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Adegbulugbe AA, Farah E, Ruan Y, Yong JHE, Cheung WY, Brenner DR. The projected health and economic impact of increased colorectal cancer screening participation among Canadians by income quintile. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:384-394. [PMID: 38502494 PMCID: PMC11133258 DOI: 10.17269/s41997-024-00868-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/09/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Disparities in colorectal cancer (CRC) screening uptake by socioeconomic status have been observed in Canada. We used the OncoSim-Colorectal model to evaluate the health and economic outcomes associated with increasing the participation rates of CRC screening programs to 60% among Canadians in different income quintiles. METHODS Baseline CRC screening participation rates were obtained from the 2017 Canadian Community Health Survey. The survey participants were categorized into income quintiles using their reported household income and 2016 Canadian Census income quintile thresholds. Within each quintile, the participation rate was the proportion of respondents aged 50-74 who reported having had a fecal test in the past two years. Using the OncoSim-Colorectal model, we simulated an increase in CRC screening uptake to 60% across income quintiles to assess the effects on CRC incidence, mortality, and associated economic costs from 2024 to 2073. RESULTS Increasing CRC screening participation rates to 60% across all income quintiles would prevent 69,100 CRC cases and 36,600 CRC deaths over 50 years. The improvement of clinical outcomes would also translate to increased person-years and health-adjusted person-years. The largest impact was observed in the lowest income group, with 22,200 cases and 11,700 deaths prevented over 50 years. Increased participation could lead to higher screening costs ($121 million CAD more per year) and lower treatments costs ($95 million CAD less per year), averaged over the period 2024-2073. CONCLUSION Increased screening participation will improve clinical outcomes across all income groups while alleviating associated treatment costs. The benefits of increased participation will be strongest among the lowest income quintile.
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Affiliation(s)
- Abisola A Adegbulugbe
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Eliya Farah
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada
| | - Jean H E Yong
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Winson Y Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada
| | - Darren R Brenner
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada.
- Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, AB, Canada.
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Martinez ME, Roesch S, Largaespada V, Castañeda SF, Nodora JN, Rabin BA, Covin J, Ortwine K, Preciado-Hidalgo Y, Howard N, Schultz J, Stamm N, Ramirez D, Halpern MT, Gupta S. A pragmatic randomized trial of mailed fecal immunochemical testing to increase colorectal cancer screening among low-income and minoritized populations. Cancer 2024. [PMID: 38795024 DOI: 10.1002/cncr.35369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/12/2024] [Accepted: 04/24/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) screening is underused, particularly among low-income and minoritized populations, for whom the coronavirus disease 2019 (COVID-19) pandemic has challenged progress in achieving equity. METHODS A hub-and-spoke model was used. The hub was a nonacademic organization and the spokes were three community health center (CHC) systems overseeing numerous clinic sites. Via a cluster-randomized trial design, nine clinic sites were randomized to intervention and 16 clinic sites were randomized to usual care. Patient-level interventions included invitation letters, mailed fecal immunochemical tests (FITs), and call/text-based reminders. Year 1 intervention impact, which took place during the COVID-19 pandemic, was assessed as the proportion completing screening among individuals not up to date at baseline, which compared intervention and nonintervention clinics accounting for intraclinic cluster variation; confidence intervals (CIs) around differences not including 0 were interpreted as statistically significant. RESULTS Among 26,736 patients who met eligibility criteria, approximately 58% were female, 55% were Hispanic individuals, and 44% were Spanish speaking. The proportion completing screening was 11.5 percentage points (ppts) (95% CI, 6.1-16.9 ppts) higher in intervention versus usual care clinics. Variation in differences between intervention and usual care clinics was observed by sex (12.6 ppts [95% CI, 7.2-18.0 ppts] for females; 8.8 ppts [95% CI, 4.7-13.9 ppts] for males) and by racial and ethnic group (13.8 ppts [95% CI, 7.0-20.6 ppts] for Hispanic individuals; 13.0 ppts [95% CI, 3.6-22.4 ppts] for Asian individuals; 11.3 ppts [95% CI, 5.8-16.8 ppts] for non-Hispanic White individuals; 6.1 ppts [95% CI, 0.8-10.4 ppts] for Black individuals). CONCLUSIONS A regional mailed FIT intervention was effective for increasing CRC screening rates across CHC systems serving diverse, low-income populations.
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Affiliation(s)
- Maria Elena Martinez
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Valesca Largaespada
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Sheila F Castañeda
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jesse N Nodora
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
- Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Borsika A Rabin
- Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla, California, USA
| | - Jennifer Covin
- Health Quality Partners of Southern California, San Diego, California, USA
| | - Kristine Ortwine
- Integrated Health Partners of Southern California, San Diego, California, USA
| | | | - Nicole Howard
- Health Quality Partners of Southern California, San Diego, California, USA
| | | | | | | | | | - Samir Gupta
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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Coronado GD, Nyongesa DB, Petrik AF, Thompson JH, Escaron AL, Pham T, Leo MC. The Reach of Calls and Text Messages for Mailed FIT Outreach in the PROMPT Stepped-Wedge Colorectal Cancer Screening Trial. Cancer Epidemiol Biomarkers Prev 2024; 33:525-533. [PMID: 38319289 DOI: 10.1158/1055-9965.epi-23-0940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/27/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Mailed fecal immunochemical test (FIT) outreach can improve colorectal cancer screening participation. We assessed the reach and effectiveness of adding notifications to mailed FIT programs. METHODS We conducted secondary analyses of a stepped-wedge evaluation of an enhanced mailed FIT program (n = 15 clinics). Patients were stratified by prior FIT completion. Those with prior FIT were sent a text message (Group 1); those without were randomized 1:1 to receive a text message (Group 2) or live phone call (Group 3). All groups were sent automated phone call reminders. In stratified analysis, we measured reach and effectiveness (FIT completion within 6 months) and assessed patient-level associations using generalized estimating equations. RESULTS Patients (n = 16,934; 83% Latino; 72% completed prior FIT) were reached most often by text messages (78%), followed by live phone calls (71%), then automated phone calls (56%). FIT completion was higher in patients with prior FIT completion versus without [44% (Group 1) vs. 19% (Group 2 + Group 3); P < 0.01]. For patients without prior FIT, effectiveness was higher in those allocated to a live phone call [20% (Group 3) vs. 18% (Group 2) for text message; P = 0.04] and in those who personally answered the live call (28% vs. 9% no call completed; P < 0.01). CONCLUSIONS Text messages reached the most patients, yet effectiveness was highest in those who personally answered the live phone call. IMPACT Despite the broad reach and low cost of text messages, personalized approaches may more successfully boost FIT completion.
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Affiliation(s)
- Gloria D Coronado
- Kaiser Permanente Center for Health Research, Portland, Oregon
- University of Arizona Cancer Center, Tucson, Arizona
| | | | - Amanda F Petrik
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Anne L Escaron
- AltaMed Health Services Corporation, Los Angeles, California
| | - Tuan Pham
- AltaMed Health Services Corporation, Los Angeles, California
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon
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Williams RM, Whealan J, Taylor KL, Adams-Campbell L, Miller KE, Foley K, Luta G, Brandt H, Glassmeyer K, Sangraula A, Yee P, Camidge K, Blumenthal J, Modi S, Kratz H. Multilevel approaches to address disparities in lung cancer screening: a study protocol. Implement Sci Commun 2024; 5:15. [PMID: 38365820 PMCID: PMC10870584 DOI: 10.1186/s43058-024-00553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Low-dose computed tomography (lung cancer screening) can reduce lung cancer-specific mortality by 20-24%. Based on this evidence, the United States Preventive Services Task Force recommends annual lung cancer screening for asymptomatic high-risk individuals. Despite this recommendation, utilization is low (3-20%). Lung cancer screening may be particularly beneficial for African American patients because they are more likely to have advanced disease, lower survival, and lower screening rates compared to White individuals. Evidence points to multilevel approaches that simultaneously address multiple determinants to increase screening rates and decrease lung cancer burden in minoritized populations. This study will test the effects of provider- and patient-level strategies for promoting equitable lung cancer screening utilization. METHODS Guided by the Health Disparities Research Framework and the Practical, Robust Implementation and Sustainability Model, we will conduct a quasi-experimental study with four primary care clinics within a large health system (MedStar Health). Individuals eligible for lung cancer screening, defined as 50-80 years old, ≥ 20 pack-years, currently smoking, or quit < 15 years, no history of lung cancer, who have an appointment scheduled with their provider, and who are non-adherent to screening will be identified via the EHR, contacted, and enrolled (N = 184 for implementation clinics, N = 184 for comparison clinics; total N = 368). Provider participants will include those practicing at the partner clinics (N = 26). To increase provider-prompted discussions about lung screening, an electronic health record (EHR) clinician reminder will be sent to providers prior to scheduled visits with the screening-eligible participants. To increase patient-level knowledge and patient activation about screening, an inreach specialist will conduct a pre-visit phone-based educational session with participants. Patient participants will be assessed at baseline and 1-week post-visit to measure provider-patient discussion, screening intentions, and knowledge. Screening referrals and screening completion rates will be assessed via the EHR at 6 months. We will use mixed methods and multilevel assessments of patients and providers to evaluate the implementation outcomes (adoption, feasibility, acceptability, and fidelity). DISCUSSION The study will inform future work designed to measure the independent and overlapping contributions of the multilevel implementation strategies to advance equity in lung screening rates. TRIAL REGISTRATION ClinicalTrials.gov, NCT04675476. Registered December 19, 2020.
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Affiliation(s)
- Randi M Williams
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA.
| | - Julia Whealan
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Kathryn L Taylor
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Lucile Adams-Campbell
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | | | - Kristie Foley
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Heather Brandt
- Epidemiology and Cancer Control Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Katharine Glassmeyer
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Anu Sangraula
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Peyton Yee
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Kaylin Camidge
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | | | | | - Heather Kratz
- The Catholic University of America, Washington, DC, USA
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Paskett ED, Kruse-Diehr AJ, Oliveri JM, Vanderpool RC, Gray DM, Pennell ML, Huang B, Young GS, Fickle D, Cromo M, Katz ML, Reiter PL, Rogers M, Gross DA, Fairchild V, Xu W, Carman A, Walunis JM, McAlearney AS, Huerta TR, Rahurkar S, Biederman E, Dignan M. Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial. Transl Behav Med 2023; 13:748-756. [PMID: 37202831 PMCID: PMC10538475 DOI: 10.1093/tbm/ibad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Appalachian regions of Kentucky and Ohio are hotspots for colorectal cancer (CRC) mortality in the USA. Screening reduces CRC incidence and mortality; however, screening uptake is needed, especially in these underserved geographic areas. Implementation science offers strategies to address this challenge. The aim of the current study was to conduct multi-site, transdisciplinary research to evaluate and improve CRC screening processes using implementation science strategies. The study consists of two phases (Planning and Implementation). In the Planning Phase, a multilevel assessment of 12 health centers (HC) (one HC from each of the 12 Appalachian counties) was conducted by interviewing key informants, creating community profiles, identifying HC and community champions, and performing HC data inventories. Two designated pilot HCs chose CRC evidence-based interventions to adapt and implement at each level (i.e., patient, provider, HC, and community) with evaluation relative to two matched control HCs. During the Implementation Phase, study staff will repeat the rollout process in HC and community settings in a randomized, staggered fashion in the remaining eight counties/HCs. Evaluation will include analyses of electronic health record data and provider and county surveys. Rural HCs have been reluctant to participate in research because of concerns about capacity; however, this project should demonstrate that research does not need to be burdensome and can adapt to local needs and HC abilities. If effective, this approach could be disseminated to HC and community partners throughout Appalachia to encourage the uptake of effective interventions to reduce the burden of CRC.
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Affiliation(s)
- Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, OH, USA
| | - Aaron J Kruse-Diehr
- University of Kentucky College of Medicine, Department of Family and Community Medicine, Lexington, KY, USA
- University of Kentucky Markey Cancer Center, Cancer Prevention and Control Research Program, Lexington, KY, USA
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Robin C Vanderpool
- University of Kentucky College of Public Health, Department of Health, Behavior and Society, Lexington, KY, USA
| | - Darrell M Gray
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, OH, USA
| | - Michael L Pennell
- The Ohio State University College of Public Health, Division of Biostatistics, Columbus, OH, USA
| | - Bin Huang
- University of Kentucky Markey Cancer Center, Division of Biostatistics, Biostatistics and Bioinformatics Shared Resource Facility, Lexington, KY, USA
| | | | - Darla Fickle
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Cromo
- University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, KY, USA
| | - Mira L Katz
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, Columbus, OH, USA
| | - Paul L Reiter
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, Columbus, OH, USA
| | - Melinda Rogers
- University of Kentucky Markey Cancer Center, Community Impact Office, Lexington, KY, USA
| | - David A Gross
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Vickie Fairchild
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Wendy Xu
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
| | - Angela Carman
- University of Kentucky Markey Cancer Center, Cancer Prevention and Control Research Program, Lexington, KY, USA
| | - Jean M Walunis
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Ann Scheck McAlearney
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Family and Community Medicine, Columbus, OH, USA
| | - Timothy R Huerta
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Family and Community Medicine, Columbus, OH, USA
| | | | - Erika Biederman
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Dignan
- University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, KY, USA
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Abdul Latip SNB, Chen SE, Im YR, Zielinska AP, Pawa N. Systematic review of randomised controlled trials on interventions aimed at promoting colorectal cancer screening amongst ethnic minorities. ETHNICITY & HEALTH 2023; 28:661-695. [PMID: 36352539 DOI: 10.1080/13557858.2022.2139815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 10/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Significant disparities exist between different ethnic groups when it comes to participation in colorectal cancer (CRC) screening programmes. A variety of interventions have been proposed to improve participation rates of ethnic minorities for CRC screening. This systematic review aims to appraise the evidence available from published randomised controlled trials (RCTs) and to identify effective interventions aimed at promoting CRC screening amongst underserved ethnic minorities. DESIGN We searched EmBASE, Medline, PsychInfo, Scopus and CINAHL for RCTs that analysed interventions to promote CRC screening in all ethnic minorities. CRC screening was measured as documented or self-reported screening rates. The protocol of this study was registered prospectively on PROSPERO with the registration number CRD42020216384. RESULTS We identified 42 relevant RCT articles, out of 1805 articles highlighted by the initial search. All except one were conducted in the US. The most frequently studied ethnic groups were African-Americans (33%), East Asians (30%), and Hispanics/Latinos (23%). In total, 7/42 (16%) RCTs had multiple arms. Interventions mainly intended to educate (52%), provide patient navigation services (21%), or provide a combination of these interventions (19%). We demonstrate that combination methods are most effective. CONCLUSION Many RCTs, mostly in the US, have trialed interventions aimed to increase CRC screening uptake amongst ethnic minorities to varying success. We conclude that using a combination of methods with patient navigation, education, and cultural tailoring is most effective at increasing CRC screening uptake amongst ethnic minorities. This highlights that multiple factors may hinder CRC screening and finding a one-size-fits-all solution that can be reliably implemented among different cultures and countries may be complex.
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Affiliation(s)
- Siti Nadiah Binte Abdul Latip
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
| | | | - Yu Ri Im
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Agata P Zielinska
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Nikhil Pawa
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
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Mojica CM, Gunn R, Pham R, Miech EJ, Romer A, Renfro S, Clark KD, Davis MM. An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees. BMC Cancer 2022; 22:106. [PMID: 35078444 PMCID: PMC8787027 DOI: 10.1186/s12885-021-09106-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 12/12/2021] [Indexed: 01/06/2023] Open
Abstract
Abstract
Background
Screening supports early detection and treatment of colorectal cancer (CRC). Provision of fecal immunochemical tests/fecal occult blood tests (FIT/FOBT) in primary care can increase CRC screening, particularly in populations experiencing health disparities. This study was conducted to describe clinical workflows for FIT/FOBT in Oregon primary care practices and to identify specific workflow processes that might be associated (alone or in combination) with higher (versus lower) CRC screening rates.
Methods
Primary care practices were rank ordered by CRC screening rates in Oregon Medicaid enrollees who turned age 50 years from January 2013 to June 2014 (i.e., newly age-eligible). Practices were recruited via purposive sampling based on organizational characteristics and CRC screening rates. Data collected were from surveys, observation visits, and informal interviews, and used to create practice-level CRC screening workflow reports. Data were analyzed using descriptive statistics, qualitative data analysis using an immersion-crystallization process, and a matrix analysis approach.
Results
All participating primary care practices (N=9) used visit-based workflows, and four higher performing and two lower performing used population outreach workflows to deliver FIT/FOBTs. However, higher performing practices (n=5) had more established workflows and staff to support activities. Visit-based strategies in higher performing practices included having dedicated staff identify patients due for CRC screening and training medical assistants to review FIT/FOBT instructions with patients. Population outreach strategies included having clinic staff generate lists and check them for accuracy prior to direct mailing of kits to patients. For both workflow types, higher performing clinics routinely utilized systems for patient reminders and follow-up after FIT/FOBT distribution.
Conclusions
Primary care practices with higher CRC screening rates among newly age-eligible Medicaid enrollees had more established visit-based and population outreach workflows to support identifying patients due for screening, FIT/FOBT distribution, reminders, and follow up. Key to practices with higher CRC screening was having medical assistants discuss and review FIT/FOBT screening and instructions with patients. Findings present important workflow processes for primary care practices and may facilitate the implementation of evidence-based interventions into real-world, clinical settings.
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Reich M, Buki LP. Colorectal cancer screening in Uruguay: current assessment and roadmap for the future. PSICOLOGIA-REFLEXAO E CRITICA 2021; 34:20. [PMID: 34185179 PMCID: PMC8241939 DOI: 10.1186/s41155-021-00178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/25/2021] [Indexed: 11/24/2022] Open
Abstract
Cancer is a leading cause of death worldwide and is expected to remain a public health concern for years to come. Within Latin America, Uruguay has the highest colorectal cancer rates. Heeding past calls to action, in this article we provide a critical assessment of colorectal cancer needs and opportunities in Uruguay with a focus on developing a roadmap for future action. First, we provide an overview of risk factors, screening procedures and guidelines, and screening rates. Next, we provide an overview of psychosocial factors that influence colorectal cancer screening, with the goal of providing guidance for future behavioral health promotion initiatives in Uruguay. In this effort, we present four conceptual models that may be used for interventions: the ecological systems theory, informed decision-making, the health beliefs model, and the health literacy model. Subsequently, we propose using an integrated model based on the ecological systems theory and health literacy model to develop national, local, and community-based interventions to increase screening rates and lower the colorectal cancer burden in Uruguay. We close the paper with a summary and implications section, including recommendations for future research programs focused on the assessment of factors that influence screening.
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Affiliation(s)
- Micaela Reich
- Universidad Católica del Uruguay, Montevideo, Uruguay.
| | - Lydia P Buki
- University of Miami, Coral Gables, Florida, 33146, USA
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9
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Sharma KP, Leadbetter S, DeGroff A. Characterizing clinics with differential changes in the screening rate in the Colorectal Cancer Control Program of the Centers for Disease Control and Prevention. Cancer 2020; 127:1049-1056. [PMID: 33301173 DOI: 10.1002/cncr.33325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) funds the Colorectal Cancer Control Program (CRCCP) to increase colorectal cancer (CRC) screening rates in primary care clinics by implementing evidence-based interventions (EBIs). This study examined differences in clinic characteristics and implementation efforts among clinics with differential changes in screening rates over time. METHODS CRCCP clinic data collected by the CDC were used. The outcome was the clinic status (highest quartile [Q4] vs lowest quartile [Q1]), which was based on the absolute screening rate change between the first and second program years. Five clinic characteristic variables and 12 clinic-level CRCCP variables (eg, EBIs) were assessed in bivariable analyses, and logistic regression was used to determine significant predictors of the outcome. RESULTS Each group included 78 clinics (N = 156). Clinics with a Q4 status saw a 14.9 percentage point increase in the screening rate, whereas clinics with a Q1 status experienced a 9.1 percentage point decline. Q4s were more likely than Q1s to have a CRC champion, implement 4 EBIs versus fewer EBIs, implement at least 1 new EBI, and increase the number of implemented EBIs. The adjusted odds of Q4 status were 5.3 times greater (95% confidence interval [CI], 1.9-14.9) if a clinic implemented an additional EBI. The adjusted odds of Q4 status increased to 7.1 (95% CI, 2.2-23.1) if a clinic implemented 2 to 4 additional EBIs. CONCLUSIONS Implementing new EBIs or enhancing existing ones improves CRC screening rates. Additionally, clinics with lower screening rates had greater rate increases and may have benefited more from the CRCCP.
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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
| | - Steven Leadbetter
- 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
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Gawron AJ, Kaltenbach T, Dominitz JA. The Impact of the Coronavirus Disease-19 Pandemic on Access to Endoscopy Procedures in the VA Healthcare System. Gastroenterology 2020; 159:1216-1220.e1. [PMID: 32710908 PMCID: PMC7375295 DOI: 10.1053/j.gastro.2020.07.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Andrew J Gawron
- VA Salt Lake City Health Care System and, University of Utah School of Medicine, Division of Gastroenterology, Salt Lake City, Utah
| | - Tonya Kaltenbach
- San Francisco VA Health Care System and, University of California San Francisco, San Francisco, California
| | - Jason A Dominitz
- VA Puget Sound Health Care System and, University of Washington School of Medicine, Division of Gastroenterology, Seattle, Washington
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