Primary care office strategies may increase colon cancer screening

Patients are more likely to receive colorectal cancer screening when primary care practices use an office systems approach, according to an article in the March 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Screenings for colorectal cancer (CRC) reduce its incidence and mortality from the disease, according to background information in the article. Up to fifty percent of people 50 years or older have been screened for CRC by fecal occult blood test (FOBT) or lower endoscopy. Clinician advice for CRC screening can be a major force in a patient obtaining screening tests; however, clinicians face a complicated series of recommended testing strategies for CRC screening.

Esther K. Wei, Sc.D., from Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues studied the efficacy of an office systems method in improving CRC screening behaviors. An office systems approach includes five clinician behaviors: educating patients; identifying patients due for screening; enabling patient compliance; monitoring patient compliance; and notifying patients of their test results. American Cancer Society staff visited practices and found areas for improvement in CRC screening, spending an average of 3 ½ hours in direct contact via telephone or in-person interaction. One hundred twenty-seven clinicians who were provided with resources, tools, and support to make possible positive changes also completed follow-up questionnaires.

Medical records of 551 patients showed a significant increase in the number of patients who became up-to-date with screening recommendations (38.7 percent to 56.1 percent) and tests (34.4 percent to 43.2 percent). Throughout the study period, the use of posters and brochures about CRC screening increased from 20.5 percent to 69.3 percent. The most common method for educating the patient was direct discussion of screening (96.1 percent). The researchers also found improvements in the monitoring of fecal occult blood tests, an increase from 20.6 percent to 37.3 percent.

".we believe that the clinicians would not have implemented changes as effectively without the facilitators' providing attention, support, and technical assistance," the authors wrote. "Overall, our results suggest that use of an office systems approach toward improving CRC screening behavior in real-world primary care practices is feasible and effective enough to warrant considering wider dissemination."