提高农村初级保健中的结直肠癌筛查效果：合作性邮寄粪便免疫化学检测试验的初步效果和实施。
Improving colorectal cancer screening in rural primary care: Preliminary effectiveness and implementation of a collaborative mailed fecal immunochemical test pilot.
机构信息
Oregon Rural Practice-based Research Network, Portland, Oregon, USA.
Department of Family Medicine and School of Public Health, Oregon Health & Science University, Portland, Oregon, USA.
出版信息
J Rural Health. 2023 Jan;39(1):279-290. doi: 10.1111/jrh.12685. Epub 2022 Jun 15.
BACKGROUND
Mailed fecal immunochemical test (FIT) outreach can improve colorectal cancer (CRC) screening rates. We piloted a collaborative mailed FIT program with health plans and rural clinics to evaluate preliminary effectiveness and refine implementation strategies.
METHODS
We conducted a single-arm study using a convergent, parallel mixed-methods design to evaluate the implementation of a collaborative mailed FIT program. Enrollees were identified using health plan claims and confirmed via clinic scrub. The intervention included a vendor-delivered automated phone call (auto-call) prompt, FIT mailing, and reminder auto-call; clinics were encouraged to make live reminder calls. Practice facilitation was the primary implementation strategy. At 12 months post mailing, we assessed the rates of: (1) mailed FIT return and (2) completion of any CRC screening. We took fieldnotes and conducted postintervention key informant interviews to assess implementation outcomes (eg, feasibility, acceptability, and adaptations).
RESULTS
One hundred and sixty-nine Medicaid or Medicare enrollees were mailed a FIT. Over the 12-month intervention, 62 participants (37%) completed screening of which 21% completed the mailed FIT (most were returned within 3 months), and 15% screened by other methods (FITs distributed in-clinic, colonoscopy). Enrollee demographics and the reminder call may encourage mailed FIT completion. Program feasibility and acceptability was high and supported by perceived positive benefit, alignment with existing workflows, adequate staffing, and practice facilitation.
CONCLUSION
Collaborative health plan-clinic mailed FIT programs are feasible and acceptable for implementation in rural clinics and support CRC screening completion. Studies that pragmatically test collaborative approaches to mailed FIT and patient navigation follow-up after abnormal FIT and support broad scale-up in rural settings are needed.
背景
邮寄粪便免疫化学测试（FIT）外展可以提高结直肠癌（CRC）的筛查率。我们与健康计划和农村诊所合作，试点了一个协作式邮寄 FIT 计划，以评估初步效果并完善实施策略。
方法
我们采用收敛平行混合方法设计进行了一项单臂研究，以评估协作式邮寄 FIT 计划的实施情况。使用健康计划的索赔记录和诊所的核对来确认参与者的身份。干预措施包括供应商提供的自动电话（自动呼叫）提示、FIT 邮寄和提醒自动呼叫；诊所被鼓励进行实时提醒电话呼叫。实践促进是主要的实施策略。在邮寄后的 12 个月，我们评估了以下指标的比率：（1）邮寄 FIT 的返回率和（2）任何 CRC 筛查的完成率。我们记录了实地笔记并进行了干预后关键知情人访谈，以评估实施结果（例如，可行性、可接受性和适应性）。
结果
有 169 名医疗补助或医疗保险的参保人收到了 FIT 的邮寄。在 12 个月的干预期间，有 62 名参与者（37%）完成了筛查，其中 21%完成了邮寄 FIT（大多数在 3 个月内返回），15%通过其他方法进行了筛查（在诊所分发的 FIT、结肠镜检查）。参保人的人口统计学特征和提醒电话可能会鼓励邮寄 FIT 的完成。该计划的可行性和可接受性很高，这得益于感知到的积极效益、与现有工作流程的一致性、充足的人员配备和实践促进。
结论
协作式健康计划-诊所邮寄 FIT 计划在农村诊所中是可行且可接受的，可以支持 CRC 筛查的完成。需要进行更具实用性的研究，以测试邮寄 FIT 和异常 FIT 后的患者导航随访的协作方法，并支持在农村地区的广泛推广。
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