODS An electronic survey was administered to PCPs in a Midwest Health Institution community internal medicine practice from September 25, 2019 through November 27, 2019. RESULTS Among 37 participants (9 NP/Pas and 28 MD/DOs), the NP/PA group was more likely to agree that alerts were helpful (50%; P-value = .0335) and the number of alerts (89%; P = .0227) in the EMR was appropriate. The NP/PA group also was more likely to find alerts straightforward to use (78%, P = .0239). Both groups agreed about feeling comfortable using the health maintenance alerts (MD/DO = 79%; NP/PA = 100%). CONCLUSION CDSSs can promote and facilitate ordering of cancer screening tests. The use of technology can promptly identify patients due for a test and act as a reminder to the PCP. PCPs identify these alerts to be a beneficial tool in the EMR when they do not interrupt workflow and provide value to patient care. More work is needed to identify factors that could optimize alerts to be even more helpful, particularly to MD/DO groups.
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Efficiency over thoroughness in laboratory testing decision making in primary care: findings from a realist review. BJGP Open 2021; 5:bjgpopen20X101146. [PMID: 33293413 PMCID: PMC8170611 DOI: 10.3399/bjgpopen20x101146] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Existing research demonstrates significant variation in test-ordering practice, and growth in the use of laboratory tests in primary care. Reviews of interventions designed to change test-ordering practice report heterogeneity in design and effectiveness. Improving understanding of clinicians’ decision making in relation to laboratory testing is an important means of understanding practice patterns and developing theory-informed interventions. Aim To develop explanations for the underlying causes of patterns of variation and increasing use of laboratory tests in primary care, and make recommendations for future research and intervention design. Design & setting Realist review of secondary data from primary care. Method Diverse evidence, including data from qualitative and quantitative studies, was gathered via systematic and iterative searching processes. Data were synthesised according to realist principles to develop explanations accounting for clinicians’ decision making in relation to laboratory tests. Results A total of 145 documents contributed data to the synthesis. Laboratory test ordering can fulfil many roles in primary care. Decisions about tests are incorporated into practice heuristics and tests are deployed as a tool to manage patient interactions. Ordering tests may be easier than not ordering tests in existing systems. Alongside high workloads and limited time to devote to decision making, there is a common perception that laboratory tests are relatively inconsequential interventions. Clinicians prioritise efficiency over thoroughness in decision making about laboratory tests. Conclusion Interventions to change test-ordering practice can be understood as aiming to preserve efficiency or encourage thoroughness in decision making. Intervention designs and evaluations should consider how testing decisions are made in real-world clinical practice.
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15
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Gastroenterology visitation and reminders predict surveillance uptake for patients with adenomas with high-risk features. Sci Rep 2021; 11:8764. [PMID: 33888839 PMCID: PMC8062682 DOI: 10.1038/s41598-021-88376-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 04/05/2021] [Indexed: 01/19/2023] Open
Abstract
Individuals diagnosed with colorectal adenomas with high-risk features during screening colonoscopy have increased risk for the development of subsequent adenomas and colorectal cancer. While US guidelines recommend surveillance colonoscopy at 3 years in this high-risk population, surveillance uptake is suboptimal. To inform future interventions to improve surveillance uptake, we sought to assess surveillance rates and identify facilitators of uptake in a large integrated health system. We utilized a cohort of patients with a diagnosis of ≥ 1 tubular adenoma (TA) with high-risk features (TA ≥ 1 cm, TA with villous features, TA with high-grade dysplasia, or ≥ 3 TA of any size) on colonoscopy between 2013 and 2016. Surveillance colonoscopy completion within 3.5 years of diagnosis of an adenoma with high-risk features was our primary outcome. We evaluated surveillance uptake over time and utilized logistic regression to detect factors associated with completion of surveillance colonoscopy. The final cohort was comprised of 405 patients. 172 (42.5%) patients successfully completed surveillance colonoscopy by 3.5 years. Use of a patient reminder (telephone, electronic message, or letter) for due surveillance (adjusted odds = 1.9; 95%CI = 1.2-2.8) and having ≥ 1 gastroenterology (GI) visit after diagnosis of an adenoma with high-risk features (adjusted odds = 2.6; 95%CI = 1.6-4.2) significantly predicted surveillance colonoscopy completion at 3.5 years. For patients diagnosed with adenomas with high-risk features, surveillance colonoscopy uptake is suboptimal and frequently occurs after the 3-year surveillance recommendation. Patient reminders and visitation with GI after index colonoscopy are associated with timely surveillance completion. Our findings highlight potential health system interventions to increase timely surveillance uptake for patients diagnosed with adenomas with high-risk features.
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16
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Holden CA, Frank O, Caruso J, Turnbull D, Reed RL, Miller CL, Olver I. From participation to diagnostic assessment: a systematic scoping review of the role of the primary healthcare sector in the National Bowel Cancer Screening Program. Aust J Prim Health 2021; 26:191-206. [PMID: 32536362 DOI: 10.1071/py19181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/07/2020] [Indexed: 12/19/2022]
Abstract
Primary health care (PHC) plays a vital support role in organised colorectal cancer (CRC) screening programs by encouraging patient participation and ensuring timely referral for diagnostic assessment follow up. A systematic scoping review of the current evidence was conducted to inform strategies that better engage the PHC sector in organised CRC screening programs. Articles published from 2005 to November 2019 were searched across five databases. Evidence was synthesised and interventions that specifically require PHC involvement were mapped to stages of the CRC screening pathway. Fifty-seven unique studies were identified in which patient, provider and system-level interventions align with defined stages of the CRC screening pathway: namely, identifying/reminding patients who have not responded to CRC screening (non-adherence) (n=46) and follow up of a positive screen referral (n=11). Self-management support initiatives (patient level) and improvement initiatives (system level) demonstrate consistent benefits along the CRC screening pathway. Interventions evaluated as part of a quality-improvement process tended to report effectiveness; however, the variation in reporting makes it difficult to determine which elements contributed to the overall study outcomes. To maximise the benefits of population-based screening programs, better integration into existing primary care services can be achieved through targeting preventive and quality care interventions along the entire screening pathway.
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Affiliation(s)
- Carol A Holden
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia; and Corresponding author.
| | - Oliver Frank
- Discipline of General Practice, University of Adelaide, Helen Mayo North, Frome Road, Adelaide, SA 5005, Australia
| | - Joanna Caruso
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia
| | - Deborah Turnbull
- School of Psychology, University of Adelaide, Level 7, Hughes Building, North Terrace Campus, Adelaide, SA 5000, Australia
| | - Richard L Reed
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Caroline L Miller
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia; and School of Public Health, University of Adelaide, 57 North Terrace, Adelaide, SA 5000, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Level 7, Hughes Building, North Terrace Campus, Adelaide, SA 5000, Australia
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17
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Inadomi JM, Issaka RB, Green BB. What Multilevel Interventions Do We Need to Increase the Colorectal Cancer Screening Rate to 80%? Clin Gastroenterol Hepatol 2021; 19:633-645. [PMID: 31887438 PMCID: PMC8288035 DOI: 10.1016/j.cgh.2019.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/05/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
Abstract
Screening reduces colorectal cancer mortality; however, this remains the second leading cause of cancer deaths in the United States and adherence to colorectal cancer screening falls far short of the National Colorectal Cancer Roundtable goal of 80%. Numerous studies have examined the effectiveness of interventions to increase colorectal cancer screening uptake. Outreach is the active dissemination of screening outside of the primary care setting, such as mailing fecal blood tests to individuals' homes. Navigation uses trained personnel to assist individuals through the screening process. Patient education may take the form of brochures, videos, or websites. Provider education can include feedback about screening rates of patient panels. Reminders to healthcare providers can be provided by dashboards of patients due for screening. Financial incentives provide monetary compensation to individuals when they complete screening tests, either as fixed payments or via a lottery. Individual preference for specific screening strategies has also been examined in several trials, with a choice of screening strategies yielding higher adherence than recommendation of a single strategy.
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Affiliation(s)
- John M. Inadomi
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, WA,Divisions of Clinical Research and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA,Department of Health Services, University of Washington School of Public Health, Seattle, WA
| | - Rachel B. Issaka
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, WA,Divisions of Clinical Research and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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Yakubu M, Meggetto O, Lai Y, Peirson L, Walker M, Lofters A. Impact of postal correspondence letters on participation in cancer screening: a rapid review. Prev Med 2021; 145:106404. [PMID: 33388326 DOI: 10.1016/j.ypmed.2020.106404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/20/2020] [Accepted: 12/29/2020] [Indexed: 01/08/2023]
Abstract
The purpose of this rapid review was to identify and synthesize evidence on the impact of postal correspondence letters on participation in cancer screening and to determine whether impact varied by cancer site or inclusion of the participant's physician's name within the letter (i.e., physician-linked). PubMed and the Cochrane Database of Systematic Reviews were searched for English-language systematic reviews and randomized controlled trials (RCTs) published up until October 2019. One reviewer completed citation screening and data extraction with 30% verification by a second reviewer. Systematic reviews and RCTs were appraised using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 and Cochrane Risk of Bias 2.0 tools, respectively, by one reviewer with complete verification by a second reviewer. Findings from systematic reviews and RCTs were examined separately and presented narratively. Six systematic reviews and 18 RCTs of generally low quality were included. Evidence generally demonstrated a positive impact of a letter as compared to no letter or usual practice on screening participation. This finding was consistent for breast cancer and cervical screening participation but inconsistent for colorectal cancer screening participation. Studies comparing physician-linked letters to no letters or usual practice reported similar effect estimates as those examining letters in general. Limited and inconsistent evidence was identified on the impact of physician-linked letters as compared to non-physician-linked letters on screening participation. Evidence identified in this rapid review, and other contextual and implementation considerations, may be useful for jurisdictions considering how to promote cancer screening participation.
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Affiliation(s)
- Mafo Yakubu
- Ontario Health (Cancer Care Ontario), Prevention and Cancer Control, Toronto, Canada
| | - Olivia Meggetto
- Ontario Health (Cancer Care Ontario), Prevention and Cancer Control, Toronto, Canada.
| | - Yonda Lai
- Ontario Health (Cancer Care Ontario), Prevention and Cancer Control, Toronto, Canada
| | - Leslea Peirson
- Ontario Health (Cancer Care Ontario), Prevention and Cancer Control, Toronto, Canada
| | - Meghan Walker
- Ontario Health (Cancer Care Ontario), Prevention and Cancer Control, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Aisha Lofters
- Ontario Health (Cancer Care Ontario), Prevention and Cancer Control, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada; IC/ES, Toronto, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Canada
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19
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Zheng S, Zhang X, Greuter MJW, de Bock GH, Lu W. Determinants of Population-Based Cancer Screening Performance at Primary Healthcare Institutions in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063312. [PMID: 33806890 PMCID: PMC8005057 DOI: 10.3390/ijerph18063312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
Background: For a decade, most population-based cancer screenings in China are performed by primary healthcare institutions. To assess the determinants of performance of primary healthcare institutions in population-based breast, cervical, and colorectal cancer screening in China. Methods: A total of 262 primary healthcare institutions in Tianjin participated in a survey on cancer screening. The survey consisted of questions on screening tests, the number of staff members and training, the introduction of the screening programs to residents, the invitation of residents, and the number of performed screenings per year. Logistic regression models were used to analyze the determinants of performance of an institution to fulfil the target number of screenings. Results: In 58% and 61% of the institutions between three and nine staff members were dedicated to breast and cervical cancer screening, respectively, whereas in 71% of the institutions ≥10 staff members were dedicated to colorectal cancer screening. On average 60% of institutions fulfilled the target number of breast and cervical cancer screenings, whereas 93% fulfilled the target number for colorectal cancer screening. The determinants of performance were rural districts for breast (OR = 5.16 (95%CI: 2.51–10.63)) and cervical (OR = 4.17 (95%CI: 2.14–8.11)) cancer screenings, and ≥3 staff members dedicated to cervical cancer screening (OR = 2.34 (95%CI: 1.09–5.01)). Conclusions: Primary healthcare institutions in China perform better in colorectal than in breast and cervical cancer screening, and institutions in rural districts perform better than institutions in urban districts. Increasing the number of staff members on breast and cervical cancer screening could improve the performance of population-based cancer screening.
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Affiliation(s)
- Senshuang Zheng
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 CP Groningen, The Netherlands; (S.Z.); (G.H.d.B.)
- Department of Epidemiology and Health statistics, Tianjin Medical University, Tianjin 300070, China;
| | - Xiaorui Zhang
- Department of Epidemiology and Health statistics, Tianjin Medical University, Tianjin 300070, China;
| | - Marcel J. W. Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9713 CP Groningen, The Netherlands;
- Technical Medical Centre, Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, 7522 NH Enschede, The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 CP Groningen, The Netherlands; (S.Z.); (G.H.d.B.)
| | - Wenli Lu
- Department of Epidemiology and Health statistics, Tianjin Medical University, Tianjin 300070, China;
- Correspondence:
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20
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Miguel CA, Paskett ED, Fisher JL, Fickle DK, Washington CM, Degraffinreid C, Tatum C, Gray II DM. Scripted tours through a giant inflatable colon: An innovative and effective educational tool in urban communities. Prev Med Rep 2020; 20:101248. [PMID: 33294315 PMCID: PMC7695982 DOI: 10.1016/j.pmedr.2020.101248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/22/2020] [Accepted: 11/08/2020] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer-related death among men and women in the US and mortality rates are increasing among young adults. Although CRC is largely preventable with screening and often curable when detected at an early stage, many age-appropriate individuals remain unscreened or are not currently up-to-date with screening. We aimed to examine the impact of providing guided, scripted tours through an inflatable colon on three domains: CRC knowledge, likelihood of communicating about CRC with others, and the intention to be screened for CRC in a diverse, urban population. The inflatable walk-through colon was exhibited at five community events in Franklin County, Ohio between March 2015 and August 2016. A pre and posttest research design and composite scores were stratified into three age groups (<45 years, 45-49 years and ≥ 50 years of age). Descriptive statistics were used to describe and compare demographic characteristics. Logistic regression was used to examine potential associations between demographic factors and the three outcomes of interest. These tours led to statistically significant increases in CRC knowledge, communication, and intention to undergo CRC screening among participants in all three age cohorts. In addition, the intention of undergo screening after a tour among individuals<45 years of age were nearly three times that of those older than 50 (OR = 2.66; 95%CI = 1.49-4.75). Overall, this study supports the use of scripted tours through an inflatable colon exhibit as a potentially effective intervention to increase age-appropriate CRC screening uptake.
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Affiliation(s)
| | - Electra D. Paskett
- The Ohio State University College of Medicine, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - James L. Fisher
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Darla K. Fickle
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | | | - Cathy Tatum
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Darrell M. Gray II
- The Ohio State University College of Medicine, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Division of Gastroenterology, Hepatology and Nutrition. The Ohio State University College of Medicine, Columbus, OH, USA
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21
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Doubeni CA, Selby K, Gupta S. Framework and Strategies to Eliminate Disparities in Colorectal Cancer Screening Outcomes. Annu Rev Med 2020; 72:383-398. [PMID: 33208026 DOI: 10.1146/annurev-med-051619-035840] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Preventable differences in colorectal cancer (CRC) mortality across racial/ethnic, economic, geographic, and other groups can be eliminated by assuring equitable access and quality across the care continuum, but few interventions have been demonstrated to do so. Multicomponent strategies designed with a health equity framework may be effective. A health equity framework takes into account social determinants of health, multilevel influences (policy, community, delivery, and individual levels), screening processes, and community engagement. Effective strategies for increasing screening uptake include patient navigation and other interventions for structural barriers, reminders and clinical decision support, and data to continuously track metrics and guide targets for improvement. Community resource gaps should be addressed to assure high-quality services irrespective of racial/ethnic and socioeconomic status. One model combinespopulation-based proactive outreach screening with screening delivery at in-person or virtual points of contact, as well as community engagement. Patient- and provider-based behavioral interventions may be considered for increasing screening demand and delivery. Providing a choice of screening tests is recommended for CRC screening, and access to colonoscopy is required for completion of the CRC screening process.
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Affiliation(s)
- Chyke A Doubeni
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota 55905, USA; .,Department of Family Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), Lausanne 1011, Switzerland;
| | - Samir Gupta
- Section of Gastroenterology, Veterans Affairs San Diego Healthcare System, San Diego, California 92161, USA.,Department of Medicine, University of California at San Diego, La Jolla, California 92103, USA; .,Moores Cancer Center, University of California at San Diego, La Jolla, California 92103, USA
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22
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Kew GS, Koh CJ. Strategies to Improve Persistent Adherence in Colorectal Cancer Screening. Gut Liver 2020; 14:546-552. [PMID: 31822055 PMCID: PMC7492491 DOI: 10.5009/gnl19306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 01/08/2023] Open
Abstract
Colorectal cancer is a major cause of morbidity and mortality, and screening has been shown to reduce morbidity and mortality. This review highlights pertinent aspects of adherence to screening including the various options available and key concepts to consider in any systematic program. Persistent adherence, which is key to an efficacious screening program, is the compliance with repeated screening tests over a period of time. A “chain of survival” mindset emphasizes the stepwise, sequential and persistent approach to screening and is a helpful concept to drive the message of persistent adherence. A framework for the patient and physician interactions that support screening intervention is examined, and various factors that impact both patient and physician adoption and screening modality recommendations are reviewed. While systems-based approaches to screening have great utility in automation and monitoring in a surveillance program, some emerging data suggests that the human touch is still an essential driver for active participation in these programs. Finally, the proportion of time concept is discussed as a useful index for monitoring persistent adherence in both individuals and populations.
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Affiliation(s)
- Guan Sen Kew
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Calvin Jianyi Koh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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23
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Tomasone JR, Kauffeldt KD, Chaudhary R, Brouwers MC. Effectiveness of guideline dissemination and implementation strategies on health care professionals' behaviour and patient outcomes in the cancer care context: a systematic review. Implement Sci 2020; 15:41. [PMID: 32493348 PMCID: PMC7268663 DOI: 10.1186/s13012-020-0971-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care professionals (HCPs) use clinical practice guidelines (CPGs) to make evidence-informed decisions regarding patient care. Although a large number of cancer-related CPGs exist, it is unknown which CPG dissemination and implementation strategies are effective for improving HCP behaviour and patient outcomes in a cancer care context. This review aimed to determine the effectiveness of CPG dissemination and/or implementation strategies among HCPs in a cancer care context. METHODS A comprehensive search of five electronic databases was conducted. Studies were limited to the dissemination and/or implementation of a CPG targeting both medical and/or allied HCPs in cancer care. Two reviewers independently coded strategies using the Mazza taxonomy, extracted study findings, and assessed study quality. RESULTS The search strategy identified 33 studies targeting medical and/or allied HCPs. Across the 33 studies, 23 of a possible 49 strategies in the Mazza taxonomy were used, with a mean number of 3.25 (SD = 1.45) strategies per intervention. The number of strategies used per intervention was not associated with positive outcomes. Educational strategies (n = 24), feedback on guideline compliance (n = 11), and providing reminders (n = 10) were the most utilized strategies. When used independently, providing reminders and feedback on CPG compliance corresponded with positive significant changes in outcomes. Further, when used as part of multi-strategy interventions, group education and organizational strategies (e.g. creation of an implementation team) corresponded with positive significant changes in outcomes. CONCLUSIONS Future CPG dissemination and implementation interventions for cancer care HCPs may benefit from utilizing the identified strategies. Research in this area should aim for better alignment between study objectives, intervention design, and evaluation measures, and should seek to incorporate theory in intervention design, so that behavioural antecedents are considered and measured; doing so would enhance the field's understanding of the causal mechanisms by which interventions lead, or do not lead, to changes in outcomes at all levels.
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Affiliation(s)
- Jennifer R Tomasone
- School of Kinesiology & Health Studies, Queen's University, 28 Division Street, Kingston, Ontario, Canada.
| | - Kaitlyn D Kauffeldt
- School of Kinesiology & Health Studies, Queen's University, 28 Division Street, Kingston, Ontario, Canada
| | - Rushil Chaudhary
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada
| | - Melissa C Brouwers
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada
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Teo BS, Li E, Tan C, Munro YL. Educational pamphlets for improving uptake of cancer screening: a systematic review. J Prim Health Care 2020; 11:207-216. [PMID: 32171373 DOI: 10.1071/hc18093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/09/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The effectiveness of cancer screening programmes is highly dependent on screening uptake. Many interventions have been tested to increase screening uptake. AIM The goal of this study was to evaluate the effectiveness of cancer screening pamphlets as a standalone intervention. The outcome of interest was uptake of cancer screening tests. METHODS A systematic review was performed on the effectiveness of pamphlets compared to usual care without pamphlets. We searched five databases for research papers in English from 2000 up to May 2019. Randomised controlled trials were included. This research group independently selected studies, extracted data, assessed risk of bias and then compared the information as a group. RESULTS A total of nine trials involving 4912 participants met our inclusion criteria, of which five were about colorectal cancer screening, three were about prostate cancer screening and one was about lung cancer screening. Five of the nine trials showed that pamphlets alone increased uptake significantly, while the remaining four trials did not show significant effects. DISCUSSION There is some evidence that pamphlets increase uptake for cancer screenings, especially for colorectal cancer. Due to the small number of studies in this area, generalisability could be limited.
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Affiliation(s)
- Boon See Teo
- Camry Medical Centre, Block 95 Toa Payoh Lorong 4, #01-66, Singapore; and Yong Loo Lin School of Medicine, National University of Singapore, Singapore; and Duke-NUS Medical School, Singapore; and Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; and Corresponding author.
| | - Esther Li
- Camry Medical Centre, Block 95 Toa Payoh Lorong 4, #01-66, Singapore
| | - Clara Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yasmin Lynda Munro
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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25
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Keswani RN, Gregory DL, Wood M, Dolan NC, Chmiel R, Manka M, Cameron KA. Colonoscopy education delivered via the patient portal does not improve adherence to scheduled first-time screening colonoscopy. Endosc Int Open 2020; 8:E401-E406. [PMID: 32118113 PMCID: PMC7035025 DOI: 10.1055/a-1072-4556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/07/2019] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Non-adherence to scheduled colonoscopy burdens endoscopic practices and innovative approaches to improve adherence are needed. We aimed to assess the effect of an educational video emphasizing colonoscopy importance delivered through the electronic health record patient portal upon "no-show" and late cancellation rates (non-adherence) in patients scheduled for first-time screening colonoscopy. Patients and methods We conducted a single center randomized controlled trial among patients scheduled for their first screening colonoscopy. Patients were randomized to routine care ("control") or video education ("video"). Control patients received a portal message 14 days prior to colonoscopy date; video patients additionally received a link to the educational video. Results In total, 830 patients (59 % female, median age 55 years) were randomized ("control": 406; "video": 424). Nearly all (88 %) opened the message; in the video arm, most (72 %) watched a majority of the video. Overall, 80 % attended their scheduled colonoscopy appointment (late cancel: 18 %, "no show": 1 %) and 90 % underwent colonoscopy within 3 months of appointment. Adherence rates did not differ between video and control arms for the scheduled appointment (OR 1.2, CI 0.9-1.8) or for colonoscopy within 3 months of scheduled appointment (OR 1.3, CI 0.8-2.1). Bowel preparation quality did not differ between the groups. Conclusion Most patients scheduled for colonoscopy will open a patient portal message and, when delivered, watch an educational video. However, delivery of an educational video two weeks prior to screening colonoscopy appointment did not improve adherence.
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Affiliation(s)
- Rajesh N. Keswani
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States,Corresponding author Rajesh N. Keswani MD MS 676 N. St. Clair, Suite 1400Chicago, IL 60611
| | - Dyanna L. Gregory
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
| | - Mariah Wood
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
| | - Nancy C. Dolan
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Ryan Chmiel
- Northwestern Memorial Hospital, Chicago, Illinois, United States
| | - Michael Manka
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
| | - Kenzie A. Cameron
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, Illinois, United States
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Del Fiol G, Kohlmann W, Bradshaw RL, Weir CR, Flynn M, Hess R, Schiffman JD, Nanjo C, Kawamoto K. Standards-Based Clinical Decision Support Platform to Manage Patients Who Meet Guideline-Based Criteria for Genetic Evaluation of Familial Cancer. JCO Clin Cancer Inform 2020; 4:1-9. [PMID: 31951474 PMCID: PMC7000231 DOI: 10.1200/cci.19.00120] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The ubiquitous adoption of electronic health records (EHRs) with family health history (FHH) data provides opportunities for tailoring cancer screening strategies to individuals. We aimed to enable a standards-based clinical decision support (CDS) platform for identifying and managing patients who meet guidelines for genetic evaluation of hereditary cancer. METHODS The CDS platform (www.opencds.org) was used to implement algorithms based on the 2018 National Comprehensive Cancer Network guidelines for genetic evaluation of hereditary breast/ovarian and colorectal cancer. The platform was designed to be interfaced with different EHR systems via the Health Level Seven International Fast Healthcare Interoperability Resources standard. The platform was integrated with the Epic EHR and evaluated in a pilot study at an academic health care system. RESULTS The CDS platform was executed against a target population of 143,012 patients; 5,245 (3.7%) met criteria for genetic evaluation based on the FHH recorded in the EHR. In a clinical pilot study, genetic counselors attempted to reach out to 71 of the patients. Of those patients, 25 (35%) scheduled an appointment, 10 (14%) declined, 2 (3%) did not need genetic counseling, 7 (10%) said they would consider it in the future, and 27 (38%) were unreachable. To date, 13 (52%) of the scheduled patients completed visits, and 2 (15%) of those were found to have pathogenic variants in cancer predisposition genes. CONCLUSION A standards-based CDS platform integrated with EHR systems is a promising population-based approach to identify patients who are appropriate candidates for genetic evaluation of hereditary cancers.
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Affiliation(s)
- Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Richard L. Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Charlene R. Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Michael Flynn
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Rachel Hess
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Joshua D. Schiffman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Claude Nanjo
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
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Individual and Geospatial Characteristics Associated With Use and Nonuse of the Fecal Immunochemical Test (FIT) for Colorectal Cancer Screening in an Urban Minority Population. J Clin Gastroenterol 2019; 53:744-749. [PMID: 30222644 DOI: 10.1097/mcg.0000000000001132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Initiatives by the Centers for Disease Control and Prevention as well as the National Colorectal Cancer Roundtable aim to increase the rate of colorectal cancer (CRC) screening. We assess individual and geographic characteristics associated fecal immunochemical test (FIT) CRC screening over 3 years. METHODS This is a retrospective study of 1500 FIT kits which were mailed or opportunistically handed to eligible participants in Brooklyn, New York from January 2014 to December 2016. Eligibility criteria included increased risk for colon cancer, uninsured or underinsured, and a minimum age of 50 years to warrant CRC screening. We looked at the association of individual demographic characteristics and FIT screening by logistic regression using SPPS version 23 software. In addition, using ArcGIS, we coded patients address and layered census tract population information to find associations. RESULTS In total, 1367 Cancer Services Participants met our study criteria. The study sample was predominantly female (95.2%) and minority (46% African American, 24.7% Hispanic, 17.3% Caucasian, 11.4% Asian) and on average 59 years old (SD, 5.7). A large majority (73%) had household incomes below $20,000/year. Approximately half (49.9%) of all Cancer Services Participants returned their FIT kit. In participants who did not return their FIT kit, the majority were African American (41%), followed by Hispanics (26.5%), Caucasians (20.6%), and Asians (11.8%). Multivariable logistic regression showed that a screening history of prior colonoscopy or FIT, gender, ethnicity, and educational attainment were significantly associated with FIT CRC screening uptake (P<0.05). Geospatial mapping showed clusters of low screening uptake in areas of high poverty. Hot-spot analysis identified areas of significant vulnerability. CONCLUSIONS FIT uptake remains suboptimal. Individual predictors as well as area poverty is associated with low screening uptake. Geospatial mapping is an effective tool for evaluating CRC screening uptake.
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Arnold CL, Rademaker AW, Morris JD, Ferguson LA, Wiltz G, Davis TC. Follow-up approaches to a health literacy intervention to increase colorectal cancer screening in rural community clinics: A randomized controlled trial. Cancer 2019; 125:3615-3622. [PMID: 31355924 DOI: 10.1002/cncr.32398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/28/2019] [Accepted: 04/05/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Significant disparities exist in colorectal cancer (CRC) screening rates among those of low socioeconomic status, with fewer years of education, lacking health insurance, or living in rural areas. METHODS A randomized controlled trial was conducted to compare the effectiveness of 2 follow-up approaches to a health literacy intervention to improve CRC screening: automated telephone call or personal call. Patients aged 50 to 75 years residing in 4 rural community clinics in Louisiana were given a structured interview that assessed demographic, health literacy and CRC screening barriers, knowledge, and attitudes. All were given health literacy-informed CRC education, a patient-friendly CRC screening pamphlet, simplified fecal immunochemical test (FIT) instructions, and a FIT kit, and a "teach-back" method was used to confirm understanding. Patients were randomized to 1 of 2 telephone follow-up arms. If they did not mail their FIT kit within 4 weeks, they received a reminder call and were called again at 8 weeks if the test still was not received. RESULTS A total of 620 patients were enrolled. Approximately 55% were female, 66% were African American, and 40% had limited literacy. The overall FIT completion rate was 68%: 69.2% in the automated telephone call arm and 67% in the personal call arm. Greater than one-half of the patients (range, 58%-60%) returned the FIT kit without receiving a telephone call. There was no difference noted with regard to the effectiveness of the follow-up calls; each increased the return rate by 9%. CONCLUSIONS Providing FIT kits and literacy-appropriate education at regularly scheduled clinic visits with a follow-up telephone call when needed was found to increase CRC screening among low-income, rural patients. The lower cost automated call was just as effective as the personal call.
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Affiliation(s)
- Connie L Arnold
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Alfred W Rademaker
- Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - James D Morris
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Laurie Anne Ferguson
- College of Nursing and Health, Loyola University New Orleans, New Orleans, Louisiana
| | - Gary Wiltz
- Teche Action Clinic, Franklin, Louisiana
| | - Terry C Davis
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
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Jager M, Demb J, Asghar A, Selby K, Mello EM, Heskett KM, Lieberman AJ, Geng Z, Bharti B, Singh S, Gupta S. Mailed Outreach Is Superior to Usual Care Alone for Colorectal Cancer Screening in the USA: A Systematic Review and Meta-analysis. Dig Dis Sci 2019; 64:2489-2496. [PMID: 30915656 PMCID: PMC6706307 DOI: 10.1007/s10620-019-05587-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/08/2019] [Indexed: 12/26/2022]
Abstract
Mailed outreach promoting colorectal cancer (CRC) screening with a stool blood test kit may increase participation, but magnitude and consistency of benefit of this intervention strategy is uncertain. Our aim was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing mailed outreach offering stool tests to usual care, clinic-based screening offers on CRC screening uptake in the USA. We performed a systematic literature search of five databases for RCTs of mailed outreach from January 1980 through June 2017. Primary outcome was screening completion, summarized using random-effects meta-analysis as pooled differences in proportion completing the screening and relative risk of achieving screening compared to control. Subgroup analyses by test type offered-fecal immunochemical test (FIT) or guaiac fecal occult blood test (gFOBT), the presence of telephone reminders, and the presence of predominant underserved/minority population within study were performed. Quality of evidence was evaluated using the GRADE framework. Seven RCTs which enrolled 12,501 subjects were included (n = 5703 assigned mailed outreach and n = 6798 usual care). Mailed outreach resulted in a 28% absolute (95% CI 25-30%; I2 = 47%) and a 2.8-fold relative (RR 2.65, 95% CI 2.03-3.45; I2 = 92%) increase in screening completion compared to usual care, with a number needed to invite estimated to be 3.6. Similar outcomes were observed across subgroups. Overall body of evidence was at moderate quality. Mailed outreach offering a gFOBT or FIT is associated with a large and consistent increase in CRC screening completion and should be considered for more widespread implementation for improving screening rates nationwide.
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Affiliation(s)
- Mark Jager
- San Diego State University, San Diego, USA
| | - Josh Demb
- Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, USA
| | - Ali Asghar
- Department of Medicine, University of California San Diego, San Diego, USA
| | - Kevin Selby
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, USA
| | | | | | | | - Zhuo Geng
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, USA
| | | | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, San Diego, USA
- Division of Biomedical Informatics, University of California San Diego, San Diego, USA
| | - Samir Gupta
- Moores Cancer Center, UC San Diego, San Diego, USA.
- Division of Gastroenterology, VA San Diego Healthcare System, 3350 La Jolla Village Drive MC 111D, San Diego, CA, 92161, USA.
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Dodd N, Carey M, Mansfield E, Oldmeadow C, Evans T. Testing the effectiveness of a general practice intervention to improve uptake of colorectal cancer screening: a randomised controlled trial. Aust N Z J Public Health 2019; 43:464-469. [DOI: 10.1111/1753-6405.12913] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 02/01/2023] Open
Affiliation(s)
- Natalie Dodd
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales
- Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
- School of Medicine, Griffith University, Queensland
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales
- Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales
- Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Christopher Oldmeadow
- Clinical Research Design, IT and Statistical Support (CReDITSS), Hunter Medical Research Institute, New South Wales
| | - Tiffany‐Jane Evans
- Clinical Research Design, IT and Statistical Support (CReDITSS), Hunter Medical Research Institute, New South Wales
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Green BB, Vollmer WM, Keast E, Petrik AF, Coronado GD. Challenges in assessing population reach in a pragmatic trial. Prev Med Rep 2019; 15:100910. [PMID: 31198661 PMCID: PMC6558213 DOI: 10.1016/j.pmedr.2019.100910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 05/20/2019] [Accepted: 05/26/2019] [Indexed: 11/19/2022] Open
Abstract
Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) was a pragmatic cluster-randomized trial conducted at federally qualified health centers and designed to “Reach” as many unscreened patients as possible by directly mailing them fecal screening tests. STOP CRC used an electronic health record registry to identify individuals' needing CRC screening and mail interventions to them. The registry was updated daily removing individuals completing CRC screening or those who no longer were clinic patients. Reach, a component RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance), is defined as the absolute number, percent, and representativeness of individuals “willing to participate in” or “exposed to” an initiative. We describe the complexities of measuring Reach in a pragmatic trial. Overall 21,134 patients were on the registry list for at least one day, with 18,226 remaining after removing patients completing screening before any mailings. Observed Reached (the percent of individuals exposed to the intervention) using each denominator was 30.7% and 35.6% respectively. Reach improved only modestly after accounting for factors that made it impossible for clinics to send mailings. Few differences were observed in demographic and health care utilization factors among individuals Reached versus not Reached, suggesting that health center Implementation was more influential than patients' willingness or ability to participate. A pragmatic definition of Reach that accounted for dynamic changes the absolute number eligible and the proportion exposed was more useful than traditional definitions of Reach. Actual Reach was dependent on Implementation and not patient level characteristics. Clinical Trials Registration Number: ClincalTrials.gov (NCT01742065).
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Affiliation(s)
- Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, United States of America
- Corresponding author at: Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington Medical Group, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States of America.
| | - William M. Vollmer
- Kaiser Permanente Northwest Center for Health Research, United States of America
| | - Erin Keast
- Kaiser Permanente Northwest Center for Health Research, United States of America
| | - Amanda F. Petrik
- Kaiser Permanente Northwest Center for Health Research, United States of America
| | - Gloria D. Coronado
- Kaiser Permanente Northwest Center for Health Research, United States of America
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Carlson J, Laryea J. Electronic Health Record-Based Registries: Clinical Research Using Registries in Colon and Rectal Surgery. Clin Colon Rectal Surg 2019; 32:82-90. [PMID: 30647550 DOI: 10.1055/s-0038-1673358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Electronic health records (EHRs) or electronic medical records (EMRs) contain a vast amount of clinical data that can be useful for multiple purposes including research. Disease registries are collections of data in predefined formats for population management, research, and other purposes. There are differences between EHRs and registries in the data structure, data standards, and protocols. Proprietary EHR systems use different coding systems and data standards, which are usually kept secret. For EHR data to flow seamlessly into registries, there is the need for interoperability between EHR systems and between EHRs and registries. The levels of interoperability required include functional, structural, and semantic interoperability. EHR data can be manually mapped to registry data, but that is a tedious, resource-intensive endeavor. The development of data standards that can be used as building blocks for both EHRs and registries will help overcome the problem of interoperability.
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Affiliation(s)
- Jacob Carlson
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jonathan Laryea
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Polubriaginof FCG, Shang N, Hripcsak G, Tatonetti NP, Vawdrey DK. Low Screening Rates for Diabetes Mellitus Among Family Members of Affected Relatives. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:1471-1477. [PMID: 30815192 PMCID: PMC6371358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cardiovascular disease is the leading cause of death in the United States, and abnormal blood glucose is an important risk factor. Delayed diagnosis of diabetes mellitus can increase patients' morbidity. In an urban academic medical center with a large clinical data warehouse, we used a novel algorithm to identify 56,794 family members of diabetic patients that were eligible for disease screening. We found that 30.6% of patients did not receive diabetes screening as recommended by current guidelines. Further, our analysis showed that having more than one family member affected and being a female were important contributors to being screened for diabetes mellitus. This study demonstrates that informatics methods applied to electronic health record data can be used to identify patients at risk for disease development, and therefore support clinical care.
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Affiliation(s)
| | - Ning Shang
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY
| | | | - David K Vawdrey
- Value Institute, NewYork-Presbyterian Hospital, New York, NY
- Department of Biomedical Informatics, Columbia University, New York, NY
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Dougherty MK, Brenner AT, Crockett SD, Gupta S, Wheeler SB, Coker-Schwimmer M, Cubillos L, Malo T, Reuland DS. Evaluation of Interventions Intended to Increase Colorectal Cancer Screening Rates in the United States: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:1645-1658. [PMID: 30326005 PMCID: PMC6583619 DOI: 10.1001/jamainternmed.2018.4637] [Citation(s) in RCA: 212] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Colorectal cancer screening (CRC) is recommended by all major US medical organizations but remains underused. OBJECTIVE To identify interventions associated with increasing CRC screening rates and their effect sizes. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and ClinicalTrials.gov were searched from January 1, 1996, to August 31, 2017. Key search terms included colorectal cancer and screening. STUDY SELECTION Randomized clinical trials of US-based interventions in clinical settings designed to improve CRC screening test completion in average-risk adults. DATA EXTRACTION AND SYNTHESIS At least 2 investigators independently extracted data and appraised each study's risk of bias. Where sufficient data were available, random-effects meta-analysis was used to obtain either a pooled risk ratio (RR) or risk difference (RD) for screening completion for each type of intervention. MAIN OUTCOMES AND MEASURES The main outcome was completion of CRC screening. Examination included interventions to increase completion of (1) initial CRC screening by any recommended modality, (2) colonoscopy after an abnormal initial screening test result, and (3) continued rounds of annual fecal blood tests (FBTs). RESULTS The main review included 73 randomized clinical trials comprising 366 766 patients at low or medium risk of bias. Interventions that were associated with increased CRC screening completion rates compared with usual care included FBT outreach (RR, 2.26; 95% CI, 1.81-2.81; RD, 22%; 95% CI, 17%-27%), patient navigation (RR, 2.01; 95% CI, 1.64-2.46; RD, 18%; 95% CI, 13%-23%), patient education (RR, 1.20; 95% CI, 1.06-1.36; RD, 4%; 95% CI, 1%-6%), patient reminders (RR, 1.20; 95% CI, 1.02-1.41; RD, 3%; 95% CI, 0%-5%), clinician interventions of academic detailing (RD, 10%; 95% CI, 3%-17%), and clinician reminders (RD, 13%; 95% CI, 8%-19%). Combinations of interventions (clinician interventions or navigation added to FBT outreach) were associated with greater increases than single components (RR, 1.18; 95% CI, 1.09-1.29; RD, 7%; 95% CI, 3%-11%). Repeated mailed FBTs with navigation were associated with increased annual FBT completion (RR, 2.09; 95% CI, 1.91-2.29; RD, 39%; 95% CI, 29%-49%). Patient navigation was not associated with colonoscopy completion after an initial abnormal screening test result (RR, 1.21; 95% CI, 0.92-1.60; RD, 14%; 95% CI, 0%-29%). CONCLUSIONS AND RELEVANCE Fecal blood test outreach and patient navigation, particularly in the context of multicomponent interventions, were associated with increased CRC screening rates in US trials. Fecal blood test outreach should be incorporated into population-based screening programs. More research is needed on interventions to increase adherence to continued FBTs, follow-up of abnormal initial screening test results, and cost-effectiveness and other implementation barriers for more intensive interventions, such as navigation.
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Affiliation(s)
- Michael K Dougherty
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill
| | - Alison T Brenner
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Seth D Crockett
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill
| | - Shivani Gupta
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephanie B Wheeler
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill.,Department of Health Policy and Management, University of North Carolina at Chapel Hill
| | - Manny Coker-Schwimmer
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Laura Cubillos
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Teri Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Daniel S Reuland
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill.,Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill
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Richmond J, M Mbah O, Z Dard S, Jordan LC, Cools KS, Samuel CA, M Khan J, A Manning M. Preempting Racial Inequities in Lung Cancer Screening. Am J Prev Med 2018; 55:908-912. [PMID: 30344035 PMCID: PMC7424796 DOI: 10.1016/j.amepre.2018.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/13/2018] [Accepted: 07/09/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Jennifer Richmond
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; American Institutes for Research, Research and Evaluation, Chapel Hill, North Carolina.
| | - Olive M Mbah
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sofia Z Dard
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lauren C Jordan
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine S Cools
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cleo A Samuel
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jalaal M Khan
- Cone Health Cancer Center, Radiation Oncology, Greensboro, North Carolina
| | - Matthew A Manning
- Cone Health Cancer Center, Radiation Oncology, Greensboro, North Carolina
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Hassan C, Kaminski MF, Repici A. How to Ensure Patient Adherence to Colorectal Cancer Screening and Surveillance in Your Practice. Gastroenterology 2018; 155:252-257. [PMID: 29964039 DOI: 10.1053/j.gastro.2018.06.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
| | - Michal F Kaminski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland
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Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ, Etzioni R, McKenna MT, Oeffinger KC, Shih YCT, Walter LC, Andrews KS, Brawley OW, Brooks D, Fedewa SA, Manassaram-Baptiste D, Siegel RL, Wender RC, Smith RA. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin 2018; 68:250-281. [PMID: 29846947 DOI: 10.3322/caac.21457] [Citation(s) in RCA: 1166] [Impact Index Per Article: 194.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 12/11/2022] Open
Abstract
In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation. The ACS recommends (qualified recommendations) that: 1) average-risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. CA Cancer J Clin 2018;68:250-281. © 2018 American Cancer Society.
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Affiliation(s)
- Andrew M D Wolf
- Associate Professor and Attending Physician, University of Virginia School of Medicine, Charlottesville, VA
| | - Elizabeth T H Fontham
- Emeritus Professor, Louisiana State University School of Public Health, New Orleans, LA
| | - Timothy R Church
- Professor, University of Minnesota and Masonic Cancer Center, Minneapolis, MN
| | - Christopher R Flowers
- Professor and Attending Physician, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA
| | - Carmen E Guerra
- Associate Professor of Medicine of the Perelman School of Medicine and Attending Physician, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Samuel J LaMonte
- Independent retired physician and patient advocate, University of Washington and the Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ruth Etzioni
- Biostatistician, University of Washington and the Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Matthew T McKenna
- Professor and Director, Division of Preventive Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kevin C Oeffinger
- Professor and Director of the Duke Center for Onco-Primary Care, Durham, NC
| | - Ya-Chen Tina Shih
- Professor, Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Louise C Walter
- Professor and Attending Physician, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA
| | - Kimberly S Andrews
- Director, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Chief Medical and Scientific Officer and Executive Vice President-Research, American Cancer Society, Atlanta, GA
| | - Durado Brooks
- Vice President, Cancer Control Interventions, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Strategic Director for Risk Factor Screening and Surveillance, American Cancer Society, Atlanta, GA
| | | | - Rebecca L Siegel
- Strategic Director, Surveillance Information Services, American Cancer Society, Atlanta, GA
| | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
| | - Robert A Smith
- Vice President, Cancer Screening, Cancer Control Department, American Cancer Society, Atlanta, GA
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Effect of reminders mailed to general practitioners on colorectal cancer screening adherence: a cluster-randomized trial. Eur J Cancer Prev 2018; 25:380-7. [PMID: 26340058 DOI: 10.1097/cej.0000000000000200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Reminders have been used in various settings, but failed to produce convincing evidence of benefits on patient adherence to colorectal cancer (CRC) screening. The aim of this study was to assess the effectiveness of sending general practitioners (GPs) printed reminders about CRC screening. We conducted a cluster-randomized controlled trial involving 144 GPs in the Val-de-Marne district (France), who provided care for any reason to 20 778 patients eligible for CRC screening between June 2010 and November 2011. Data were collected from the main statutory health-insurance programme and local cancer screening agency. GPs were randomly assigned in a 1 : 1 proportion to the intervention or the control group. Every 4 months, intervention-group GPs received a computer-generated printed list of patients who had not performed scheduled faecal occult blood test (FOBT) screening. The primary outcome was patient adherence to FOBT screening or exclusion from CRC screening for medical reasons. The screening adherence rate was 31.2% [95% confidence interval (CI) 30.3-32.1] in the control group and 32.9% (95% CI 32.0-33.8) in the intervention group [crude relative risk, 1.05 (95% CI 1.01-1.09), P<0.01]. This rate was not significantly different between groups by multilevel modelling accounting for clustering and confounding variables [adjusted relative risk, 1.07 (95% CI 0.95-1.20), P=0.27]. Computer-generated printed reminders sent to GPs did not significantly improve patient adherence to organized CRC screening by the FOBT.
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Arnold CL, Rademaker A, Wolf MS, Liu D, Lucas G, Hancock J, Davis TC. Final Results of a 3-Year Literacy-Informed Intervention to Promote Annual Fecal Occult Blood Test Screening. J Community Health 2018; 41:724-31. [PMID: 26769026 DOI: 10.1007/s10900-015-0146-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This three arm study was designed to make CRC screening with FOBTs more accessible, understandable and actionable for patients cared for in predominantly rural Federally Qualified Health Centers. Patients in an enhanced version of usual care received an annual CRC recommendation and FOBT kit; those in the education arm additionally received brief literacy and culturally appropriate education and those in the nurse arm received the education by a nurse manager who followed up by telephone. Baseline FOBT rates in this population were 3 %. We evaluated if FOBT rates could be sustained over 3 years. A three-arm, quasi-experimental evaluation was conducted among eight clinics in Louisiana. Screening efforts included: (1) enhanced usual care, (2) literacy-informed education of patients, and (3) education plus nurse support. Overall, 961 average-risk patients, ages 50-85, eligible for routine CRC screenings were recruited. The primary outcome was completing three annual FOBT tests. Of 961 patients enrolled, 381 (39.6 %) participants did not complete a single FOBT, 60.4 % completed at least one FOBT of which 318 (33.1 %) completed only one, 162 (16.9 %) completed two and 100 (10.4 %) completed three FOBTs over the 3-year period (the primary study outcome). The primary outcome, return of three FOBT kits over the 3-year period, was achieved by 4.7 % in enhanced care, 11.4 % in education and 13.6 % in the nurse arm (p = 0.005). Overall 3-year FOBT screening rates were not sustained with any of the three interventions, despite reports of promising interim results at years 1 and 2. New strategies for sustaining FOBT screening over several years must be developed.
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Affiliation(s)
- Connie L Arnold
- Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA.
| | - Alfred Rademaker
- Department of Preventive Medicine, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA
| | - Dachao Liu
- Department of Preventive Medicine, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Geoffrey Lucas
- Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA
| | - Jill Hancock
- Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA
| | - Terry C Davis
- Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA
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Seo JY, Li J, Li K. Cervical Cancer Screening Experiences Among Chinese American Immigrant Women in the United States. J Obstet Gynecol Neonatal Nurs 2018; 47:52-63. [PMID: 29144960 PMCID: PMC6260927 DOI: 10.1016/j.jogn.2017.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To understand the experiences and perceptions of having cervical cancer screening tests and to explore the extant barriers to having the tests among first-generation Chinese American women in the United States. DESIGN Qualitative, descriptive, phenomenological research. SETTING Los Angeles, California. PARTICIPANTS Snowball and purposive sampling of 12 Chinese American immigrant women ages 20 to 65 years. METHODS Individual face-to-face, in-depth, semistructured interviews in which participants were asked about their experiences and perceptions about cervical cancer screening. Interviews were audiotaped, transcribed, and translated into English. Data analysis included comparing and distinguishing, collecting and counting, and presupposing and inferring. RESULTS Through the analysis process, we identified four major themes that reflected the experiences, perceptions, and barriers to having cervical cancer screening among Chinese American women: Belief in a Healthy Lifestyle, Maintaining Privacy for Female Health Problems, Fear of Losing Control, and Feeling Vulnerable in an Unfamiliar Health Care System. These themes indicated that Chinese immigrant women in the United States face challenges to their cultural health beliefs and practices with regard to decision-making and health-seeking behaviors related to cervical cancer screening. They felt more vulnerable as immigrants because of systematic barriers to navigation of the unfamiliar health care system and limited resources. CONCLUSION Women's health care providers should be aware of and give consideration to cultural differences through the provision of more educational information and comfort to Chinese immigrant women who seek cervical cancer screening. Ultimately, the development of culturally appropriate and affordable cancer prevention programs with effective strategies is important to ease Chinese American women's senses of vulnerability.
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Lairson DR, Kim J, Byrd T, Salaiz R, Shokar NK. Cost-Effectiveness of Community Interventions for Colorectal Cancer Screening: Low-Income Hispanic Population. Health Promot Pract 2017; 19:863-872. [PMID: 29290126 DOI: 10.1177/1524839917750815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of interventions to increase colorectal cancer (CRC) screening among low-income uninsured Hispanics in El Paso, Texas. METHOD Participants 50 to 75 years old who were due for screening, were uninsured, and had a Texas address were randomized to promotora, video, or promotora and video interventions. High-risk participants were offered colonoscopy, while others were offered fecal immunochemical testing. A nonintervention comparison group was recruited from a similar Texas U.S.-Mexico border county. Screening was determined at 6 months postintervention. Resources were tracked prospectively to determine cost. Incremental cost-effectiveness ratios were assessed with "intention to treat" methods. Uncertainty in the estimates was analyzed with sensitivity analysis and nonparametric bootstrap methods. RESULTS The interventions achieved screening rates of between 75% and 87% compared to 10% in the comparison group. The cost per participant ranged from $72 for group sessions to $93 for individual video sessions with video and promotora. The group video sessions cost $104 per additional person screened. CONCLUSION The CRC screening interventions were effective for increasing CRC screening. Compared to the experience in the control county, the group-based video-only intervention was the most cost-effective CRC screening promotion intervention.
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Affiliation(s)
- David R Lairson
- 1 University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Junghyun Kim
- 1 University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Theresa Byrd
- 2 Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Rebekah Salaiz
- 3 Texas Tech University Health Sciences Center, El Paso, TX, USA
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Rat C, Pogu C, Le Donné D, Latour C, Bianco G, Nanin F, Cowppli-Bony A, Gaultier A, Nguyen JM. Effect of Physician Notification Regarding Nonadherence to Colorectal Cancer Screening on Patient Participation in Fecal Immunochemical Test Cancer Screening: A Randomized Clinical Trial. JAMA 2017; 318:816-824. [PMID: 28873160 PMCID: PMC5817465 DOI: 10.1001/jama.2017.11387] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Increasing participation in fecal screening tests is a major challenge in countries that have implemented colorectal cancer (CRC) screening programs. OBJECTIVE To determine whether providing general practitioners (GPs) a list of patients who are nonadherent to CRC screening enhances patient participation in fecal immunochemical testing (FIT). DESIGN, SETTING, AND PARTICIPANTS A 3-group, cluster-randomized study was conducted from July 14, 2015, to July 14, 2016, on the west coast of France, with GPs in 801 practices participating and involving adult patients (50-74 years) who were at average risk of CRC and not up-to-date with CRC screening. The final follow-up date was July 14, 2016. INTERVENTIONS General practitioners were randomly assigned to 1 of 3 groups: 496 received a list of patients who had not undergone CRC screening (patient-specific reminders group, 10 476 patients), 495 received a letter describing region-specific CRC screening adherence rates (generic reminders group, 10 606 patients), and 455 did not receive any reminders (usual care group, 10 147 patients). MAIN OUTCOMES AND MEASURES The primary end point was patient participation in CRC screening 1 year after the intervention. RESULTS Among 1482 randomized GPs (mean age, 53.4 years; 576 women [38.9%]), 1446 participated; of the 33 044 patients of these GPs (mean age, 59.7 years; 17 949 women [54.3%]), follow-up at 1 year was available for 31 229 (94.5%). At 1 year, 24.8% (95% CI, 23.4%-26.2%) of patients in the specific reminders group, 21.7% (95% CI, 20.5%-22.8%) in the generic reminders group, and 20.6% (95% CI, 19.3%-21.8%) in the usual care group participated in the FIT screening. The between-group differences were 3.1% (95% CI, 1.3%-5.0%) for the patient-specific reminders group vs the generic reminders group, 4.2% (95% CI, 2.3%-6.2%) for the patient-specific reminders group vs the usual care group, and 1.1% (95% CI, -0.6% to 2.8%) for generic reminders group vs the usual care group. CONCLUSIONS AND RELEVANCE Providing French GPs caring for adults at average risk of CRC with a list of their patients who were not up-to-date with their CRC screening resulted in a small but significant increase in patient participation in FIT screening at 1 year compared with patients who received usual care. Providing GPs with generic reminders about regional rates of CRC screening did not increase screening rates compared with usual care. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02515344.
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Affiliation(s)
- Cédric Rat
- Department of General Practice, Faculty of Medicine, Nantes, France
- French National Institute of Health and Medical Research, INSERM U1232 - Team 2, Nantes, France
| | - Corinne Pogu
- Association in charge of colorectal cancer screening program, CAPSANTE 44, Nantes, France
| | | | - Chloé Latour
- Department of General Practice, Faculty of Medicine, Nantes, France
| | - Gaelle Bianco
- Association in charge of colorectal cancer screening program, AUDACE, La Roche sur Yon, France
| | - France Nanin
- French Health Insurance System, Division of Nantes, Nantes, France
| | - Anne Cowppli-Bony
- Cancer registry for Loire-Atlantique and Vendée geographic areas, Nantes, France
| | - Aurélie Gaultier
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
| | - Jean-Michel Nguyen
- French National Institute of Health and Medical Research, INSERM U1232 - Team 2, Nantes, France
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
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Buist DSM, Gao H, Anderson ML, Onega T, Brandzel S, Rabelhofer MA, Bradford SC, Aiello Bowles EJ. Breast cancer screening outreach effectiveness: Mammogram-specific reminders vs. comprehensive preventive services birthday letters. Prev Med 2017; 102:49-58. [PMID: 28655547 PMCID: PMC5638650 DOI: 10.1016/j.ypmed.2017.06.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 12/28/2022]
Abstract
We compared the effectiveness of two outreach strategies on timely mammography adherence: a mammogram-specific reminder letter (sent just before a woman was due) to a birthday letter (addresses multiple preventive services and not timed around due dates). We evaluated screening mammography adherence following 79,848 mammogram-specific and 151,626 birthday letters mailed between 2002 and 2012 to women aged 40-74years enrolled in Kaiser Permanente Washington. Screening mammogram adherence was specifically tied to due date and was evaluated separately by age group and up-to-date or overdue status at the time of mailing. We used generalized estimating equations to account for correlation between repeated observations, to model the odds of screening mammography adherence by letter type. Among women up-to-date, adherence following birthday letters was 22-76% lower compared to the mammogram-specific reminders, with the greatest decreases in adherence in women aged 70-74. Birthday letters were more effective at activating screening uptake among some subgroups of overdue women aged 50-69 and most overdue women aged 70-74, but universally low adherence rates were observed in overdue women. Increasing number of recommended services for women aged 50-74 who were up-to-date resulted in 12-17% lower mammography adherence, but had no effect in women aged 40-49 or in overdue women. Birthday letters are less effective than mammogram-specific reminder letters at prompting women to undergo timely breast cancer screening, particularly among women up-to-date with screening. Birthday letters may be effective at increasing overall preventive care; however, supplemental outreach may be needed around the due date to increase timely preventive services receipt.
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Affiliation(s)
- Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Tracy Onega
- Geisel School of Medicine, Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, USA.
| | - Susan Brandzel
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA; Health Stories Project Insights, 601 Union Street, Suite 4820, Seattle, WA 98101, USA.
| | - Melissa A Rabelhofer
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Susan Carol Bradford
- Kaiser Permanente Washington, Clinical Prevention and Improvement, 310 15th Ave E, Seattle, WA 98112, USA.
| | - Erin J Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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Sustersic M, Gauchet A, Foote A, Bosson J. How best to use and evaluate Patient Information Leaflets given during a consultation: a systematic review of literature reviews. Health Expect 2017; 20:531-542. [PMID: 27669682 PMCID: PMC5512995 DOI: 10.1111/hex.12487] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the past, several authors have attempted to review randomized clinical trials (RCT) evaluating the impact of Patient Information Leaflets (PILs) used during a consultation and draw some general conclusions. However, this proved difficult because the clinical situations, size and quality of RCTs were too heterogeneous to pool relevant data. OBJECTIVE To overcome this 30-year stalemate, we performed a review of reviews and propose general recommendations and suggestions for improving the quality of PILs, how to use them and methods for evaluating them. METHODOLOGY We searched five databases for reviews, systematic reviews and meta-analyses describing PILs. We drew general and condition-linked conclusions concerning the impact of PILs. Checklists summarize criteria for quality PILs, and ways of using and evaluating them. RESULTS Of 986 articles found, 24 reviews were pertinent; the five oldest considered the impact of PILs irrespective of the condition the patient consulted for; the 19 more recent ones mostly addressed precise clinical situations. DISCUSSION Whatever the clinical situation, PILs improve patients' knowledge and satisfaction. For acute conditions, in the short-term PILs also improve adherence to treatment. For chronic diseases, invasive procedures or screening situations, their impact on adherence varies depending on the context, how the PILs are given and the invasiveness of the intervention. CONCLUSION PILs are considered to be very useful, especially for acute conditions where the patient is the first to suffer from lack of information. We propose checklists for writing, designing, using and evaluating PILs in RCTs to enable comparisons between different studies.
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Affiliation(s)
- Mélanie Sustersic
- TIMC‐IMAGUniversity of Grenoble AlpesGrenobleFrance
- Groupe Hospitalier Mutualiste de Grenoble (GHM)GrenobleFrance
| | - Aurélie Gauchet
- LIP/LPC2S, EA 4145University of Grenoble AlpesGrenobleFrance
| | - Alison Foote
- Inserm CIC 1406Grenoble Alpes University HospitalGrenobleFrance
| | - Jean‐Luc Bosson
- TIMC‐IMAGUniversity of Grenoble AlpesGrenobleFrance
- Inserm CIC 1406Grenoble Alpes University HospitalGrenobleFrance
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An Electronic Health Record-based Intervention to Promote Hepatitis C Virus Testing Among Adults Born Between 1945 and 1965: A Cluster-randomized Trial. Med Care 2017; 55:590-597. [PMID: 28288075 DOI: 10.1097/mlr.0000000000000715] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) antibody testing for "Birth Cohort" adults born during 1945-1965. OBJECTIVE To examine the impact of an electronic health record (EHR)-embedded best practice alert (BPA) for HCV testing among Birth Cohort adults. DESIGN Cluster-randomized trial was conducted from April 29, 2013 to March 29, 2014. SUBJECTS AND SETTING Ten community and hospital-based primary care practices. Participants were attending physicians and medical residents during 25,620 study-eligible visits. INTERVENTION Physicians in all practices received a brief introduction to the CDC testing recommendations. At visits for eligible patients at intervention sites, physicians received a BPA through the EHR to order HCV testing or medical assistants were prompted to post a testing order for the physician. Physicians in control sites did not receive the BPA. MAIN OUTCOMES HCV testing; the incidence of HCV antibody positive tests was a secondary outcome. RESULTS Testing rates were greater among Birth Cohort patients in intervention sites (20.2% vs. 1.8%, P<0.0001) and the odds of testing were greater in intervention sites after controlling for imbalances of patient and visit characteristics between comparison groups [odds ratio (OR), 9.0; 95% confidence interval, 7.6-10.7). The adjusted OR of identifying HCV antibody positive patients was also greater in intervention sites (OR, 2.1; 95% confidence interval, 1.3-11.2). CONCLUSIONS An EHR-embedded BPA markedly increased HCV testing among Birth Cohort patients, but the majority of eligible patients did not receive testing indicating a need for more effective methods to promote uptake.
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Clinical utility of a blood-based protein assay to increase screening of elevated-risk patients for colorectal cancer in the primary care setting. J Cancer Res Clin Oncol 2017; 143:2301-2307. [PMID: 28710715 DOI: 10.1007/s00432-017-2469-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Colorectal cancer (CRC) screening is effective in finding early stage CRC and dramatically improves survival rates. Despite this, the number of eligible patients who do not obtain CRC screening is unacceptably high. METHODS We conducted a longitudinal, randomized controlled trial investigating the utility of a blood-based protein assay on the quality of care delivered by practicing PCPs in the United States. We used standardized simulated patients (CPVs), presenting with symptoms suggestive of a higher likelihood of CRC, to measure how frequently these PCPs ordered diagnostic colonoscopy. 190 PCPs cared for three patients at baseline and three patients post-intervention. The PCPs were randomized into one of two study arms: control and intervention. The intervention arm consisted of educational materials about the blood-based protein assay and positive test results. Each simulated patient in the intervention arm had a positive test result that was given to the doctor. The controls were given neither intervention materials nor blood-based protein assay results. Physician responses in both groups were scored against evidence-based criteria. Data were collected at baseline and post-intervention. RESULTS At baseline, we found that 71% of physicians ordered diagnostic colonoscopy. In round 2, 23% of physicians in the intervention arm adopted the new blood-based protein assay. Ordering physicians were 3.88 (95% CI 1.67-9.03) times more likely to order a diagnostic colonoscopy. In percentage terms, those who ordered the assay were more likely to order colonoscopy (92%) than either intervention physicians who did not order the assay (77%) or control physicians (66%) (p < 0.001). A marginal effects estimation showed that use of the assay would increase ordering colonoscopy to nearly 95%. CONCLUSION Over one-third of adults in the United States do not follow the recommended screening guidelines for CRC. The introduction of a blood-based protein assay significantly increased the likelihood that physicians would order diagnostic colonoscopies in elevated-risk patients compared to those without access to the assay results. The overall change in clinical utility observed here has the potential to significantly improve clinical care.
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Abstract
Colorectal cancer (CRC) contributes a major burden of cancer mortality in the United States. There are multiple effective screening approaches that can reduce CRC mortality. These approaches are supported by different levels of evidence, and each has its own advantages and disadvantages. Implementing a systematic approach to screening that addresses the multiple steps involved in the screening process is essential to improving population-level CRC screening. Offering patients stool-based screening is important for increasing screening uptake. However, programs that offer stool testing must support the population health infrastructure needed to promote adherence to repeat testing and follow-up of abnormal tests.
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Affiliation(s)
- Alison T Brenner
- Cecil G Sheps Center for Health Services Research, University of North Carolina, 725 Martin Luther King Jr Boulevard, CB# 7590, Chapel Hill, NC 27599-7590, USA.
| | - Michael Dougherty
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, 4182 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC 27599-6134, USA
| | - Daniel S Reuland
- Division of General Internal Medicine, Department of Medicine, University of North Carolina, 725 Martin Luther King Jr Boulevard, CB# 7590, Chapel Hill, NC 27599-7590, USA
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Goel A, Sanchez J, Paulino L, Feuille C, Arend J, Shah B, Dieterich D, Perumalswami PV. A systematic model improves hepatitis C virus birth cohort screening in hospital-based primary care. J Viral Hepat 2017; 24:477-485. [PMID: 28039935 DOI: 10.1111/jvh.12669] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/20/2016] [Indexed: 12/12/2022]
Abstract
Despite national and local governing board recommendations in the United States of America to perform an HCV screening test in baby boomers, screening rates remain low. Our goal was to study the impact of an HCV screening and link-to-care programme with patient navigation in two New York City primary care practices. This was a 2-year prospective study of patients born between 1945-1965 ("baby boomers") with encounters at two primary care practices at the Mount Sinai Hospital between November 1, 2013 and November 30, 2015. Baseline HCV screening rates were collected for four months. A multifaceted intervention was sequentially implemented involving electronic alerts, housestaff education, data feedback and patient navigation. HCV screening rates and link to care, defined as attending an appointment with a viral hepatitis specialist, were compared before and after these interventions. There were 14 642 primary care baby boomer patients of which 4419 (30.2%) were newly screened during the study. There was a significant increase in HCV screening rates from 55% to 75% (P<.01) with an HCV seropositive rate of 3.3%. Factors associated with being HCV seropositive included older age (P<.01), male sex (P<.01), African American race (P<.01) and receiving care in the housestaff practice (P<.01). With patient navigation, 78 of 84 (93%) newly diagnosed HCV-infected persons were referred to a specialist and 60 (77%) attended their first appointment. A structured, multifaceted HCV screening programme using well-studied principles identifies a large number of undiagnosed baby boomers within hospital-based primary care and improves access to specialty providers in a timely manner.
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Affiliation(s)
- A Goel
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - J Sanchez
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - L Paulino
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - C Feuille
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - J Arend
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - B Shah
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - D Dieterich
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - P V Perumalswami
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
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Castrejón M, Chew KW, Javanbakht M, Humphries R, Saab S, Klausner JD. Implementation of a Large System-Wide Hepatitis C Virus Screening and Linkage to Care Program for Baby Boomers. Open Forum Infect Dis 2017; 4:ofx109. [PMID: 28752101 PMCID: PMC5527269 DOI: 10.1093/ofid/ofx109] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/26/2017] [Indexed: 01/14/2023] Open
Abstract
Background We implemented and evaluated a large health system-wide hepatitis C virus (HCV) screening and linkage to care program for persons born between 1945 and 1965 (“baby boomers”). Methods An electronic health record (EHR) clinical decision support (CDS) tool for HCV screening for baby boomers was introduced in August 2015 for patients seen in the outpatient University of California, Los Angeles healthcare system setting. An HCV care coordinator was introduced in January 2016 to facilitate linkage to HCV care. We compared HCV testing in the year prior (August 2014–July 2015) to the year after (August 2015–July 2016) implementation of the CDS tool. Among patients with reactive HCV antibody testing, we compared outcomes related to the care cascade including HCV ribonucleic acid (RNA) testing, HCV RNA positivity, and linkage to HCV specialty care. Results During the study period, 19606 participants were screened for HCV antibody. Hepatitis C virus antibody screening increased 145% (from 5676 patients tested to 13930 tested) after introduction of the CDS intervention. Screening increased across all demographic groups including age, sex, and race/ethnicity, with the greatest increases among those in the older age groups. The addition of an HCV care coordinator increased follow-up HCV RNA testing for HCV antibody positive patients from 83% to 95%. Ninety-four percent of HCV RNA positive patients were linked to care postimplementation. Conclusions Introduction of an EHR CDS tool and care coordination markedly increased the number of baby boomers screened for HCV, rates of follow-up HCV RNA testing, and linkage to specialty HCV care for patients with chronic HCV infection.
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Affiliation(s)
| | - Kara W Chew
- Department of Medicine, Division of Infectious Diseases
| | - Marjan Javanbakht
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health
| | | | - Sammy Saab
- Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles; and
| | - Jeffrey D Klausner
- Department of Medicine, Division of Infectious Diseases.,Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health
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Patel S, Hemmige V, Street RL, Viswanath K, Arya M. Activating Racial and Ethnic Minorities to Engage in Preventive Health: Patient Preferences for Health Reminders. J Particip Med 2017; 9:e8. [PMID: 29270330 PMCID: PMC5736376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVES The objective of this study was to determine racial and ethnic minority patient receptiveness to health reminders, and preferences for media channels and messengers for preventive health reminders. METHODS A pen and paper survey was administered to patients in the waiting room of a publicly funded clinic serving predominately racial and ethnic minorities. RESULTS Three-fourths of participants said they would like to receive health reminders. The top three preferred methods of receiving health reminders were via text message, phone call, and letter by mail. About half of participants wanted their doctor or nurse to send them the health reminder. CONCLUSIONS Health reminders could be a tool to successfully encourage racial and ethnic minority patients to participate in their own health. If physicians or nurses use a cell phone text message, a phone call, or a letter to send these health reminders they may be particularly effective at improving patient health outcomes.
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Affiliation(s)
- Sajani Patel
- Address: 10518 Windwalker Trail Houston, TX 77095; Telephone: 713-409-9304
| | - Vagish Hemmige
- Address: 6620 Main Street, #1375, Houston, TX 77030; Telephone: 713-798-2900
| | - Richard L Street
- Address: Houston VA Medical Center (Mailstop 152), 2002 Holcombe Blvd, Houston, TX 77030
| | - Kasisomayajula Viswanath
- Address: Dana-Farber Cancer Institute, 450 Brookline Avenue, LW 601, Boston, Massachusetts 02215; Telephone: 617.632.2225
| | - Monisha Arya
- Address: Houston VA Medical Center (Mailstop 152), 2002 Holcombe Blvd, Houston, TX 77030; Telephone: 713 794-8601
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