Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.
Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Dig Dis Sci. 2021 Nov;66(11):3760-3768. doi: 10.1007/s10620-021-06866-x. Epub 2021 Feb 20.
The fecal immunochemical test (FIT) is a common colorectal cancer screening modality in the USA but often is not followed by diagnostic colonoscopy.
We investigated the efficacy of patient navigation to increase diagnostic colonoscopy after positive FIT results and determined persistent barriers to follow-up despite navigation in a large, academic healthcare system.
The study cohort included all health system outpatients with an assigned primary care provider, a positive FIT result between 12/01/2016 and 06/01/2019, and no documentation of colonoscopy after positive FIT. Two non-clinical patient navigators engaged patients and providers to encourage follow-up, offer solutions to barriers, and assist with colonoscopy scheduling. The primary intervention endpoint was completion of colonoscopy within 6 months of navigation. We documented reasons for persistent barriers to colonoscopy despite navigation and determined predictors of successful follow-up after navigation.
There were 119 patients who received intervention. Of these, 37 (31.1%) patients completed colonoscopy at 6 months. In 41/119 (34.5%) cases, the PCP did not recommend colonoscopy, most commonly due to a normal colonoscopy prior to the positive FIT (19, 46.3%). There were 41/119 patients (34.5%) that declined colonoscopy despite the patient navigator and the PCP order. Male sex and younger age were significant predictors of follow-up (aOR = 2.91, 95%CI, 1.18-7.13; aOR = 0.92, 95%CI, 0.87-0.99).
After implementation of patient navigation, diagnostic colonoscopy was completed for 31.1% of patients with a positive FIT result. However, navigation also highlighted persistent multilevel barriers to follow-up. Future work will develop targeted solutions for these barriers to further increase FIT follow-up rates in our health system.
粪便免疫化学检测（FIT）是美国常用的结直肠癌筛查方法，但常不进行诊断性结肠镜检查。
我们旨在调查患者导航在增加阳性 FIT 结果后的诊断性结肠镜检查效果，并确定在大型学术医疗系统中尽管有导航仍存在持续的随访障碍。
研究队列包括所有有指定初级保健提供者的医疗系统门诊患者，FIT 结果阳性时间在 2016 年 12 月 1 日至 2019 年 6 月 1 日之间，且阳性 FIT 后无结肠镜检查记录。两名非临床患者导航员与患者和医生合作，鼓励其进行随访，解决随访障碍，并协助安排结肠镜检查。主要干预终点是在接受导航后 6 个月内完成结肠镜检查。我们记录了尽管有导航但仍存在持续结肠镜检查障碍的原因，并确定了导航后成功随访的预测因素。
共有 119 名患者接受了干预。其中，37 名（31.1%）患者在 6 个月内完成了结肠镜检查。在 119 例中有 41 例（34.5%）患者的初级保健医生不建议进行结肠镜检查，最常见的原因是 FIT 阳性前有正常的结肠镜检查（19 例，46.3%）。尽管有患者导航员和初级保健医生的医嘱，但仍有 41 例（34.5%）患者拒绝进行结肠镜检查。男性和年轻是随访的显著预测因素（aOR=2.91，95%CI，1.18-7.13；aOR=0.92，95%CI，0.87-0.99）。
实施患者导航后，31.1%的阳性 FIT 结果患者完成了诊断性结肠镜检查。然而，导航也突显了持续存在的多层次随访障碍。未来的工作将针对这些障碍制定有针对性的解决方案，以进一步提高我们医疗系统中的 FIT 随访率。
