Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Gastrointest Endosc. 2018 Aug;88(2):323-331.e2. doi: 10.1016/j.gie.2018.02.023. Epub 2018 Feb 23.
Colorectal cancer (CRC) screening can reduce CRC incidence and mortality, but measuring screening adherence over time is challenging. We examined adherence using a novel measure characterizing the proportion of time covered (PTC) by screening tests.
Eligible patients were age 50 to 60 years and followed at a large, safety-net health care system between January 2010 and September 2014. We estimated PTC as the number of days up to date with screening divided by the number of days from cohort entry until study end, CRC diagnosis, or death. We estimated mean and median PTC and used least-significant difference tests to assess differences in adherence by patient characteristics.
Of 18,257 patients, most were non-Hispanic black (40.5%) or Hispanic (34.9%) and/or female (62.4%). Approximately 40% (n = 7559) were never screened during the study period; the remaining 10,698 patients completed 19,105 screening examinations (14,481 fecal immunochemical tests [FITs], 4393 colonoscopies, 94 sigmoidoscopies, and 137 barium enemas). Overall, the mean PTC was 29.1% (95% confidence interval [CI], 28.6%-29.5%). Among those who completed at least one screening test (n = 10,698), the mean PTC was 49.0% (95% CI, 48.5%-49.5%). The most common reasons for non-adherence were lack of repeat FIT and no diagnostic colonoscopy after abnormal results for the FIT. The mean PTC increased with the number of primary care visits (0 visits, 21%; 1 visit, 29%; 2-3 visits, 35%; ≥4 visits, 37%; all P < .05).
PTC provides a reliable estimate of screening adherence, capturing breakdowns in the CRC screening process amenable to intervention. Repeat FIT and diagnostic colonoscopy are important intervention targets that may increase adherence in underserved populations.
结直肠癌（CRC）筛查可以降低 CRC 的发病率和死亡率，但随着时间的推移，衡量筛查的依从性具有挑战性。我们使用一种新的方法来衡量筛查测试的覆盖时间比例（PTC），以此来检查依从性。
合格的患者年龄在 50 至 60 岁之间，并于 2010 年 1 月至 2014 年 9 月期间在一家大型的、以保障安全为重点的医疗保健系统中接受随访。我们将 PTC 估计为及时进行筛查的天数除以从队列入组到研究结束、CRC 诊断或死亡的天数。我们估计了 PTC 的平均值和中位数，并使用最小显著差异检验来评估患者特征对依从性的差异。
在 18257 名患者中，大多数为非西班牙裔黑人（40.5%）或西班牙裔（34.9%）和/或女性（62.4%）。大约 40%（n=7559）在研究期间从未接受过筛查；其余 10698 名患者完成了 19105 次筛查检查（14481 次粪便免疫化学测试[FIT]、4393 次结肠镜检查、94 次乙状结肠镜检查和 137 次钡灌肠检查）。总体而言，PTC 的平均值为 29.1%（95%置信区间[CI]，28.6%-29.5%）。在至少完成一次筛查测试的 10698 名患者中，PTC 的平均值为 49.0%（95%CI，48.5%-49.5%）。最常见的不依从原因是缺乏重复的 FIT 和 FIT 结果异常后未进行诊断性结肠镜检查。PTC 随初级保健就诊次数的增加而增加（无就诊，21%；就诊 1 次，29%；就诊 2-3 次，35%；就诊 4 次或以上，37%；所有 P<0.05）。
PTC 提供了一种可靠的筛查依从性估计方法，可以发现 CRC 筛查过程中的缺陷，从而可以进行干预。重复的 FIT 和诊断性结肠镜检查是重要的干预目标，可能会提高服务不足人群的依从性。
