Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2016 Oct;31(10):1190-7.
doi: 10.1007/s11606-016-3760-9. Epub 2016 Jun 8.

Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach

Ethan A Halm  1 , Elisabeth F Beaber  2 , Dale McLerran  2 , Jessica Chubak  3 , Douglas A Corley  4 , Carolyn M Rutter  5 , Chyke A Doubeni  6 , Jennifer S Haas  7 , Bijal A Balasubramanian  8
Affiliations
Multicenter Study

Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach

Ethan A Halm et al. J Gen Intern Med. 2016 Oct.

Abstract

Background: 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.

Objective: 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).

Design: Population-based cohort study.

Participants: 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.

Measures: 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.

Results: 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).

Conclusions: 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.

Keywords: colorectal cancer screening; population health outreach; primary care.

PubMed Disclaimer

Conflict of interest statement

Compliance with ethical standards Funding This study was conducted as part of the NCI-funded consortium Population-Based Research Optimizing Screening through Personalized Regiments (PROSPR), with support from NIH/NCI-funded PROSPR cooperative agreements (grant numbers U54CA163308, U01CA163304, U54CA163261, U5U54CA163262, U54CA163303, U54CA163307, U54CA163313). Dr. Halm was also supported in part by the AHRQ Center for Patient-Centered Outcomes Research (R24 HS022418). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or AHRQ. Conflict of Interest The authors have no conflicts of interest to report, other than receiving funding from the NCI as investigators in the PROSPR U54 grants listed above.

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62(1):10–29. doi: 10.3322/caac.20138. - DOI - PubMed
    1. Bromley EG, May FP, Federer L, Spiegel BM, van Oijen MG. Explaining persistent under-use of colonoscopic cancer screening in African Americans: a systematic review. Prev Med. 2014;71c:40–8. - PMC - PubMed
    1. Ferrante JM, Lee JH, McCarthy EP, et al. Primary care utilization and colorectal cancer incidence and mortality among medicare beneficiaries: a population-based, case–control study. Ann Intern Med. 2013;159(7):437–46. doi: 10.7326/0003-4819-159-7-201310010-00003. - DOI - PMC - PubMed
    1. Cokkinides VE, Chao A, Smith RA, Vernon SW, Thun MJ. Correlates of underutilization of colorectal cancer screening among U.S. adults, age 50 years and older. Prev Med. 2003;36(1):85–91. doi: 10.1006/pmed.2002.1127. - DOI - PubMed
    1. Gupta S, Tong L, Allison JE, et al. Screening for colorectal cancer in a safety-net health care system: access to care is critical and has implications for screening policy. Cancer Epidemiol Biomark Prev. 2009;18(9):2373–9. doi: 10.1158/1055-9965.EPI-09-0344. - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources