Safety Net Hospital Improves Colon Cancer Screening in Primary Care Setting

Elizabeth Broussard, MD Clinical Assistant Professor Division of Gastroenterology Harborview Medical Center Seattle, WA 98105MedicalResearch.com Interview with:
Elizabeth Broussard, MD
Clinical Assistant Professor
Division of Gastroenterology
Harborview Medical Center
Seattle, WA 98105

Medical Research: What is the background for this study? What are the main findings?

Dr. Broussard: I am a clinical assistant professor of gastroenterology and I practice and teach fellows and residents GI at a safety-net hospital in Seattle and I was seeing too many late stage colorectal cancer (CRC) in our patient population. CRC is preventable with screening, and I wanted to see how the primary care clinics were performing in getting patients screened. When I looked at the baseline percentages, I realized this was an opportunity for improvement. I teamed up with an internal medicine resident Kara Walter, and we did a deep dive into the process of screening. The results of the poster presentation are a product of this teamwork, with cooperation and input from the directors of the six primary care clinics at our hospital. The main findings are that performing the FIT test is complicated and tricky for some patients, that this process can be streamlined with providing a toilet hat, a prepaid postage envelope, and improved and visual instructions. After one year, we saw statistically significant increases in overall screening with FIT in our patient population.

Medical Research: What should clinicians and patients take away from your report?

Dr. Broussard: FIT is not an easy screening test to perform, and especially when you have to instruct patients in a different language or who have other barriers to performing the test. I think you have to look at the patient population you serve, identify baseline data, and try to modify your intervention based on specific patient and provider preference and practice. For example, we found that for one of the clinics, Pioneer Square Clinic (PSQ), a toilet hat was not going to work. PSQ serves mostly homeless patients, and they were not willing or able to carry around a plastic toilet hat as they moved about during the day, and so the clinic staff decided that providing a roll of Saran wrap or some aluminum foil would be a better approach. Homeless patients can create a “seat” using the wrap or foil, and get a sample for FIT in this way. It’s not one size “fits” all.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Broussard: Although we saw a statistically significant increase in overall screening, uptake of FIT was variable across the 6 primary care clinics, and so there are barriers that still remain to screening. I would like to know more information about this differential uptake. Why did certain patients agree to FIT, and others did not? Who are these patients resistant to screening and how do we reach them? How will compliance with FIT be in 2 or 3 years, and will we see a drop off in this population?

Citation:

Presented at the ACG October 2015

Improving Colorectal Cancer Screening Rates Within a Safety-net Hospital Primary Care System

Kara Walter, MD1, Stephen M. Vindigni, MD, MPH1, Alyssa Y. Choi, MD2, Elizabeth Broussard, MD3

University of Washington, Seattle, WA; 2. University of Washington, Issaquah, WA; 3. University of Washington, Seattle, VA

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Elizabeth Broussard, MD (2015). Safety Net Hospital Improves Colon Cancer Screening in Primary Care Setting

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