Physician-Oriented Intervention on Follow-Up in Colorectal Cancer Screening

Highlights
Program Title Physician-Oriented Intervention on Follow-Up in Colorectal Cancer Screening
Purpose Designed to increase physician recommendation and performance of complete diagnostic evaluation (CDE) screenings for individuals aged 50 years and older and with an abnormal colorectal cancer screening result. (2004)
Program Focus Awareness building
Population Focus Clinicians
Topic Colorectal Cancer Screening
Age Adults (40-65 years), Older Adults (65+ years)
Gender Female, Male
Race/Ethnicity This information has not been reported.
Setting Clinical
Origination United States
Funded by NCI (Grant number(s): CA68683)
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RE-AIM Scores
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Details about Reach
Reach
100.0%
Details about Effectiveness
Effectiveness
33.3%
Details about Adoption
Adoption
83.3%
Details about Implementation
Implementation
42.9%
The Need
Colorectal cancer screening tests are recommended for women and men 50 years of age and older.  Periodic fecal occult blood testing (FOBT) screening is the most commonly used screening modality.  FOBT can reduce colorectal cancer mortality when patients who show an abnormal result (FOBT positive) undergo a complete diagnostic evaluation (i.e., either colonoscopy or combined flexible sigmoidoscopy and barium enema X-ray).  Yet, primary care physicians frequently do not recommend or perform complete diagnostic evaluation (CDE) screenings for FOBT positive patients.  Programs that focus on increasing physician recommendation and performance of CDE among these patients are needed.
The Program
The Physician-Oriented Intervention program aims to increase the recommendation and thorough follow-up for patients aged 50 years and older with an FOBT positive result.  The program increases physician awareness of patient eligibility for CDE by providing CDE reminders and feedback. The reminders are patient-specific forms sent to physicians when a patient has had an FOBT positive result in the last 60 days.  The feedback component is a biannual report of patients who have had abnormal FOBT results during the prior 6 months, as well as their CDE status.  The program also includes an educational component, in which physicians receive two in-office academic detailing visits, a tailored letter, and a tailored telephone call.  The educational component reviews practice-specific CDE rates and addresses barriers to CDE recommendation identified by providers.
Community Preventive Services Task Force Finding
Guide to Community Preventive Services This program uses intervention approaches recommended by the Community Preventive Services Task Force: one-on-one education interventions (Colorectal Cancer Screening) and client reminder interventions (Colorectal Cancer Screening).
Time Required
Implementation times vary depending on physician appointment-scheduling for academic detailing.  The academic detailing session can be completed in 1 hour.  During the study, physicians received reminder-feedback materials and educational outreach sessions over 12 months. 
Intended Audience
Participants who tested this program were primary care physicians from managed care organization-affiliated practices in southeastern Pennsylvania and southern New Jersey.  The participants of the study included the following populations: Asian, Black, Hispanic and White.
Suitable Settings
The intervention is suitable for implementation in a physician's office.
Required Resources
Required materials include introductory letter to physicians, reminders (internal chart audit form), CDE feedback report, slide presentation on colorectal cancer screening, attendance sheet for the presentation, educational brochures, a tailored letter, Complete Diagnostic Evaluation Review vol. 1 and 2, letter accompanying CME certificates, and the baseline and follow-up surveys. Costs associated with the program's implementation are not provided.
About the Study

A large sample (N = 318) of primary care practices with a total of 470 physicians were randomized to the physician-oriented intervention or to a control group.  All physicians completed a baseline survey.  Physicians in intervention practices received reminder-feedback materials and educational outreach materials over the course of one year.  The reminders were patient-specific forms sent to physicians 60 days after a patient had an abnormal FOBT result.  The feedback component was a biannual report of patients who had abnormal FOBT results during the prior 6 months, as well as their CDE status.  The educational outreach included two in-office academic detailing visits, a tailored letter, and a telephone call.  Physicians in control practices only received reminders during the initial 4 months of intervention.  

Results indicated:

  • CDE recommendation rates were significantly higher for the physicians in the intervention group (79.6%) compared to physicians in the control group (67.3%).

Graph of Study Results

  • CDE performance rates were also significantly higher for the physicians in the intervention group (63.3%) compared to physicians in the control group (53.7%).

Graph of Study Results

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Updated: 04/20/2016
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Please note that RE-AIM stands for Reach, Effectiveness, Adoption, Implementation and Maintenance. However, since “Maintenance” occurs after a program has been implemented, a notes section for this is not included as a part of this tool.