title: The effectiveness of the FLU-FOBT program in primary care a randomized trial.
abstract: BACKGROUND
  The FLU-FOBT Program is an intervention in which nurses provide home fecal occult blood tests (FOBTs) to eligible patients during annual influenza vaccination (FLU) campaigns. The effectiveness of the FLU-FOBT Program when implemented during primary care visits has not been extensively studied.
  
  
  OBJECTIVE
  The effectiveness of the FLU-FOBT Program was tested as adapted for use during primary care visits in community clinics serving multiethnic patients with low baseline colorectal cancer (CRC) screening rates.
  
  
  METHODS
  Randomized clinical trial. During intervention weeks, nurses routinely initiated the offering of FOBT to eligible patients who were given FLU (FLU-FOBT group). During control weeks, nurses provided FOBT with FLU only when ordered by the primary care clinician during usual care (FLU-only group).
  
  
  METHODS
  The study was conducted in six community clinics in San Francisco. Participants were patients aged 50-75 years who received FLU during primary care visits during an 18-week intervention beginning on September 28, 2009.
  
  
  METHODS
  The primary outcome was the change in CRC screening rates in the FLU-FOBT group compared to the FLU-only group at the end of the study period, on March 30, 2010. Multivariate logistic regression analysis was used to determine predictors of becoming up-to-date with CRC screening.
  
  
  RESULTS
  Data were analyzed in 2010. A total of 695 participants received FLU on FLU-FOBT dates, and 677 received FLU on FLU-only dates. The CRC screening rate increased from 32.5% to 45.5% (+13.0 percentage points) in the FLU-FOBT group, and from 31.3% to 35.6% (+4.3 percentage points) in the FLU-only group (p=0.018 for change difference). For those due for CRC screening, the OR for completing CRC screening by the end of the measurement period was 2.22 (95% CI=1.24, 3.95) for the FLU-FOBT group compared to the FLU-only group.
  
  
  CONCLUSIONS
  FLU-FOBT Program participants were twice as likely to complete CRC screening as those receiving usual care. The FLU-FOBT Program is a practical strategy to increase CRC screening in community clinics. TRIAL REGISTRATION #: NCT01211379.
authors.affiliation: Department of Family and Community Medicine, University of California San Francisco School of Medicine, 94143-0900, USA. potterm@fcm.ucsf.edu.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Potter
authors.forename: Judith M E
authors.initials: JM
authors.lastname: Walsh
authors.forename: Tina M
authors.initials: TM
authors.lastname: Yu
authors.forename: Ginny
authors.initials: G
authors.lastname: Gildengorin
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Green
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: McPhee
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003153:Community Health Services / Q000379:methods; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000379:methods; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D009780:Occult Blood; D011320:Primary Health Care / Q000379:methods; D012495:San Francisco
chemical_list: D007252:Influenza Vaccines