title: Effectiveness of a primary care practice intervention for increasing colorectal cancer screening in Appalachian Kentucky.
abstract: OBJECTIVE
  This report describes findings from a randomized controlled trial of an intervention to increase colorectal cancer (CRC) screening in primary care practices in Appalachian Kentucky.
  
  
  METHODS
  Sixty-six primary care practices were randomized to early or delayed intervention groups. The intervention was provided at practices using academic detailing, a method of education where providers receive information on a specific topic through personal contact. Data were collected in cross-sectional surveys of medical records at baseline and six months post-intervention.
  
  
  RESULTS
  A total of 3844 medical records were reviewed at baseline and 3751 at the six-month follow-up. At baselines, colonoscopy was recommended more frequently (43.4%) than any other screening modality, followed by fecal occult blood testing (18.0%), flexible sigmoidoscopy (0.4%), and double-contrast barium enema (0.3%). Rates of documented screening results were higher for all practices at the six-month follow-up for colonoscopy (31.8% vs 29.6%) and fecal occult blood testing (12.2% vs 11.2%). For early intervention practices that recommended screening, colonoscopy rates increased by 15.7% at six months compared to an increase of 2.4% in the delayed intervention practices (p=.01).
  
  
  CONCLUSIONS
  Using academic detailing to reach rural primary care providers with a CRC screening intervention was associated with an increase in colonoscopy.
authors.affiliation: University of Kentucky, Department of Internal Medicine, 800 Rose Street, Room CC444, Lexington, KY 40536-0093, USA. Electronic address: Mbdign2@email.uky.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Dignan
authors.affiliation: Department of Biostatistics, University of Kentucky, USA; Markey Cancer Center, University of Kentucky, USA.
authors.forename: Brent
authors.initials: B
authors.lastname: Shelton
authors.affiliation: Markey Cancer Center, University of Kentucky, USA.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Slone
authors.affiliation: Markey Cancer Center, University of Kentucky, USA.
authors.forename: Cheri
authors.initials: C
authors.lastname: Tolle
authors.affiliation: College of Public Health, University of Kentucky, USA.
authors.forename: Sohail
authors.initials: S
authors.lastname: Mohammad
authors.affiliation: Department of Behavioral Science, University of Kentucky, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Schoenberg
authors.affiliation: Department of Family & Community Medicine, University of Kentucky, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Pearce
authors.affiliation: Markey Cancer Center, University of Kentucky, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Van Meter
authors.affiliation: College of Social Work, University of Kentucky, USA.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Ely
mesh_terms: D000328:Adult; D001061:Appalachian Region; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D037001:Directive Counseling / Q000592:standards / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007629:Kentucky; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008499:Medical Records; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012812:Sigmoidoscopy; D055815:Young Adult
keywords: Appalachia; Colorectal cancer screening; Primary care; Randomized controlled trial