Analysis of Visit Factors Associated with Colorectal Cancer Screening in an Academic Outpatient Care Center
Mishra K, Willens DE, and Heidemann DL. Analysis of Visit Factors Associated with Colorectal Cancer Screening in an Academic Outpatient Care Center. J Gen Intern Med 2019; 34(2):S129.
J Gen Intern Med
Background: Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the second leading cause of cancer related death in the United States. CRC screening recommendations by all major organizations allow for either the use of stool-based tests such as fecal immunochem-ical test (FIT), fecal occult blood testing (FOBT) and multitargeted stool DNA (such as Cologuard) or visual tests such as Colonoscopy, CT Colonography, and flexible sigmoidoscopy. Prior literature has shown that screening services are inconsistently delivered across practice settings and continue to be underutilized. Most insurance cover preventative visits to accomplish screening goals and offer services in form of outreach, however, data is lacking on effectiveness of these visits. Likewise, interventions to increase CRC screening uptake have focused on modifying provider attitudes, although, studies have not addressed provider level and gender as a potential factor. Our primary objective was to assess the frequency and type of CRC screening offered by primary care doctors. Our secondary objective was to assess how type of visit and provider factors affect if screening was offered and the type of screening offered. Methods: A retrospective chart review of 2196 patients who were seen in an outpatient academic tertiary care center was performed. Patients between the ages 50-75 years old who had a primary care doctor and were seen in clinic between July 1, 2017 and July 31, 2018 were assessed. Screening offered was defined as either stool tests (FIT, FOBT and Cologuard) or visual tests (Colonoscopy and CT colonography). Results: A total of 2196 patients met our criteria. The mean age was 62.7 years; body mass index (BMI), 31.1kg/m2; females, 54.7%. Cohort was divided into Group A (62%), comprising of people who did not have CRC screening ordered and Group B (38%), who had one or more CRC screening tests ordered. In Group B, some patients had more than one test ordered: 83.1% had Colonoscopy ordered, 10.7% had Cologuard ordered, 13.5% had FIT/FOBT ordered. The rate of colonoscopy completion was 14.7%, and stool testing completion was 34-37.5%. Out of 739 visits during which CRC screening was implemented, 90% were office visits. Surprisingly, having a preventative visit was not associated with an increased likelihood of having CRC screening test ordered (p=0.91). Among patients who had either test ordered, 65.6% of Colonoscopies or 48.4% of Stool tests were ordered by residents (p< 0.001). Conclusions: A significant amount of patients (62.3%) that were seen by their primary care doctor had no CRC screening ordered. Having a wellness visit was not associated with having CRC screening tests ordered. Although colonoscopy was the most commonly ordered screening test, compliance to stool testing was twice as that of colonoscopy. Residents as provider were more likely to order colonoscopy compared to senior staff.