Intervention during wait time: Identification and referral of individuals nonadherent for colorectal screening
Abar B, Dalawari P, Ogedegbe C, Klausner HA, Adler D, Bradley K, and Sethuraman KN. Intervention during wait time: Identification and referral of individuals nonadherent for colorectal screening. Acad Emerg Med 2019; 26:S183-S184.
Acad Emerg Med
Background: This study examined the extent to which volunteer pre-health professions students, (research associates; RAs), could identify patients and their visitors non-adherent for recommended colorectal screening and refer non-adherent individuals. Methods: Patients and their visitors 50-75 years were questioned on their history of colorectal screening by RAs using a standardized interview in REDCap. A convenience sample of participants was enrolled from 7 EDs around the country, ranging from community hospitals to academic institutions. Participants were excluded for high acuity or inability to communicate with the RAs. Those found to be non-adherent to US Preventive Services Task Force recommendations received information on how to obtain colorectal screening through options in each hospital's system. Results: RAs approached 24,411 individuals; 10,041 (41%) were eligible. Of these, 8,530 (85%) consented: 6,333 patients and 2,197 visitors. 54% were women, 63% self-identified as White and 26% Black, and Hispanic/Latino ethnicity was reported for 13%. The vast majority (88%) had a PCP. 5,816 individuals (68%) reported they had previously received a colonoscopy, sigmoidoscopy, or recent (i.e., w/i 12 mos.) fecal occult blood test. Of previously screened individuals, 327 (6%) reported their last colonoscopy was > 10 years ago (i.e., non-adherent), and 68 (1%) reported their last sigmoidoscopy was > 5 years ago (non-adherent; 35 non-adherent for both). The total rate of non-adherence or uncertainty about adherence to recommended colorectal screening in this sample was 36%. Non-Hispanic participants were more likely to be adherent than Hispanic participants (65% vs 58%, p < 0.001), and White participants were more likely than non-White participants (68% vs 58%, p < 0.001). Greater education was associated with greater likelihood of screening (p < 0.001), as was private insurance (71% vs 57%), Medicare insurance (70% vs. 61%), and having a PCP (69% vs. 35%; p's < 0.001). Conclusion: RAs are an effective resource for identifying patients and visitors in need of colorectal screening and referring non-adherent individuals. Distinct demographic associations were observed with adherence status, such that tailored interventions may need to be developed in order to effectively improve adherence.