1
|
Mog AC, Liang PS, Donovan LM, Sayre GG, Shaukat A, May FP, Glorioso TJ, Jorgenson MA, Wood GB, Mueller C, Dominitz JA. Timely Colonoscopy After Positive Fecal Immunochemical Tests in the Veterans Health Administration: A Qualitative Assessment of Current Practice and Perceived Barriers. Clin Transl Gastroenterol 2022; 13:e00438. [PMID: 35060937 PMCID: PMC8865517 DOI: 10.14309/ctg.0000000000000438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/04/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The Veterans Health Administration introduced a clinical reminder system in 2018 to help address process gaps in colorectal cancer screening, including the diagnostic evaluation of positive fecal immunochemical test (FIT) results. We conducted a qualitative study to explore the differences between facilities who performed in the top vs bottom decile for follow-up colonoscopy. METHODS Seventeen semistructured interviews with gastroenterology (GI) providers and staff were conducted at 9 high-performing and 8 low-performing sites. RESULTS We identified 2 domains, current practices and perceived barriers, and most findings were described by both high- and low-performing sites. Findings exclusive to 1 group mainly pertained to current practices, especially arranging colonoscopy for FIT-positive patients. We observed only 1 difference in the perceived barriers domain, which pertained to primary care providers. DISCUSSION These results suggest that what primarily distinguishes high- and low-performing sites is not a difference in barriers but rather in the GI clinical care process. Developing and disseminating patient education materials about the importance of diagnostic colonoscopy, eliminating in-person precolonoscopy visits when clinically appropriate, and involving GI in missed colonoscopy appointments and outside referrals should all be considered to increase follow-up colonoscopy rates. Our study illustrates the challenges of performing a timely colonoscopy after a positive FIT result and provides insights on improving the clinical care process for patients who are at substantially increased risk for colorectal cancer.
Collapse
Affiliation(s)
- Ashley C. Mog
- Veteran Affairs Puget Sound Healthcare System, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Peter S. Liang
- Veteran Affairs New York Harbor Healthcare System, New York, New York, USA
- NYU Langone Health, New York, New York, USA
| | - Lucas M. Donovan
- Veteran Affairs Puget Sound Healthcare System, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - George G. Sayre
- Veteran Affairs Puget Sound Healthcare System, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Aasma Shaukat
- Minneapolis Veteran Affairs Healthcare System, Minneapolis, Minnesota, USA
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Folasade P. May
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- University of California, Los Angeles, California, USA
| | - Thomas J. Glorioso
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, USA
| | | | - Gordon Blake Wood
- Veteran Affairs Puget Sound Healthcare System, Seattle, Washington, USA
| | - Candice Mueller
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, USA
| | - Jason A. Dominitz
- Veteran Affairs Puget Sound Healthcare System, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| |
Collapse
|
2
|
Piper MS, Zikmund-Fisher BJ, Maratt JK, Kurlander J, Metko V, Waljee AK, Saini SD. Patients' Willingness to Share Limited Endoscopic Resources: A Brief Report on the Results of a Large Regional Survey. MDM Policy Pract 2021; 6:23814683211045648. [PMID: 34616912 PMCID: PMC8488065 DOI: 10.1177/23814683211045648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/05/2021] [Indexed: 12/25/2022] Open
Abstract
Background. In some health care systems, patients face long wait times for screening colonoscopy. We sought to assess whether patients at low risk for colorectal cancer (CRC) would be willing to delay their own colonoscopy so higher-risk peers could undergo colonoscopy sooner. Methods. We surveyed 1054 Veterans regarding their attitudes toward repeat colonoscopy and risk-based prioritization. We used multivariable regression to identify patient factors associated with willingness to delay screening for a higher-risk peer. Results. Despite a physician recommendation to stop screening, 29% of respondents reported being "not at all likely" to stop. However, 94% reported that they would be willing to delay their own colonoscopy for a higher-risk peer. Greater trust in physician and greater health literacy were positively associated with willingness to wait, while greater perceived threat of CRC and Black or Latino race/ethnicity were negatively associated with willingness to wait. Conclusion. Despite high enthusiasm for repeat screening, patients were willing to delay their own colonoscopy for higher-risk peers. Appealing to altruism could be effective when utilizing scarce resources.
Collapse
Affiliation(s)
- Marc S. Piper
- Division of Gastroenterology, Department of
Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Division of Gastroenterology, Department of
Internal Medicine, Providence Park Hospital, Michigan State University
College of Human Medicine, Southfield, Michigan
| | - Brian J. Zikmund-Fisher
- Department of Health Behavior and Health
Education, University of Michigan School of Public Health, Ann Arbor,
Michigan
- Department of Internal Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer K. Maratt
- Division of Gastroenterology, Department of
Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Division of Gastroenterology, Department of
Internal Medicine, Indiana University School of Medicine, Indianapolis,
Indiana
- Richard L. Roudebush VA Medical Center,
Indianapolis, Indiana
- Regenstrief Institute, Inc, Indianapolis,
Indiana
| | - Jacob Kurlander
- Division of Gastroenterology, Department of
Internal Medicine, University of Michigan, Ann Arbor, Michigan
- VA HSR&D Center for Clinical Management
Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Valbona Metko
- Division of Gastroenterology, Department of
Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Akbar K. Waljee
- Division of Gastroenterology, Department of
Internal Medicine, University of Michigan, Ann Arbor, Michigan
- VA HSR&D Center for Clinical Management
Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Sameer D. Saini
- Division of Gastroenterology, Department of
Internal Medicine, University of Michigan, Ann Arbor, Michigan
- VA HSR&D Center for Clinical Management
Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| |
Collapse
|