Comparative Effectiveness of a Multifaceted Intervention to Improve Adherence to Annual Colorectal Cancer Screening in Community Health Centers A Randomized Clinical Trial
Comparative Effectiveness of a Multifaceted Intervention to Improve Adherence to Annual Colorectal Cancer Screening in Community Health Centers A Randomized Clinical Trial
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DOI：
10.1001/jamainternmed.2014.2352
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发表时间：
2014-08-01
影响因子：
39
通讯作者：
Wolf, Michael S.
中科院分区：
文献类型：
--
作者：
Baker, David W.;Brown, Tiffany;Wolf, Michael S.
拉丁美洲人和生活贫困的人中，结直肠癌(CRC)筛查率较低。粪便潜血检测(FOBT)是一种推荐的筛查方式，可以克服成本和获取障碍。然而，FOBT降低结直肠癌死亡率的能力依赖于每年筛查的高依从率。目的确定与通常的护理相比，多方面干预是否增加了对每年FOBT的依从性。设计、设置和参与者在社区卫生中心网络中进行的患者级随机对照试验。纳入的患者包括450名在2011年3月至2012年2月期间完成家庭FOBT且测试结果为阴性的患者：72%的参与者是女性；87%是拉丁裔；83%的人表示西班牙语是他们的首选语言；77%的患者没有保险。干预参与的卫生中心的日常护理包括计算机化的提醒、医务助理为患者进行家庭粪便免疫化学测试(FIT)的常规命令，以及临床医生对结直肠癌筛查率的反馈。干预组还收到了(1)邮寄的提醒信，一封带有低识字说明的免费试衣，以及一个邮资已付的退货信封；(2)自动电话和短信，提醒他们该筛查了，试衣正在邮寄给他们；(3)两周后，没有退回试衣者的自动电话和短信提醒；和(4)3个月后由结直肠癌筛查导航员通过个人电话联系。主要结果和衡量FOBT在患者预定进行年度筛查的日期起6个月内完成。结果干预患者完成FOBT的可能性显著高于常规护理的患者(82.2%vs37.3%；P<；.001)。在185名完成筛查的干预患者中，10.2%的患者在预产期之前完成筛查(未给予干预)，39.6%的患者在2周内完成(初始干预后)，24.0%的患者在2-13周内完成(自动电话/短信提醒)，8.4%的患者在13-26周(个人电话后)完成筛查。结论和相关性这一干预措施大大提高了对年度结直肠癌筛查的依从性；大多数筛查是在没有个人电话的情况下完成的。利用卫生信息技术促进的相对低成本的战略，有可能改善对弱势人群的年度CRC筛查。
IMPORTANCE Colorectal cancer (CRC) screening rates are lower among Latinos and people living in poverty. Fecal occult blood testing (FOBT) is one recommended screening modality that may overcome cost and access barriers. However, the ability of FOBT to reduce CRC mortality depends on high rates of adherence to annual screening.OBJECTIVE To determine whether a multifaceted intervention increases adherence to annual FOBT compared with usual care.DESIGN, SETTING, AND PARTICIPANTS Patient-level randomized controlled trial conducted in a network of community health centers. Included were 450 patients who had previously completed a home FOBT from March 2011 through February 2012 and had a negative test result: 72% of participants were women; 87% were Latino; 83% stated that Spanish was their preferred language; and 77% were uninsured.INTERVENTIONS Usual care at participating health centers included computerized reminders, standing orders for medical assistants to give patients home fecal immunochemical tests (FIT), and clinician feedback on CRC screening rates. The intervention group also received (1) a mailed reminder letter, a free FIT with low-literacy instructions, and a postage-paid return envelope; (2) an automated telephone and text message reminding them that they were due for screening and that a FIT was being mailed to them; (3) an automated telephone and text reminder 2 weeks later for those who did not return the FIT; and (4) personal telephone outreach by a CRC screening navigator after 3 months.MAIN OUTCOMES AND MEASURES Completion of FOBT within 6 months of the date the patient was due for annual screening.RESULTS Intervention patients were much more likely than those in usual care to complete FOBT (82.2% vs 37.3%; P < .001). Of the 185 intervention patients completing screening, 10.2% completed prior to their due date (intervention was not given), 39.6% within 2 weeks (after initial intervention), 24.0% within 2 to 13 weeks (after automated call/text reminder), and 8.4% between 13 and 26 weeks (after personal call).CONCLUSIONS AND RELEVANCE This intervention greatly increased adherence to annual CRC screening; most screenings were achieved without personal calls. It is possible to improve annual CRC screening for vulnerable populations with relatively low-cost strategies that are facilitated by health information technologies.