Strategies to Improve Repeat Fecal Occult Blood Testing Cancer Screening
Menée dans 8 cliniques communautaires de Louisiane auprès de 461 patients âgés de 50 à 85 ans, cette étude évalue l'efficacité et les coûts associés à différentes stratégies pour inciter les patients à utiliser chaque année le test de recherche du sang occulte dans les selles
Background : A comparative effectiveness intervention by this team improved initial fecal occult blood testing (FOBT) rates from 3% to 53% among community clinic patients. The purpose of this study was to evaluate the effectiveness and costs associated with a literacy-informed intervention on repeat FOBT testing. Methods : Between 2008 and 2011, a three-arm quasi-experiential comparative effectiveness evaluation was conducted in 8 community clinics in Louisiana. Clinics were randomly assigned to receive: enhanced care, a screening recommendation and FOBT kit annually; a brief educational intervention where patients additionally received a literacy appropriate pamphlet and simplified FOBT instructions; or nurse support where a nurse manager provided the education and followed up with phone support. In year 2 all materials were mailed. The study consisted of 461 patients, ages 50-85, with a negative initial FOBT. Results : Repeat FOBT rates were 38% enhanced care, 33% education, and 59% with nurse support (p=0.017). After adjusting for age, race, gender, and literacy, patients receiving nurse support were 1.46 times more likely to complete repeat FOBT screening than those receiving education (95% CI 1.14-1.06, p=0.002) and 1.45 times more likely than those in enhanced care but this was not significant (95% CI 0.93-2.26 p=0.10). The incremental cost per additional person screened was $2,450 for nurse over enhanced care. Conclusion : A mailed pamphlet and FOBT with simplified instructions did not improve annual screening. Impact : Telephone outreach by a nurse manager was effective in improving rates of repeat FOBT yet this may be too costly for community clinics.