Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach.
Population outreach strategies are increasingly used to improve colorectal cancer (CRC) screening. The influence of primary care on cancer screening in this context is unknown.



To assess associations between primary care provider (PCP) visits and receipt of CRC screening and colonoscopy after a positive fecal immunochemical (FIT) or fecal occult blood test (FOBT).



Population-based cohort study.



A total of 968,072 patients ages 50-74 years who were not up to date with CRC screening in 2011 in four integrated healthcare systems (three with screening outreach programs using FIT kits) in the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium.



Demographic, clinical, PCP visit, and CRC screening data were obtained from electronic health records and administrative databases. We examined associations between PCP visits in 2011 and receipt of FIT/FOBT, screening colonoscopy, or flexible sigmoidoscopy (CRC screening) in 2012 and follow-up colonoscopy within 3 months of a positive FIT/FOBT in 2012. We used multivariable logistic regression and propensity score models to adjust for confounding.



Fifty-eight percent of eligible patients completed a CRC screening test in 2012, most by FIT. Those with a greater number of PCP visits had higher rates of CRC screening at all sites. Patients with ≥1 PCP visit had nearly twice the adjusted-odds of CRC screening (OR = 1.88, 95 % CI: 1.86-1.89). Overall, 79.6 % of patients with a positive FIT/FOBT completed colonoscopy within 3 months. Patients with ≥1 PCP visit had 30 % higher adjusted odds of completing colonoscopy after positive FIT/FOBT (OR = 1.30; 95 % CI: 1.22-1.40).



Patients with a greater number of PCP visits had higher rates of both incident CRC screening and colonoscopy after positive FIT/FOBT, even in health systems with active population health outreach programs. In this era of virtual care and population outreach, primary care visits remain an important mechanism for engaging patients in cancer screening.
Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA. ethan.halm@utsouthwestern.edu.
Ethan A
EA
Halm
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Elisabeth F
EF
Beaber
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Dale
D
McLerran
Group Health Research Institute, Seattle, WA, USA.
Jessica
J
Chubak
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Douglas A
DA
Corley
RAND Corporation, Santa Monica, CA, USA.
Carolyn M
CM
Rutter
Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Chyke A
CA
Doubeni
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
Jennifer S
JS
Haas
Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Dallas, TX, USA.
Bijal A
BA
Balasubramanian
D000359:Aftercare / Q000706:statistics & numerical data; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D009819:Office Visits / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States
colorectal cancer screening; population health outreach; primary care