School of Medicine, University of California San Francisco, San Francisco, California.
Division of Gastroenterology, University of California San Francisco, San Francisco, California.
Clin Gastroenterol Hepatol. 2022 Jun;20(6):1326-1333.e4. doi: 10.1016/j.cgh.2021.07.022. Epub 2021 Jul 16.
BACKGROUND & AIMS: Reports of mailed fecal immunochemical test (FIT) outreach effectiveness over time are minimal. We aimed to better evaluate a mailed FIT program with longitudinal metrics.
A total of 10,771 patients aged 50 to 75 years not up-to-date with colorectal cancer screening were randomized to intervention or usual care. The intervention arm received an advanced notification call and informational postcard prior to a mailed FIT. Usual care was at the discretion of the primary care provider. Patients were followed for up to 2.5 years. The primary outcome was the difference in cumulative proportion of completed FIT screening between arms. Screening was further examined with the proportion of time up-to-date, consistency of adherence, and frequency of abnormal FIT.
The cumulative proportion of FIT completion was higher in the outreach intervention (73.2% vs 55.1%; P < .001). The proportion of time covered by screening was higher in the intervention group (46.8% vs 27.3%; Δ19.6%; 95% confidence interval, 18.2%-20.9%). Patients assigned to FIT outreach were more likely to consistently complete FITs (2 completed of 2 offered) (50.1% vs 21.8%; P < .001). However, for patients who did not complete the FIT during the first cycle, only 17.1% completed a FIT during the second outreach cycle. The number and overall proportion of abnormal FIT was significantly higher in the outreach intervention (6.9% Outreach vs 4.1% Usual Care; P < .01).
Organized mailed FIT outreach significantly increased colorectal cancer screening over multiple years in this safety-net health system. Although mailing was overall effective, the effect was modest in patients who did not complete FIT in first cycle of intervention. (ClincialTrials.gov, NCT02613260).
有关随邮件寄出的粪便免疫化学检测（FIT）随时间推移的效果报告很少。我们旨在通过纵向指标更好地评估随邮件寄出的 FIT 项目。
共纳入 10771 名年龄在 50 至 75 岁之间、尚未进行结直肠癌筛查的患者，将其随机分配至干预组或常规护理组。干预组在收到邮寄的 FIT 之前先接受高级通知电话和信息明信片。常规护理由初级保健提供者自行决定。患者随访时间长达 2.5 年。主要结局是两组间完成 FIT 筛查的累积比例差异。进一步通过时间覆盖比例、一致性、以及异常 FIT 的频率来检查筛查情况。
在干预组中，FIT 完成的累积比例更高（73.2% vs 55.1%；P <.001）。干预组的筛查时间覆盖比例更高（46.8% vs 27.3%；Δ19.6%；95%置信区间，18.2%-20.9%）。被分配到 FIT 外展服务的患者更有可能持续完成 FIT（2 次提供的 2 次完成）（50.1% vs 21.8%；P <.001）。然而，对于在第一个周期未完成 FIT 的患者，只有 17.1%的患者在第二个外展周期完成了 FIT。在外展干预组中，异常 FIT 的数量和总体比例明显更高（6.9% 外展 vs 4.1% 常规护理；P <.01）。
在这个医疗保障系统中，组织性的随邮件寄出的 FIT 外展在多年内显著增加了结直肠癌筛查。尽管邮寄总体上是有效的，但在第一轮干预中未完成 FIT 的患者中效果不大。（ClinicalTrials.gov，NCT02613260）。
