Timeliness of Colonoscopy After Abnormal Fecal Test Results in a Safety Net Practice
Timeliness of Colonoscopy After Abnormal Fecal Test Results in a Safety Net Practice
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DOI：
10.1007/s10900-016-0165-y
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发表时间：
2016-08-01
影响因子：
5.9
通讯作者：
Coronado, Gloria D.
中科院分区：
文献类型：
--
作者：
Oluloro, Ann;Petrik, Amanda F.;Coronado, Gloria D.
粪便检测只有在检测结果异常的患者接受后续结肠镜检查时才能降低结直肠癌死亡率。作为在优先人群中阻止结肠癌的策略和机会（STOP CRC）项目的一部分，我们检查了与粪便检测结果异常患者坚持随访结肠镜检查相关的因素。作为STOP CRC外展的一部分，弗吉尼亚加西亚纪念健康中心的工作人员分发了1753份粪便免疫化学测试（FIT），其中677份（39%）完成，56份结果异常（8%）。项目工作人员使用逻辑回归分析来检查与结肠镜检查转诊和完成相关的因素。在56例FIT结果异常的患者中，45例（80%）有转诊结肠镜检查的证据，32例（57%）有在18个月内完成结肠镜检查的证据，14例（25%）在粪便检测结果异常的60天内。在校正分析中，西班牙裔在60天内完成随访结肠镜检查的几率低于非西班牙裔白人（校正OR 0.20; 95% CI 0.04，0.92）。女性60天内结肠镜检查的趋势低于男性（调整后OR 0.25; 95% CI 0.06-1.04）。在24例缺乏结肠镜检查病历证据的患者中，19例（79%）有记录在案的原因，包括临床医生未继续、患者拒绝和结肠镜检查无指征。21%的人找不到原因。需要改进以提高随访结肠镜检查完成率，特别是女性和西班牙裔患者。
Fecal testing can only reduce colorectal cancer mortality if patients with an abnormal test result receive a follow-up colonoscopy. As part of the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) project, we examined factors associated with adherence to follow-up colonoscopy among patients with abnormal fecal test results. As part of STOP CRC outreach, Virginia Garcia Memorial Health Center staff distributed 1753 fecal immunochemical tests (FIT), of which 677 (39 %) were completed, and 56 had an abnormal result (8 %). Project staff used logistic regression analyses to examine factors associated with colonoscopy referral and completion. Of the 56 patients with abnormal FIT results; 45 (80 %) had evidence of a referral for colonoscopy, 32 (57 %) had evidence of a completed colonoscopy within 18 months, and 14 (25 %) within 60 days of an abnormal fecal test result. In adjusted analysis, Hispanics had lower odds of completing follow-up colonoscopy within 60 days than non-Hispanic whites (adjusted OR 0.20; 95 % CI 0.04, 0.92). Colonoscopy within 60 days trended lower for women than for men (adjusted OR 0.25; 95 % CI 0.06-1.04). Among the 24 patients lacking medical record evidence of a colonoscopy, 19 (79 %) had a documented reason, including clinician did not pursue, patient refused, and colonoscopy not indicated. No reason was found for 21 %. Improvements are needed to increase rates of follow-up colonoscopy completion, especially among female and Hispanic patients.