Effectiveness of a primary care practice intervention for increasing colorectal cancer screening in Appalachian Kentucky

Prev Med. 2014 Jan:58:70-4. doi: 10.1016/j.ypmed.2013.10.018. Epub 2013 Nov 8.

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.

Keywords: Appalachia; Colorectal cancer screening; Primary care; Randomized controlled trial.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Appalachian Region
  • Colonoscopy
  • Colorectal Neoplasms / diagnosis*
  • Cross-Sectional Studies
  • Directive Counseling / standards
  • Directive Counseling / statistics & numerical data
  • Early Detection of Cancer / methods*
  • Early Detection of Cancer / standards
  • Female
  • Follow-Up Studies
  • Humans
  • Kentucky
  • Male
  • Mass Screening / standards*
  • Medical Records
  • Middle Aged
  • Physicians, Primary Care / standards*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Program Evaluation
  • Sigmoidoscopy
  • Young Adult