title: Impact of a Multifaceted Intervention on Promoting Adherence to Screening Colonoscopy Among Persons in HIV Primary Care: A Pilot Study.
abstract: HIV-positive patients have lower colon cancer screening rates and are at increased risk for colon adenocarcinoma. We tested a transdisciplinary prevention model to increase provider and patient adherence to screening colonoscopy. Of 1,339 HIV-positive patients with scheduled clinic appointments during the period September to November 2009, we identified 400 records of eligible patients ≥50 years and retrospectively reviewed for screening colonoscopy referral; if never referred, flagged for referral at next visit. Providers referred 43.5% (174/400) patients and 36.2% (63/174) kept appointment. Within 6 months before the study, 337 patients attended clinic and providers referred 18%. Note that 211/226 patients with flagged records attended clinic at least once during the study 6-month period and providers referred (43.6%). The referral rate for flagged records was significantly different from that for the prior 6 months (p < 0.0001). A randomized trial compared the efficacy of patient decision support versus usual care on screening adherence. Among patients randomized to intervention 17 (51.5%) compared to usual care only 16 (48.5%), intervention group showed significant adherence of 70.6% (12/17) versus 29.4% (5/16), (p = 0.024). In addition, intervention patients had good bowel preparation of 76.9% (10/13) versus usual care 23.1% (3/13), (p = 0.05). This transdisciplinary intervention model significantly increased provider and patient screening colonoscopy behavior.
authors.affiliation: University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Pansy
authors.initials: P
authors.lastname: Ferron
authors.affiliation: University of Miami, Miami, Florida, USA.
authors.forename: Shihab S
authors.initials: SS
authors.lastname: Asfour
authors.affiliation: University of Miami, Miller School of Medicine, Miami, Florida, USA.|Columbia University, New York, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Metsch
authors.affiliation: University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Antoni
authors.affiliation: University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Allan E
authors.initials: AE
authors.lastname: Rodriguez
authors.affiliation: University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Duncan
authors.affiliation: University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Findlay
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010865:Pilot Projects; D011320:Primary Health Care; D012017:Referral and Consultation
keywords: HIV; behavioral studies; colon cancer; evidence based medicine; prevention