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Menon U, Szalacha LA, Kue J, Herman PM, Bucho-Gonzalez J, Lance P, Larkey L. Effects of a Community-to-Clinic Navigation Intervention on Colorectal Cancer Screening Among Underserved People. Ann Behav Med 2021; 54:308-319. [PMID: 31676898 DOI: 10.1093/abm/kaz049] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Colorectal cancer screening remains suboptimal among poor and underserved people. PURPOSE We tested the effectiveness of a community-to-clinic navigator intervention to guide multicultural, underinsured individuals into primary care clinics to complete colorectal cancer screening. METHODS This two-phase behavioral intervention study was conducted in Phoenix, Arizona (2012-2018). Community sites were randomized to group education or group education plus tailored navigation to increase attendance at primary care clinics (Phase I). Individuals who completed a clinic appointment received the tailored navigation in person or via phone (Phase II). RESULTS In Phase I (N = 345), 37.9% of the intervention group scheduled a clinic appointment versus 19.4% of the comparison group. In Phase II, 26.5% of the original intervention group were screened versus only 10.4% of the original comparison group. Those in the intervention group were 3.84 times more likely to be screened than were those in the comparison group (odds ratio = 3.84; 95% confidence interval = 1.81-6.92). CONCLUSIONS Translation of an efficacious tailored navigation intervention for colorectal cancer screening to a community-to-clinic context is associated with significantly increased rates of colorectal cancer screening. Navigation assistance to address barriers to screening may serve as the most important component of any educational program to increase individual adherence to colorectal cancer screening.
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Affiliation(s)
- Usha Menon
- University of South Florida, Tampa, FL, USA
| | | | | | | | | | - Peter Lance
- University of Arizona Cancer Center, Tucson, AZ, USA
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An Examination of Multilevel Factors Influencing Colorectal Cancer Screening in Primary Care Accountable Care Organization Settings: A Mixed-Methods Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 25:562-570. [PMID: 30180112 DOI: 10.1097/phh.0000000000000837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify patient, provider, and delivery system-level factors associated with colorectal cancer (CRC) screening and validate findings across multiple data sets. DESIGN A concurrent mixed-methods design using electronic health records, provider survey, and provider interview. SETTING Eight primary care accountable care organization clinics in Nebraska. MEASURES Patients' demographic/social characteristics, health utilization behaviors, and perceptions toward CRC screening; provider demographics and practice patterns; and clinics' delivery systems (eg, reminder system). ANALYSIS Quantitative (frequencies, logistic regression, and t tests) and qualitative analyses (thematic coding). RESULTS At the patient level, being 65 years of age and older (odds ratio [OR] = 1.34, P < .001), being non-Hispanic white (OR = 1.93, P < .001), having insurance (OR = 1.90, P = .01), having an annual physical examination (OR = 2.36, P < .001), and having chronic conditions (OR = 1.65 for 1-2 conditions, P < .001) were associated positively with screening, compared with their counterparts. The top 5 patient-level barriers included discomfort/pain of the procedure (60.3%), finance/cost (57.4%), other priority health issues (39.7%), lack of awareness (36.8%), and health literacy (26.5%). At the provider level, being female (OR = 1.88, P < .001), having medical doctor credentials (OR = 3.05, P < .001), and having a daily patient load less than 15 (OR = 1.50, P = .01) were positively related to CRC screening. None of the delivery system factors were significant except the reminder system. Interview data provided in-depth information on how these factors help or hinder CRC screening. Discrepancies in findings were observed in chronic condition, colonoscopy performed by primary doctors, and the clinic-level system factors. CONCLUSIONS This study informs practitioners and policy makers on the effective multilevel strategies to promote CRC screening in primary care accountable care organization or equivalent settings. Some inconsistent findings between data sources require additional prospective cohort studies to validate those identified factors in question. The strategies may include (1) developing programs targeting relatively younger age groups or racial/ethnic minorities, (2) adapting multilevel/multicomponent interventions to address low demands and access of local population, (3) promoting annual physical examination as a cost-effective strategy, and (4) supporting organizational capacity and infrastructure (eg, IT system) to facilitate implementation of evidence-based interventions.
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Luque Mellado FJ, Paino Pardal L, Condomines Feliu I, Tora-Rocamora I, Cuadras Rofastes M, Romero Díaz E, Pacheco Ortiz M, Camuñez Bravo JC, Aldea M, Grau Cano J. Impact of a Primary Care intervention on the colorectal cancer early detection programme. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:351-361. [PMID: 30954319 DOI: 10.1016/j.gastrohep.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/01/2018] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
AIM To assess the effectiveness of a telephonic interview performed by primary care professionals among non-participants in the first round of the colorectal cancer early detection programme in the basic urban health area Guineueta in Barcelona, Spain. PATIENTS AND METHODS The Primary Healthcare Team of La Guineueta contacted people who did not respond to the invitation to the first round of the colorectal cancer early detection programme using a standardised telephone call protocol. We analysed the impact of the intervention based on participation and diagnosed disease. RESULTS We made 3,327 phone calls to 2,343 people. After the intervention the participation rate was 54.9%, which meant an increase of 5.7% with respect to the participation in the usual protocol for the programme (49.2%). The intervention allowed 5cancers, 2high-risk neoplasms and 8low- and intermediate-risk lesions to be diagnosed. An average of 9phone calls was necessary to achieve the participation of one additional person. DISCUSSION The telephonic intervention performed by primary care professionals has significantly increased the population participation rate and the detection of neoplasms with respect to the usual colorectal cancer early detection programme protocol.
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Affiliation(s)
| | - Lidia Paino Pardal
- Equipo de Atención Primaria Guineueta, Institut Català de la Salut, Barcelona, España
| | | | - Isabel Tora-Rocamora
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic de Barcelona, Barcelona, España
| | | | - Elvira Romero Díaz
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic de Barcelona, Barcelona, España
| | - Maribel Pacheco Ortiz
- Equipo de Atención Primaria Guineueta, Institut Català de la Salut, Barcelona, España
| | | | - Marta Aldea
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic de Barcelona, Barcelona, España
| | - Jaume Grau Cano
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic de Barcelona, Barcelona, España
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Larkey L, Szalacha L, Herman P, Gonzalez J, Menon U. Randomized controlled dissemination study of community-to-clinic navigation to promote CRC screening: Study design and implications. Contemp Clin Trials 2017; 53:106-114. [PMID: 27940183 PMCID: PMC6386159 DOI: 10.1016/j.cct.2016.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/30/2016] [Accepted: 12/03/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Regular screening facilitates early diagnosis of colorectal cancer (CRC) and reduction of CRC morbidity and mortality. Screening rates for minorities and low-income populations remain suboptimal. Provider referral for CRC screening is one of the strongest predictors of adherence, but referrals are unlikely among those who have no clinic home (common among poor and minority populations). METHODS/STUDY DESIGN This group randomized controlled study will test the effectiveness of an evidence based tailored messaging intervention in a community-to-clinic navigation context compared to no navigation. Multicultural, underinsured individuals from community sites will be randomized (by site) to receive CRC screening education only, or education plus navigation. In Phase I, those randomized to education plus navigation will be guided to make a clinic appointment to receive a provider referral for CRC screening. Patients attending clinic appointments will continue to receive navigation until screened (Phase II) regardless of initial arm assignment. We hypothesize that those receiving education plus navigation will be more likely to attend clinic appointments (H1) and show higher rates of screening (H2) compared to those receiving education only. Phase I group assignment will be used as a control variable in analysis of screening follow-through in Phase II. Costs per screening achieved will be evaluated for each condition and the RE-AIM framework will be used to examine dissemination results. CONCLUSION The novelty of our study design is the translational dissemination model that will allow us to assess the real-world application of an efficacious intervention previously tested in a randomized controlled trial.
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Affiliation(s)
- Linda Larkey
- Arizona State University, College of Nursing and Health Innovation, 550 N 3rd Street, Phoenix, AZ 85004, United States.
| | - Laura Szalacha
- The University of Arizona, College of Nursing, 1305 N. Martin, Tucson, AZ 85721, United States
| | - Patricia Herman
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, United States
| | - Julie Gonzalez
- Arizona State University, College of Nursing and Health Innovation, 550 N 3rd Street, Phoenix, AZ 85004, United States
| | - Usha Menon
- The University of Arizona, College of Nursing, 1305 N. Martin, Tucson, AZ 85721, United States
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Alerts in electronic medical records to promote a colorectal cancer screening programme: a cluster randomised controlled trial in primary care. Br J Gen Pract 2016; 66:e483-90. [PMID: 27266861 DOI: 10.3399/bjgp16x685657] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/25/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Participation rates in colorectal cancer screening are below recommended European targets. AIM To evaluate the effectiveness of an alert in primary care electronic medical records (EMRs) to increase individuals' participation in an organised, population-based colorectal cancer screening programme when compared with usual care. DESIGN AND SETTING Cluster randomised controlled trial in primary care centres of Barcelona, Spain. METHOD Participants were males and females aged 50-69 years, who were invited to the first round of a screening programme based on the faecal immunochemical test (FIT) (n = 41 042), and their primary care professional. The randomisation unit was the physician cluster (n = 130) and patients were blinded to the study group. The control group followed usual care as per the colorectal cancer screening programme. In the intervention group, as well as usual care, an alert to health professionals (cluster level) to promote screening was introduced in the individual's primary care EMR for 1 year. The main outcome was colorectal cancer screening participation at individual participant level. RESULTS In total, 67 physicians and 21 619 patients (intervention group) and 63 physicians and 19 423 patients (control group) were randomised. In the intention-to-treat analysis screening participation was 44.1% and 42.2% respectively (odds ratio 1.08, 95% confidence interval [CI] = 0.97 to 1.20, P = 0.146). However, in the per-protocol analysis screening uptake in the intervention group showed a statistically significant increase, after adjusting for potential confounders (OR, 1.11; 95% CI = 1.02 to 1.22; P = 0.018). CONCLUSION The use of an alert in an individual's primary care EMR is associated with a statistically significant increased uptake of an organised, FIT-based colorectal cancer screening programme in patients attending primary care centres.
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Reinvitation to screening colonoscopy: a randomized-controlled trial of reminding letter and invitation to educational meeting on attendance in nonresponders to initial invitation to screening colonoscopy (REINVITE). Eur J Gastroenterol Hepatol 2016; 28:538-42. [PMID: 26967693 DOI: 10.1097/meg.0000000000000578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The response rate to initial invitation to population-based primary screening colonoscopy within the NordICC trial (NCT 00883792) in Poland is around 50%. The aim of this study was to compare the effect of a reinvitation letter and invitation to an educational intervention on participation in screening colonoscopy in nonresponders to initial invitation. METHODS Within the NordICC trial framework, individuals living in the region of Warsaw, who were drawn from Population Registries and assigned randomly to the screening group, received an invitation letter and a reminder with a prespecified screening colonoscopy appointment date. One thousand individuals, aged 55 to 64 years, who did not respond to both the invitation and the reminding letter were assigned randomly in a 1:1 ratio to the reinvitation group (REI) and the educational meeting group (MEET). The REI group was sent a reinvitation letter and reminder 6 and 3 weeks before the new colonoscopy appointment date, respectively. The MEET group was sent an invitation 6 weeks before an educational meeting date. Outcome measures were participation in screening colonoscopy within 6 months and response rate within 3 months from the date of reinvitation or invitation to an educational meeting. RESULTS The response rate and the participation rate in colonoscopy were statistically significantly higher in the REI group compared with the MEET group (16.5 vs. 4.3%; P<0.001 and 5.2 vs. 2.1%; P=0.008, respectively). CONCLUSION A simple reinvitation letter results in a higher response rate and participation rate to screening colonoscopy than invitation to tailored educational meeting in nonresponders to previous invitations. (NCT01183156).
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Tarver WL, Menachemi N. The impact of health information technology on cancer care across the continuum: a systematic review and meta-analysis. J Am Med Inform Assoc 2016; 23:420-7. [PMID: 26177658 PMCID: PMC5009923 DOI: 10.1093/jamia/ocv064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/05/2015] [Accepted: 05/10/2015] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Health information technology (HIT) has the potential to play a significant role in the management of cancer. The purpose of this review is to identify and examine empirical studies that investigate the impact of HIT in cancer care on different levels of the care continuum. METHODS Electronic searches were performed in four academic databases. The authors used a three-step search process to identify 122 studies that met specific inclusion criteria. Next, a coding sheet was used to extract information from each included article to use in an analysis. Logistic regression was used to determine study-specific characteristics that were associated with positive findings. RESULTS Overall, 72.4% of published analyses reported a beneficial effect of HIT. Multivariate analysis found that the impact of HIT differs across the cancer continuum with studies targeting diagnosis and treatment being, respectively, 77 (P = .001) and 39 (P = .039) percentage points less likely to report a beneficial effect when compared to those targeting prevention. In addition, studies targeting HIT to patients were 31 percentage points less likely to find a beneficial effect than those targeting providers (P = .030). Lastly, studies assessing behavior change as an outcome were 41 percentage points less likely to find a beneficial effect (P = .006), while studies targeting decision making were 27 percentage points more likely to find a beneficial effect (P = .034). CONCLUSION Based on current evidence, HIT interventions seem to be more successful when targeting physicians, care in the prevention phase of the cancer continuum, and/or decision making. An agenda for future research is discussed.
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Affiliation(s)
- Will L Tarver
- Doctoral Candidate, Department of Health Care Organization and Policy, University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
| | - Nir Menachemi
- Professor and Chair, Health Policy and Management, Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
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Shultz CG, Malouin JM, Green LA, Plegue M, Greenberg GM. A Systems Approach to Improving Tdap Immunization Within 5 Community-Based Family Practice Settings: Working Differently (and Better) by Transforming the Structure and Process of Care. Am J Public Health 2015; 105:1990-7. [PMID: 26270283 PMCID: PMC4566568 DOI: 10.2105/ajph.2015.302739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined how family medicine clinic physicians and staff worked in collaborative teams to implement an automated clinical reminder to improve tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccine administration and documentation. METHODS A clinical reminder was developed at 5 University of Michigan family medicine clinics to identify patients 11 to 64 years old who were in need of the Tdap booster vaccine. Quality improvement cycles were used to improve clinic care processes. Immunization rates from 2008 to 2011 were compared with rates at 4 primary care control clinics. RESULTS Vaccination rates among eligible patients increased from 15.5% to 47.3% within the family medicine clinics and from 14.1% to 30.2% within the control clinics. After adjustment for covariates, family medicine patients had a higher probability of vaccination than control patients during each measurement period (0.17 vs 0.15 at baseline, 0.53 vs 0.22 during year 1, and 0.50 vs 0.30 during year 2). CONCLUSIONS Automated clinical reminders, when designed and implemented via a consensus-based framework that addresses the process of care, can dramatically improve provision of preventive health care.
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Affiliation(s)
- Cameron G Shultz
- Cameron G. Shultz, Jean M. Malouin, Melissa Plegue, and Grant M. Greenberg are with the Department of Family Medicine, University of Michigan, Ann Arbor. Lee A. Green is with the Department of Family Medicine, University of Alberta, Edmonton
| | - Jean M Malouin
- Cameron G. Shultz, Jean M. Malouin, Melissa Plegue, and Grant M. Greenberg are with the Department of Family Medicine, University of Michigan, Ann Arbor. Lee A. Green is with the Department of Family Medicine, University of Alberta, Edmonton
| | - Lee A Green
- Cameron G. Shultz, Jean M. Malouin, Melissa Plegue, and Grant M. Greenberg are with the Department of Family Medicine, University of Michigan, Ann Arbor. Lee A. Green is with the Department of Family Medicine, University of Alberta, Edmonton
| | - Melissa Plegue
- Cameron G. Shultz, Jean M. Malouin, Melissa Plegue, and Grant M. Greenberg are with the Department of Family Medicine, University of Michigan, Ann Arbor. Lee A. Green is with the Department of Family Medicine, University of Alberta, Edmonton
| | - Grant M Greenberg
- Cameron G. Shultz, Jean M. Malouin, Melissa Plegue, and Grant M. Greenberg are with the Department of Family Medicine, University of Michigan, Ann Arbor. Lee A. Green is with the Department of Family Medicine, University of Alberta, Edmonton
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DeVoe JE, Huguet N, Likumahuwa-Ackman S, Angier H, Nelson C, Marino M, Cohen D, Sumic A, Hoopes M, Harding RL, Dearing M, Gold R. Testing health information technology tools to facilitate health insurance support: a protocol for an effectiveness-implementation hybrid randomized trial. Implement Sci 2015; 10:123. [PMID: 26652866 PMCID: PMC4676134 DOI: 10.1186/s13012-015-0311-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with gaps in health insurance coverage often defer or forgo cancer prevention services. These delays in cancer detection and diagnoses lead to higher rates of morbidity and mortality and increased costs. Recent advances in health information technology (HIT) create new opportunities to enhance insurance support services that reduce coverage gaps through automated processes applied in healthcare settings. This study will assess the implementation of insurance support HIT tools and their effectiveness at improving patients' insurance coverage continuity and cancer screening rates. METHODS/DESIGN This study uses a hybrid cluster-randomized design-a combined effectiveness and implementation trial-in community health centers (CHCs) in the USA. Eligible CHC clinic sites will be randomly assigned to one of two groups in the trial's implementation component: tools + basic training (Arm I) and tools + enhanced training + facilitation (Arm II). A propensity score-matched control group of clinics will be selected to assess the tools' effectiveness. Quantitative analyses of the tools' impact will use electronic health record and Medicaid data to assess effectiveness. Qualitative data will be collected to evaluate the implementation process, understand how the HIT tools are being used, and identify facilitators and barriers to their implementation and use. DISCUSSION This study will test the effectiveness of HIT tools to enhance insurance support in CHCs and will compare strategies for facilitating their implementation in "real-world" practice settings. Findings will inform further development and, if indicated, more widespread implementation of insurance support HIT tools. TRIAL REGISTRATION Clinical trial NTC02355262.
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Affiliation(s)
- Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA. .,OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Sonja Likumahuwa-Ackman
- Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | | | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Deborah Cohen
- Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | | | - Megan Hoopes
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Rose L Harding
- Department of Family Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Marla Dearing
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Rachel Gold
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA. .,Center for Health Research Northwest, Kaiser Permanente, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
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Nápoles AM, Santoyo-Olsson J, Stewart AL, Olmstead J, Gregorich SE, Farren G, Cabral R, Freudman A, Pérez-Stable EJ. Physician counseling on colorectal cancer screening and receipt of screening among Latino patients. J Gen Intern Med 2015; 30:483-9. [PMID: 25472506 PMCID: PMC4370980 DOI: 10.1007/s11606-014-3126-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Latinos have lower rates of colorectal cancer (CRC) screening and later stage diagnosis than Whites, which may be partially explained by physician communication factors. OBJECTIVE We assessed associations between patient-reported physician counseling regarding CRC screening and receipt of CRC screening among Latino primary care patients. DESIGN This was a cross-sectional telephone survey. PARTICIPANTS The participants of this study were Latino primary care patients 50 years of age or older, with one or more visits during the preceding year. MAIN MEASURES We developed patient-reported measures to assess whether physicians provided explanations of CRC risks and tests, elicited patients' barriers to CRC screening, were responsive to patients' concerns about screening, and encouraged patients to be screened. Outcomes were patient reports of receipt of endoscopy (sigmoidoscopy or colonoscopy) and fecal occult blood test (FOBT) within recommended guidelines. KEY RESULTS Of 817 eligible patients contacted, 505 (62 %) completed the survey; mean age was 61 years (SD 8.4), 69 % were women, and 53 % had less than high school education. Forty-six percent reported obtaining endoscopy (with or without FOBT), 13 % reported FOBT only, and 41 % reported no CRC screening. In bivariate analyses, physician explanations, elicitation of barriers, responsiveness to concerns, and greater encouragement for screening were associated with receipt of endoscopy (p < 0.001), and explanations (p < 0.05) and encouragement (p < 0.001) were associated with FOBT. Adjusting for covariates, physician explanations (OR = 1.27; 95 % CI 1.03, 1.58) and greater physician encouragement (OR = 6.74; 95 % CI 3.57, 12.72) were associated with endoscopy; patients reporting quite a bit/a lot of physician encouragement had six times higher odds of obtaining the FOBT as those reporting none/a little encouragement (OR = 6.54; 95 % CI 2.76, 15.48). CONCLUSIONS Among primarily lower-socioeconomic status Latino patients, the degree to which patients perceived that physicians encouraged CRC screening was more strongly associated with screening than with providing risk information, eliciting barriers, and responding to their concerns about screening.
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Affiliation(s)
- Anna M Nápoles
- Division of General Internal Medicine, Department of Medicine, and Medical Effectiveness Research Center for Diverse Populations, University of California San Francisco (UCSF), 3333 California Street, Suite 335, San Francisco, CA, 94118-0856, USA,
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Larkey LK, McClain D, Roe DJ, Hector RD, Lopez AM, Sillanpaa B, Gonzalez J. Randomized controlled trial of storytelling compared to a personal risk tool intervention on colorectal cancer screening in low-income patients. Am J Health Promot 2015; 30:e59-70. [PMID: 25615708 DOI: 10.4278/ajhp.131111-quan-572] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Screening rates for colorectal cancer (CRC) lag for low-income, minority populations, contributing to poorer survival rates. A model of storytelling as culture-centric health promotion was tested for promoting CRC screening. DESIGN A two-group parallel randomized controlled trial. SETTING Primary care, safety-net clinics. SUBJECTS Low-income patients due for CRC screening, ages 50 to 75 years, speaking English or Spanish. INTERVENTION Patients were exposed to either a video created from personal stories composited into a drama about "Papa" receiving CRC screening, or an instrument estimating level of personal cancer risk. Patients received a health care provider referral for CRC screening and were followed up for 3 months to document adherence. MEASURES Behavioral factors related to the narrative model (identification and engagement) and theory of planned behavior. ANALYSIS Main effects of the interventions on screening were tested, controlling for attrition factors, and demographic factor associations were assessed. Path analysis with model variables was used to test the direct effects and multiple mediator models. RESULTS Main effects on CRC screening (roughly half stool-based tests, half colonoscopy) did not indicate significant differences (37% and 42% screened for storytelling and risk-based messages, respectively; n = 539; 33.6% male; 62% Hispanic). Factors positively associated with CRC screening included being female, Hispanic, married or living with a partner, speaking Spanish, having a primary care provider, lower income, and no health insurance. Engagement, working through positive attitudes toward the behavior, predicted CRC screening. CONCLUSION A storytelling and a personalized risk-tool intervention achieved similar levels of screening among unscreened/underscreened, low-income patients. Factors usually associated with lower rates of screening (e.g., no insurance, being Hispanic) were related to more adherence. Both interventions' engagement factor facilitated positive attitudes about CRC screening associated with behavior change.
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Williams EC, Rubinsky AD, Chavez LJ, Lapham GT, Rittmueller SE, Achtmeyer CE, Bradley KA. An early evaluation of implementation of brief intervention for unhealthy alcohol use in the US Veterans Health Administration. Addiction 2014; 109:1472-81. [PMID: 24773590 PMCID: PMC4257468 DOI: 10.1111/add.12600] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/22/2013] [Accepted: 04/17/2014] [Indexed: 11/28/2022]
Abstract
AIMS The US Veterans Health Administration [Veterans Affairs (VA)] used performance measures and electronic clinical reminders to implement brief intervention for unhealthy alcohol use. We evaluated whether documented brief intervention was associated with subsequent changes in drinking during early implementation. DESIGN Observational, retrospective cohort study using secondary clinical and administrative data. SETTING Thirty VA facilities. PARTICIPANTS Outpatients who screened positive for unhealthy alcohol use [Alcohol Use Disorders Identification Test Consumption (AUDIT-C ≥ 5)] in the 6 months after the brief intervention performance measure (n = 22 214) and had follow-up screening 9-15 months later (n = 6210; 28%). MEASUREMENTS Multi-level logistic regression estimated the adjusted prevalence of resolution of unhealthy alcohol use (follow-up AUDIT-C <5 with ≥2 point reduction) for patients with and without documented brief intervention (documented advice to reduce or abstain from drinking). FINDINGS Among 6210 patients with follow-up alcohol screening, 1751 (28%) had brief intervention and 2922 (47%) resolved unhealthy alcohol use at follow-up. Patients with documented brief intervention were older and more likely to have other substance use disorders, mental health conditions, poor health and more severe unhealthy alcohol use than those without (P-values < 0.05). Adjusted prevalences of resolution were 47% [95% confidence interval (CI) = 42-52%] and 48% (95% CI = 42-54%) for patients with and without documented brief intervention, respectively (P = 0.50). CONCLUSIONS During early implementation of brief intervention in the US Veterans Health Administration, documented brief intervention was not associated with subsequent changes in drinking among outpatients with unhealthy alcohol use and repeat alcohol screening.
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Affiliation(s)
- Emily C. Williams
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA, Department of Health Services, University of Washington, Seattle, WA, USA
| | - Anna D. Rubinsky
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - Laura J. Chavez
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA, Department of Health Services, University of Washington, Seattle, WA, USA
| | - Gwen T. Lapham
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA, Group Health Research Institute, Seattle, WA, USA
| | - Stacey E. Rittmueller
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - Carol E. Achtmeyer
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA, Primary and Specialty Medical Care Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - Katharine A. Bradley
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA, Department of Health Services, University of Washington, Seattle, WA, USA, Group Health Research Institute, Seattle, WA, USA, Department of Medicine, University of Washington, Seattle, WA, USA
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Guiriguet-Capdevila C, Muñoz-Ortiz L, Rivero-Franco I, Vela-Vallespín C, Vilarrubí-Estrella M, Torres-Salinas M, Grau-Cano J, Burón-Pust A, Hernández-Rodríguez C, Fuentes-Peláez A, Reina-Rodríguez D, De León-Gallo R, Mendez-Boo L, Torán-Monserrat P. Can an alert in primary care electronic medical records increase participation in a population-based screening programme for colorectal cancer? COLO-ALERT, a randomised clinical trial. BMC Cancer 2014; 14:232. [PMID: 24685117 PMCID: PMC3976172 DOI: 10.1186/1471-2407-14-232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/25/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Colorectal cancer is an important public health problem in Spain. Over the last decade, several regions have carried out screening programmes, but population participation rates remain below recommended European goals. Reminders on electronic medical records have been identified as a low-cost and high-reach strategy to increase participation. Further knowledge is needed about their effect in a population-based screening programme. The main aim of this study is to evaluate the effectiveness of an electronic reminder to promote the participation in a population-based colorectal cancer screening programme. Secondary aims are to learn population's reasons for refusing to take part in the screening programme and to find out the health professionals' opinion about the official programme implementation and on the new computerised tool. METHODS/DESIGN This is a parallel randomised trial with a cross-sectional second stage. PARTICIPANTS all the invited subjects to participate in the public colorectal cancer screening programme that includes men and women aged between 50-69, allocated to the eleven primary care centres of the study and all their health professionals. The randomisation unit will be the primary care physician. The intervention will consist of activating an electronic reminder, in the patient's electronic medical record, in order to promote colorectal cancer screening, during a synchronous medical appointment, throughout the year that the intervention takes place. A comparison of the screening rates will then take place, using the faecal occult blood test of the patients from the control and the intervention groups. We will also take a questionnaire to know the opinions of the health professionals. The main outcome is the screening status at the end of the study. Data will be analysed with an intention-to-treat approach. DISCUSSION We expect that the introduction of specific reminders in electronic medical records, as a tool to facilitate and encourage direct referral by physicians and nurse practitioners to perform colorectal cancer screening will mean an increase in participation of the target population. The introduction of this new software tool will have good acceptance and increase compliance with recommendations from health professionals. TRIAL REGISTRATION Clinical Trials.gov identifier NCT01877018.
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Affiliation(s)
- Carolina Guiriguet-Capdevila
- Primary Healthcare Centre Santa Rosa, Catalan Health Institute, Carrer El Cano s/n, 08921 Santa Coloma de Gramenet, Spain
- Grupo emergente de investigación en cáncer (CANCER-AP), IDIAP JordiGol, Catalan Health Institute, Barcelona, Spain
| | - Laura Muñoz-Ortiz
- Primary Healthcare Research Support Unit Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària (IDIAP) Jordi Gol, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain
| | - Irene Rivero-Franco
- Primary Healthcare Centre Sanllehy, Catalan Health Institute, Av Mare de Deu de Montserrat 16-18, 08024 Barcelona, Spain
- Grupo emergente de investigación en cáncer (CANCER-AP), IDIAP JordiGol, Catalan Health Institute, Barcelona, Spain
| | - Carme Vela-Vallespín
- Primary Healthcare Centre Riu Nord-Riu Sud, Catalan Health Institute, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain
- Grupo emergente de investigación en cáncer (CANCER-AP), IDIAP JordiGol, Catalan Health Institute, Barcelona, Spain
| | - Mercedes Vilarrubí-Estrella
- Primary Healthcare Centre Riu Nord-Riu Sud, Catalan Health Institute, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain
- Grupo emergente de investigación en cáncer (CANCER-AP), IDIAP JordiGol, Catalan Health Institute, Barcelona, Spain
| | - Miquel Torres-Salinas
- Department of Internal Medicine, Fundació Hospital de l’Esperit Sant, Avinguda Mossèn Pons i Rabadà s/n, 08923 Sta Coloma de Gramenet, Barcelona, Spain
| | - Jaume Grau-Cano
- Department of Preventive Medicine and Epidemiology, Hospital Clínic, Carrer del Rosselló 138, 08036 Barcelona, Spain
- Colorectal Screening Programme Research Group (PROCOLON), Barcelona, Spain
| | - Andrea Burón-Pust
- Department of Epidemiology and Evaluation, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain
- Colorectal Screening Programme Research Group (PROCOLON), Barcelona, Spain
- Health Services and Chronic Diseases Research Network (REDISSEC), Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Cristina Hernández-Rodríguez
- Department of Epidemiology and Evaluation, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain
- Colorectal Screening Programme Research Group (PROCOLON), Barcelona, Spain
| | - Antonio Fuentes-Peláez
- Direcció d’Organització i Sistemes, Gerencia Territorial Metropolitana Nord, Catalan Health Institute, Ctra.de Canyet s/n, 08916 Badalona, Spain
| | - Dolores Reina-Rodríguez
- Metodology, Quality and Care Evaluation, Metropolitana Nord Primary Care Service, Catalan Health Institute, Badalona, Spain
| | - Rosa De León-Gallo
- Primary Healthcare Centre Riu Nord-Riu Sud, Catalan Health Institute, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain
| | - Leonardo Mendez-Boo
- Primary Care Services Information System, Catalan Health Institute, Avinguda Gran Vía de les Corts Catalanes 587, 08007 Barcelona, Spain
| | - Pere Torán-Monserrat
- Primary Healthcare Research Support Unit Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària (IDIAP) Jordi Gol, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain
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Petroll AE, Phelps JK, Fletcher KE. Implementation of an electronic medical record does not change delivery of preventive care for HIV-positive patients. Int J Med Inform 2014; 83:273-7. [PMID: 24440204 DOI: 10.1016/j.ijmedinf.2013.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 12/10/2013] [Accepted: 12/16/2013] [Indexed: 01/12/2023]
Abstract
PURPOSE This study sought to determine the impact that an electronic medical record (EMR) had on the provision of preventive health measures - including obtaining serologies for viral hepatitis and administering vaccinations to non-immune patients - to HIV patients at a hospital-based clinic. METHODS Using a pre-post study design, we compared rates of preventive health delivery to HIV patients at an outpatient clinic during the use of a paper medical record (PMR) and after implementation of an EMR. Retrospective chart reviews were conducted at two time points: 12-16 months prior to and 24 months following EMR implementation. The records of 160 active patients were randomly selected for review during both time periods. RESULTS There was no difference between the PMR and EMR samples with regard to the proportion of patients who had hepatitis A (83% in PMR group; 77% in EMR) and hepatitis C (94% in both groups) serologies measured or the proportion of eligible patients who were given hepatitis vaccinations. Slightly fewer patients had a serology for hepatitis B measured in the EMR sample. CONCLUSIONS As EMR implementation expands, it is important to evaluate the effects that EMRs have on patient outcomes, including preventive health provision. Our study showed that after implementation of an EMR, the provision of most preventive care measures did not improve. This finding is in agreement with many published studies. Some studies have found positive effects from EMRs that may be attributable to specific aspects of EMRs. Further study of the effect of specific EMR attributes on health care outcomes is needed.
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Affiliation(s)
- Andrew E Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Medicine, Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Jenise K Phelps
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | - Kathlyn E Fletcher
- Department of Medicine, Division of General Internal Medicine, College of Wisconsin, Milwaukee, WI, USA; Department of Medicine, Clement J Zablocki VA Medical Center, Milwaukee, WI, USA
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Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013; 15:e286. [PMID: 24351420 PMCID: PMC3875904 DOI: 10.2196/jmir.2914] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/18/2013] [Accepted: 11/22/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Information is lacking about the capacity of those working in community practice settings to utilize health information technology for colorectal cancer screening. OBJECTIVE To address this gap we asked those working in community practice settings to share their perspectives about how the implementation of a Web-based patient-led decision aid might affect patient-clinician conversations about colorectal cancer screening and the day-to-day clinical workflow. METHODS Five focus groups in five community practice settings were conducted with 8 physicians, 1 physician assistant, and 18 clinic staff. Focus groups were organized using a semistructured discussion guide designed to identify factors that mediate and impede the use of a Web-based decision aid intended to clarify patient preferences for colorectal cancer screening and to trigger shared decision making during the clinical encounter. RESULTS All physicians, the physician assistant, and 8 of the 18 clinic staff were active participants in the focus groups. Clinician and staff participants from each setting reported a belief that the Web-based patient-led decision aid could be an informative and educational tool; in all but one setting participants reported a readiness to recommend the tool to patients. The exception related to clinicians from one clinic who described a preference for patients having fewer screening choices, noting that a colonoscopy was the preferred screening modality for patients in their clinic. Perceived barriers to utilizing the Web-based decision aid included patients' lack of Internet access or low computer literacy, and potential impediments to the clinics' daily workflow. Expanding patients' use of an online decision aid that is both easy to access and understand and that is utilized by patients outside of the office visit was described as a potentially efficient means for soliciting patients' screening preferences. Participants described that a system to link the online decision aid to a computerized reminder system could promote a better understanding of patients' screening preferences, though some expressed concern that such a system could be difficult to keep up and running. CONCLUSIONS Community practice clinicians and staff perceived the Web-based decision aid technology as promising but raised questions as to how the technology and resultant information would be integrated into their daily practice workflow. Additional research investigating how to best implement online decision aids should be conducted prior to the widespread adoption of such technology so as to maximize the benefits of the technology while minimizing workflow disruptions.
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Affiliation(s)
- Masahito Jimbo
- University of Michigan, Departments of Family Medicine and Urology, Ann Arbor, MI, United States.
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Abstract
BACKGROUND Health information technology (HIT) systems have the potential to reduce delayed, missed or incorrect diagnoses. We describe and classify the current state of diagnostic HIT and identify future research directions. METHODS A multi-pronged literature search was conducted using PubMed, Web of Science, backwards and forwards reference searches and contributions from domain experts. We included HIT systems evaluated in clinical and experimental settings as well as previous reviews, and excluded radiology computer-aided diagnosis, monitor alerts and alarms, and studies focused on disease staging and prognosis. Articles were organised within a conceptual framework of the diagnostic process and areas requiring further investigation were identified. RESULTS HIT approaches, tools and algorithms were identified and organised into 10 categories related to those assisting: (1) information gathering; (2) information organisation and display; (3) differential diagnosis generation; (4) weighing of diagnoses; (5) generation of diagnostic plan; (6) access to diagnostic reference information; (7) facilitating follow-up; (8) screening for early detection in asymptomatic patients; (9) collaborative diagnosis; and (10) facilitating diagnostic feedback to clinicians. We found many studies characterising potential interventions, but relatively few evaluating the interventions in actual clinical settings and even fewer demonstrating clinical impact. CONCLUSIONS Diagnostic HIT research is still in its early stages with few demonstrations of measurable clinical impact. Future efforts need to focus on: (1) improving methods and criteria for measurement of the diagnostic process using electronic data; (2) better usability and interfaces in electronic health records; (3) more meaningful incorporation of evidence-based diagnostic protocols within clinical workflows; and (4) systematic feedback of diagnostic performance.
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Affiliation(s)
- Robert El-Kareh
- Division of Biomedical Informatics, UCSD, , San Diego, California, USA
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Adherence to physician recommendation to colorectal cancer screening colonoscopy among Hispanics. J Gen Intern Med 2011; 26:1124-30. [PMID: 21541795 PMCID: PMC3181293 DOI: 10.1007/s11606-011-1727-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 12/21/2010] [Accepted: 03/30/2011] [Indexed: 01/04/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most commonly diagnosed cancer among Hispanics in the United States (US), yet the use of CRC screening is low in this population. Physician recommendation has consistently shown to improve CRC screening. OBJECTIVE To identify the characteristics of Hispanic patients who adhere or do not adhere to their physician's recommendation to have a screening colonoscopy. DESIGN A cross-sectional study featuring face-to-face interviews by culturally matched interviewers was conducted in primary healthcare clinics and community centers in New York City. PARTICIPANTS Four hundred Hispanic men and women aged 50 or older, at average risk for CRC, were interviewed. Two hundred and eighty (70%) reported receipt of a physician's recommendation for screening colonoscopy and are included in this study. MAIN MEASURES Dependent variable: self report of having had screening colonoscopy. INDEPENDENT VARIABLES sociodemographics, healthcare and health promotion factors. KEY RESULTS Of the 280 participants, 25% did not adhere to their physician's recommendation. Factors found to be associated with non-adherence were younger age, being born in the US, preference for completing interviews in English, higher acculturation, and greater reported fear of colonoscopy testing. The source of colonoscopy recommendation (whether it came from their usual healthcare provider or not, and whether it occurred in a community or academic healthcare facility) for CRC screening was not associated with adherence. CONCLUSIONS This study indicates that potentially identifiable subgroups of Hispanics may be less likely to follow their physician recommendation to have a screening colonoscopy and thus may decrease their likelihood of an early diagnosis and prompt treatment. Raising physicians' awareness to such patients' characteristics could help them anticipate patients who may be less adherent and who may need additional encouragement to undergo screening colonoscopy.
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Brouwers MC, De Vito C, Bahirathan L, Carol A, Carroll JC, Cotterchio M, Dobbins M, Lent B, Levitt C, Lewis N, McGregor SE, Paszat L, Rand C, Wathen N. Effective interventions to facilitate the uptake of breast, cervical and colorectal cancer screening: an implementation guideline. Implement Sci 2011; 6:112. [PMID: 21958602 PMCID: PMC3222606 DOI: 10.1186/1748-5908-6-112] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 09/29/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. Several high-quality systematic reviews and practice guidelines exist to inform the most effective screening options. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. We developed an implementation guideline to answer the question: What interventions have been shown to increase the uptake of cancer screening by individuals, specifically for breast, cervical, and colorectal cancers? METHODS A guideline panel was established as part of Cancer Care Ontario's Program in Evidence-based Care, and a systematic review of the published literature was conducted. It yielded three foundational systematic reviews and an existing guidance document. We conducted updates of these reviews and searched the literature published between 2004 and 2010. A draft guideline was written that went through two rounds of review. Revisions were made resulting in a final set of guideline recommendations. RESULTS Sixty-six new studies reflecting 74 comparisons met eligibility criteria. They were generally of poor to moderate quality. Using these and the foundational documents, the panel developed a draft guideline. The draft report was well received in the two rounds of review with mean quality scores above four (on a five-point scale) for each of the items. For most of the interventions considered, there was insufficient evidence to support or refute their effectiveness. However, client reminders, reduction of structural barriers, and provision of provider assessment and feedback were recommended interventions to increase screening for at least two of three cancer sites studied. The final guidelines also provide advice on how the recommendations can be used and future areas for research. CONCLUSION Using established guideline development methodologies and the AGREE II as our methodological frameworks, we developed an implementation guideline to advise on interventions to increase the rate of breast, cervical and colorectal cancer screening. While advancements have been made in these areas of implementation science, more investigations are warranted.
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Affiliation(s)
- Melissa C Brouwers
- Program in Evidence-based Care, Cancer Care Ontario, Hamilton, Ont., Canada
- Departments of Oncology and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Canada
| | - Carol De Vito
- Program in Evidence-based Care, Cancer Care Ontario, Hamilton, Ont., Canada
- Departments of Oncology and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Canada
| | - Lavannya Bahirathan
- Program in Evidence-based Care, Cancer Care Ontario, Hamilton, Ont., Canada
- Departments of Oncology and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Canada
| | - Angela Carol
- Hamilton Urban Core Community Centre, Hamilton, Ont., Canada
| | - June C Carroll
- Department of Family and Community Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ont., Canada
| | - Michelle Cotterchio
- Population Studies and Surveillance, Cancer Care Ontario, Toronto, Ont., Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Ont., Canada
| | - Barbara Lent
- Department of Family Medicine, The University of Western Ontario, London, Ont., Canada
| | - Cheryl Levitt
- Department of Family Medicine, McMaster University, Hamilton, Ont., Canada
- Primary Care, Cancer Care Ontario, Toronto, Ont., Canada
| | - Nancy Lewis
- Prevention and Screening, Cancer Care Ontario, Toronto, Ont., Canada
| | - S Elizabeth McGregor
- Population Health Research, Alberta Health Services - Cancer Epidemiology, Prevention and Screening, Calgary, Alb., Canada
| | - Lawrence Paszat
- Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont., Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ont., Canada
| | - Carol Rand
- Regional Cancer Prevention and Early Detection Network Hamilton, Niagara, Haldimand, Brant., Canada
- Systemic, Supportive and Regional Cancer Programs, Juravinski Cancer Centre, Hamilton, Ont., Canada
| | - Nadine Wathen
- Faculty of Information and Media Studies, The University of Western Ontario, London, Ont., Canada
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Brouwers MC, De Vito C, Bahirathan L, Carol A, Carroll JC, Cotterchio M, Dobbins M, Lent B, Levitt C, Lewis N, McGregor SE, Paszat L, Rand C, Wathen N. What implementation interventions increase cancer screening rates? a systematic review. Implement Sci 2011; 6:111. [PMID: 21958556 PMCID: PMC3197548 DOI: 10.1186/1748-5908-6-111] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 09/29/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC) screening. The interventions considered were: client reminders, client incentives, mass media, small media, group education, one-on-one education, reduction in structural barriers, reduction in out-of-pocket costs, provider assessment and feedback interventions, and provider incentives. Our primary outcome, screening completion, was calculated as the overall median post-intervention absolute percentage point (PP) change in completed screening tests. METHODS Our first step was to conduct an iterative scoping review in the research area. This yielded three relevant high-quality systematic reviews. Serving as our evidentiary foundation, we conducted a formal update. Randomized controlled trials and cluster randomized controlled trials, published between 2004 and 2010, were searched in MEDLINE, EMBASE and PSYCHinfo. RESULTS The update yielded 66 studies new eligible studies with 74 comparisons. The new studies ranged considerably in quality. Client reminders, small media, and provider audit and feedback appear to be effective interventions to increase the uptake of screening for three cancers. One-on-one education and reduction of structural barriers also appears effective, but their roles with CRC and cervical screening, respectively, are less established. More study is required to assess client incentives, mass media, group education, reduction of out-of-pocket costs, and provider incentive interventions. CONCLUSION The new evidence generally aligns with the evidence and conclusions from the original systematic reviews. This review served as the evidentiary foundation for an implementation guideline. Poor reporting, lack of precision and consistency in defining operational elements, and insufficient consideration of context and differences among populations are areas for additional research.
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Affiliation(s)
- Melissa C Brouwers
- Program in Evidence-based Care, Cancer Care Ontario, Hamilton, Ontario, Canada.
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Vedel I, Puts MT, Monette M, Monette J, Bergman H. Barriers and facilitators to breast and colorectal cancer screening of older adults in primary care: A systematic review. J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2010.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Hesse BW, Hanna C, Massett HA, Hesse NK. Outside the box: will information technology be a viable intervention to improve the quality of cancer care? J Natl Cancer Inst Monogr 2010; 2010:81-9. [PMID: 20386056 DOI: 10.1093/jncimonographs/lgq004] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The use of health information technology (IT) to resolve the crisis in communication inherent within the fragmented service environment of medical care in the United States is a strategic priority for the Department of Health and Human Services. Yet the deployment of health IT alone is not sufficient to improve quality in health service delivery; what is needed is a human factors approach designed to optimize the balance between health-care users, health-care providers, policies, procedures, and technologies. An evaluation of interface issues between primary and specialist care related to cancer reveals opportunities for human factors improvement along the cancer care continuum. Applications that emphasize cognitive support for prevention recommendations and that encourage patient engagement can help create a coordinated health-care environment conducive to cancer prevention and early detection. An emphasis on reliability, transparency, and accountability can help improve the coordination of activities among multiple service providers during diagnosis and treatment. A switch in emphasis from a transaction-based approach to one emphasizing long-term support for healing relationships should help improve patient outcomes during cancer survivorship and end-of-life care. Across the entire continuum of care, an emphasis on "meaningful use" of health IT-rather than on IT as an endpoint-should help put cancer on a path toward substantive continuous quality improvement. The accompanying research questions will focus on reducing the variance between the social and technical subsystems as IT is used to improve patient outcomes across the interfaces of care.
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Affiliation(s)
- Bradford W Hesse
- National Cancer Institute, 6130 Executive Blvd, MSC 7365, Bethesda, MD 20892-7365, USA.
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Innovative provider- and health system-directed approaches to improving colorectal cancer screening delivery. Med Care 2008; 46:S62-7. [PMID: 18725835 DOI: 10.1097/mlr.0b013e31817fdf57] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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