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

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 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.

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. 

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.

The intervention is suitable for implementation in a physician's office.

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.

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%).

• 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%).