From the Division of Gastroenterology, University Hospitals Cleveland Medical Center, Cleveland OH (GSC, AG); Center for Community Health Integration and Department of Family Medicine, Case Western Reserve University, Cleveland OH (JW, KCS); Department of Population and Quantitative Health, Case Western Reserve University, Cleveland OH (SC, PF); and the Case Comprehensive Cancer Center, Cleveland OH (GSC, JW, PF, KCS).
J Am Board Fam Med. 2021 Jan-Feb;34(1):61-69. doi: 10.3122/jabfm.2021.01.200345.
Fecal immunochemical testing (FIT) and multi-target stool DNA testing (mt-sDNA) are recommended colorectal cancer screening options but require follow-up with colonoscopy to determine the source of a positive result. We performed a retrospective analysis in an academic health system to determine adherence to colonoscopy in these patients.
We identified all patients aged 40 years and older with at least 1 primary care visit who had a positive FIT or mt-sDNA between January 2016 and June 2018. We identified receipt of colonoscopy within 6 months of the positive test and reviewed medical records to determine reasons for lack of colonoscopy.
We identified 308 eligible patients with positive FIT and 323 with positive mt-sDNA. Some patients with positive FIT (46.7%) and patients with positive mt-sDNA (71.5%) underwent colonoscopy within 6 months, and time to colonoscopy was also shorter with mt-sDNA (hazard ratio, 1.83; 95% CI, 1.48-2.25). These differences remained in a multivariable model adjusting for patient characteristics. Among patients without colonoscopy after positive FIT, 1 or more system, provider, and patient-related barriers were identified in 32.1%, 57.6%, and 36.3%, respectively. Among patients without colonoscopy after positive mt-sDNA, corresponding frequencies were 30.4%, 43.5%, and 57.6%, respectively.
Follow-up colonoscopy was higher for mt-sDNA than FIT, which could be due in part to preselection by clinicians and/or patients. Among patients who did not follow-up, provider and system factors were as frequently encountered as patient factors. These findings reinforce the need for multi-level interventions to improve follow-up.
粪便免疫化学检测（FIT）和多靶点粪便 DNA 检测（mt-sDNA）是推荐的结直肠癌筛查选择，但需要进行结肠镜检查以确定阳性结果的来源。我们在一个学术医疗系统中进行了回顾性分析，以确定这些患者接受结肠镜检查的依从性。
我们确定了所有年龄在 40 岁及以上、至少有 1 次初级保健就诊、在 2016 年 1 月至 2018 年 6 月期间进行过阳性 FIT 或 mt-sDNA 检测的患者。我们确定了在阳性检测后 6 个月内接受结肠镜检查的情况，并查阅病历以确定未进行结肠镜检查的原因。
我们确定了 308 名 FIT 阳性患者和 323 名 mt-sDNA 阳性患者符合条件。一些 FIT 阳性患者（46.7%）和 mt-sDNA 阳性患者（71.5%）在 6 个月内接受了结肠镜检查，mt-sDNA 患者的结肠镜检查时间也较短（风险比，1.83；95%CI，1.48-2.25）。在调整患者特征的多变量模型中，这些差异仍然存在。在 FIT 阳性后未接受结肠镜检查的患者中，分别有 32.1%、57.6%和 36.3%的患者存在 1 个或多个系统、提供者和患者相关的障碍。在 mt-sDNA 阳性后未接受结肠镜检查的患者中，相应的频率分别为 30.4%、43.5%和 57.6%。
mt-sDNA 的结肠镜检查随访率高于 FIT，这可能部分是由于临床医生和/或患者的预先选择。在未进行随访的患者中，提供者和系统因素与患者因素一样常见。这些发现强调需要采取多层次的干预措施来改善随访。
