Two-year follow-up of the effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers.
OBJECTIVE
We previously found that a multifaceted outreach intervention achieved 82 % annual adherence to colorectal cancer (CRC) screening with fecal occult blood testing (FOBT). This study assessed adherence to FOBT after a second outreach.


METHODS
We followed 225 patients in community health centers in Chicago, Illinois, who were randomized to the intervention group. Our primary analysis focused on 124 patients who completed FOBT during the first outreach and were due again for annual FOBT; 90% were Latino, 87% preferred to speak Spanish, and 77% were uninsured. Second outreach consisted of (1) a mailed reminder letter, a free fecal immunochemical test (FIT) with postage-paid return envelope, (2) automated phone and text messages, (3) automated reminders 2 weeks later if the FIT was not returned, and (4) a telephone call after 3 months. Our main outcome was completion of FIT within 6 months of the due date. We also analyzed the proportion of the original 225 patients who were fully screened for CRC over the 2-year study period.


RESULTS
A total of 88.7% of patients completed a FIT within 6 months of their second outreach. Over the 2 years since the first outreach, 71.6% of the 225 patients assigned to the intervention group were fully up to date on CRC screening, another 11.1% had been screened suboptimally, and 17.3% were inadequately screened or not screened.


CONCLUSIONS
It is possible to achieve high rates of CRC screening over a 2-year period for vulnerable populations using outreach with FIT as a primary strategy.
Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. dwbaker@northwestern.edu.|Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. dwbaker@northwestern.edu.|Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA. dwbaker@northwestern.edu.|Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. dwbaker@northwestern.edu.
David W
DW
Baker
Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. t-brown@northwestern.edu.|Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. t-brown@northwestern.edu.
Tiffany
T
Brown
Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. sgoldman@eriefamilyhealth.org.|Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. sgoldman@eriefamilyhealth.org.
Shira N
SN
Goldman
Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. david.liss@northwestern.edu.|Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. david.liss@northwestern.edu.
David T
DT
Liss
Erie Family Health Center, Chicago, IL, USA. skollar@eriefamilyhealth.org.
Stephanie
S
Kollar
Erie Family Health Center, Chicago, IL, USA. kate.balsley@northwestern.edu.
Kate
K
Balsley
Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. jlee1@northwestern.edu.|Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. jlee1@northwestern.edu.
Ji Young
JY
Lee
Erie Family Health Center, Chicago, IL, USA. dbuchanan@eriefamilyhealth.org.
David R
DR
Buchanan
D000368:Aged; D002641:Chicago; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003151:Community Health Centers; D003159:Community-Institutional Relations; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D016032:Randomized Controlled Trials as Topic
Colorectal cancer screening; Community health centers; Disparities; Fecal immunochemical testing; Fecal occult blood testing