Enhanced patient intervention increases colorectal screening compliance

NEW YORK (Reuters Health) - An enhanced office and patient management program improves colorectal cancer screening adherence, according to a report in the January 12 issue of the Archives of Internal Medicine.

"The enhanced physician office and patient management intervention used a standardized approach and brief motivational interviews to promote adherence to colorectal cancer screening recommendations," the researchers note. "This conceptually simple intervention could, in principle, be absorbed easily into clinical practice by assigning the task of systematic patient follow-up to existing office personnel."

The program was tested in a 2 x 2 factorial randomized trial involving 599 patients in internal medicine and family practice groups. The patients were between 50 and 79 years old. The practices initiated either enhanced or non-enhanced interventions aimed at convincing patients to complete endoscopic screening for colorectal cancer.

As described by Dr. Bruce S. Ling and colleagues at the University of Pittsburgh Medical Center in Pennsylvania, the enhanced program involved the provision of assistance from researchers to office staff in a number of areas, including implementing office protocols for encouraging screening, tracking patient acceptance of referral for endoscopy, motivational phone interviews for counseling patients, and resolving logistical and administrative barriers to screening as reported by the patients.

Some patients also received an enhanced letter that was tailored specifically to them, acknowledging their personal physician by name and containing information specific to their medical and family history.

Overall, 289 patients (48.2%) completed endoscopic colorectal screening. Completion rates were 53.3% in patients who received the enhanced intervention and the tailored letter, 54.2% in patients who received the enhanced intervention and a non-tailored letter, 43.6% in the group that got a tailored letter but non-enhanced management, and 37.9% in the group that received the non-tailored letter and the non-enhanced management.

The enhanced intervention increased the odds of completing colorectal screening by 1.63-fold, the investigators say.

Pointing to the fact that approximately half of screening-eligible patients in their study actually carried through with screening, the authors conclude, "These results underscore not only the opportunities to enhance endoscopic screening through primary care but also the difficulty of near universal screening."

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