title: The effects of teamwork and system support on colorectal cancer screening in primary care practices.
abstract: BACKGROUND
  While cancer screening is generally increasing in the U.S., colorectal cancer (CRC) screening remains low. Most CRC screening interventions focus either on patients or individual clinicians without examining the office context in which CRC screening is implemented. This study examines whether primary care practices that involve staff in general forms of health education have higher CRC screening rates than practices that do not.
  
  
  METHODS
  Cross-sectional data from 22 New Jersey and Pennsylvania family medicine practices were analyzed. Data include chart audits for 795 men and women eligible for CRC screening (age 50-70) and practice information surveys for each practice. Generalized estimating equations were used to determine CRC screening correlates.
  
  
  RESULTS
  Overall, 31.3% (n=249) of patients received CRC screening. Practices that reported using nursing or health educator staff to provide behavioral counseling to patients on topics such as diet, exercise or tobacco use were significantly more likely to also have higher CRC screening rates (z=7.30, p<0.0001). Their patients had 2.96 times increased odds of CRC screening than those in other practices (95% C.I., 2.21-3.96). Reminder system use was also associated with higher CRC screening (z=4.96, p<0.0001). In practices that used reminder systems, patients had 2.57 times increased odds of CRC screening than others (95% C.I., 1.77-3.74).
  
  
  CONCLUSIONS
  These findings suggest that interventions to achieve better CRC screening rates do not need to focus solely on CRC. Higher CRC rates may be achieved by capitalizing on the enhancing contributions of non-physician practice members providing more general health behavior change patient education.
authors.affiliation: The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA. hudsonsh@umdnj.edu
authors.forename: Shawna V
authors.initials: SV
authors.lastname: Hudson
authors.forename: Pamela
authors.initials: P
authors.lastname: Ohman-Strickland
authors.forename: Regina
authors.initials: R
authors.lastname: Cunningham
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Ferrante
authors.forename: Karissa
authors.initials: K
authors.lastname: Hahn
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D040441:Health Educators; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009726:Nurses; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic; D011216:Practice Management, Medical; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration; D017010:Reminder Systems; D012944:Social Support; D000078329:Workforce