Improving Colorectal Cancer Screening Among the Medically Underserved: A Pilot Study within a Federally Qualified Health Center |
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Authors: | Kishore Khankari Mickey Eder Chandra Y Osborn Gregory Makoul Marla Clayman Silvia Skripkauskas Linda Diamond-Shapiro Dan Makundan Michael S Wolf |
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Institution: | (1) Access Community Health Network, Chicago, IL, USA;(2) Health Literacy and Learning Program, Center for Communication and Medicine, Institute for Healthcare Studies, and Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA;(3) Health Literacy and Learning Program, Institute for Healthcare Studies &, Division of General Internal Medicine Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St., Suit 200, Chicago, IL 60611, USA |
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Abstract: | Background Colorectal cancer screening rates remain low, especially among low-income and racial/ethnic minority groups.
Objective We pilot-tested a physician-directed strategy aimed at improving rates of recommendation and patient colorectal cancer screening
completion at 1 federally qualified health center serving low-income, African-American and Hispanic patients. Colonoscopy
was specifically targeted.
Design Single arm, pretest–posttest design.
Setting Urban.
Patients 154 screening-eligible, yet nonadherent primary care patients receiving care at an urban, federally qualified health center.
Intervention 1) manually tracking screening-eligible patients, 2) mailing patients a physician letter and brochure before medical visits,
3) health literacy training to help physicians improve their communication with patients to work to resolution, and 4) establishing
a “feedback loop” to routinely monitor patient compliance.
Measurement Chart review of whether patients received a physician recommendation for screening, and completion of any colorectal cancer
screening test 12 months after intervention. Physicians recorded patients’ qualitative reasons for noncompliance, and a preliminary
cost-effectiveness analysis for screening promotion was also conducted.
Results The baseline screening rate was 11.5%, with 31.6% of patients having received a recommendation from their physician. At 1-year
follow-up, rates of screening completion had increased to 27.9 percent (p < .001), and physician recommendation had increased to 92.9% (p < .001). Common reasons for nonadherence included patient readiness (60.7%), competing health problems (11.9%), and fear
or anxiety concerning the procedure (8.3%). The total cost for implementing the intervention was $4,676 and the incremental
cost-effectiveness ratio for the intervention was $106 per additional patient screened by colonoscopy.
Conclusions The intervention appears to be a feasible means to improve colorectal cancer screening rates among patients served by community
health centers. However, more attention to patient decision making and education may be needed to further increase screening
rates. |
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Keywords: | physician– patient communication colorectal cancer screening intervention FQHC health literacy underserved |
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