Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; The University of California Los Angeles Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, University of California David Geffen School of Medicine, Los Angeles, California; Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, California.
Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, California.
Clin Gastroenterol Hepatol. 2019 Feb;17(3):469-476. doi: 10.1016/j.cgh.2018.05.022. Epub 2018 May 29.
BACKGROUND & AIMS: Colorectal cancer is common yet largely preventable. The fecal immunochemical test (FIT) is a highly recommended screening method, but patients with positive results must receive a follow-up colonoscopy to determine if they have precancerous or cancerous lesions. We characterized colonoscopic follow-up evaluations and reasons for lack of follow-up in a Veterans Affairs (VA) cohort.
We conducted a retrospective cross-sectional analysis of patients 50 to 75 years old with a positive FIT result from January 1, 2014, through May 31, 2016, in a network of 12 VAs sites in southern California. We determined the proportion of patients who received a follow-up colonoscopy, median time to colonoscopy, and colonoscopy findings. For patients who did not undergo colonoscopy, we determined the documented reason for lack of colonoscopy and factors associated with declining the colonoscopy examination.
Of the 10,635 FITs performed, 916 (8.6%) produced positive results; 569 of these (62.1%) were followed by colonoscopy. The median time to colonoscopy after a positive FIT result was 83 days (interquartile range, 54-145 d), which did not vary between veterans who received a colonoscopy at a VA facility (81 d; interquartile range, 52-143 d) vs a non-VA site (87 d; interquartile range, 60-154 d) (P = .2). For the 347 veterans (37.9%) who did not undergo follow-up colonoscopy, the reasons were patient-related (49.3%), provider-related (16.4%), system-related (12.1%), or multifactorial (22.2%). Overall, patient decline of colonoscopy (35.2%) was the most common reason.
In a cohort of veterans with positive results from FITs during CRC screening, reasons for lack of follow-up colonoscopy varied and included patient, provider, and system factors. These findings can be used to reduce barriers to follow-up colonoscopy and to address system-level challenges in scheduling and attrition for colonoscopy.
结直肠癌较为常见，但大部分是可以预防的。粪便免疫化学检测（FIT）是一种高度推荐的筛查方法，但结果阳性的患者必须接受后续结肠镜检查，以确定是否存在癌前病变或癌症病变。我们对退伍军人事务部（VA）队列中的结肠镜随访评估和缺乏随访的原因进行了描述。
我们对 2014 年 1 月 1 日至 2016 年 5 月 31 日期间在加利福尼亚州南部的 12 个 VA 站点网络中，年龄在 50 至 75 岁之间、FIT 检测结果阳性的患者进行了回顾性横断面分析。我们确定了接受结肠镜随访的患者比例、结肠镜检查的中位时间和结肠镜检查结果。对于未接受结肠镜检查的患者，我们确定了未行结肠镜检查的记录原因以及与拒绝结肠镜检查相关的因素。
在进行的 10635 次 FIT 检测中，有 916 次（8.6%）结果阳性；其中 569 次（62.1%）随后进行了结肠镜检查。阳性 FIT 结果后进行结肠镜检查的中位时间为 83 天（四分位距，54-145 天），在接受 VA 机构结肠镜检查的退伍军人（81 天；四分位距，52-143 天）与非 VA 机构（87 天；四分位距，60-154 天）之间没有差异（P=0.2）。对于 347 名（37.9%）未接受后续结肠镜检查的退伍军人，未行结肠镜检查的原因包括患者相关（49.3%）、提供者相关（16.4%）、系统相关（12.1%）或多因素相关（22.2%）。总体而言，患者拒绝结肠镜检查（35.2%）是最常见的原因。
在 CRC 筛查期间接受 FIT 阳性结果的退伍军人队列中，缺乏结肠镜随访的原因各不相同，包括患者、提供者和系统因素。这些发现可用于减少结肠镜随访的障碍，并解决结肠镜检查中的预约和流失等系统层面的挑战。
