提高初级保健环境中结直肠癌筛查质量的干预措施：一项整群随机对照试验。

Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial.

机构信息

Department of Research on Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina

Department of Research on Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.

出版信息

BMJ Open Qual. 2023 Jun;12(2). doi: 10.1136/bmjoq-2022-002158.

DOI:10.1136/bmjoq-2022-002158

PMID:37339820

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10314692/

Abstract

BACKGROUND

Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates remain below 20% in the country.

METHODS

We conducted an 18-month, two-arm, pragmatic cluster-randomised controlled trial evaluating the effect of a quality improvement intervention, based on the Plan-Do-Study-Act cycles, considering barriers and catalysts to articulate theory and practice, to increase CRC screening rates using FITs at primary care level. The study involved ten public primary health centres in Mendoza province, Argentina. The primary outcome measure was the rate of effective CRC screening. Secondary outcomes were the rate of participants with a positive FIT, tests with invalid results and the rate of participants referred for colonoscopy.

RESULTS

Screening was effective in 75% of the participants in the intervention arm vs 54.2% in the control arm, OR 2.5 (95% CI 1.4 to 4.4, p=0.001). These results remained unchanged after adjusting for individual demographic and socioeconomic characteristics. Regarding secondary outcomes, the overall prevalence of positive tests was 17.7% (21.1% in the control arm and 14.7% in the intervention arm, p=0.3648). The overall proportion of participants with inadequate test results was 5.2% (4.9% in the control arm vs 5.5% in the intervention arm, p=0.8516). All the participants with positive tests were referred for colonoscopy in both groups.

CONCLUSIONS

An intervention based on quality improvement strategies proved to be highly successful in increasing effective CRC screening in Argentina's primary care setting within the public healthcare system.

TRIAL REGISTRATION NUMBER

NCT04293315.

摘要

背景

在阿根廷，约 81%的死亡是由慢性非传染性疾病引起的，21%是由癌症引起的。结直肠癌（CRC）是阿根廷第二常见的癌症。尽管 CRC 筛查已被推荐用于年龄在 50 至 75 岁的成年人，每年使用粪便免疫化学测试（FIT）进行筛查，但该国的筛查率仍低于 20%。

方法

我们进行了一项为期 18 个月、两臂、实用、聚类随机对照试验，评估了基于计划-执行-研究-行动循环的质量改进干预措施的效果，该干预措施考虑了将理论与实践联系起来的障碍和催化剂，以提高初级保健水平使用 FIT 进行 CRC 筛查的率。该研究涉及阿根廷门多萨省的 10 个公共初级保健中心。主要结局指标是有效 CRC 筛查率。次要结局指标是阳性 FIT 的参与者比例、无效结果的检测比例和接受结肠镜检查的参与者比例。

结果

干预组的筛查有效率为 75%，而对照组为 54.2%，OR 2.5（95%CI 1.4 至 4.4，p=0.001）。调整个体人口统计学和社会经济特征后，这些结果仍然不变。关于次要结局，阳性检测的总体患病率为 17.7%（对照组为 21.1%，干预组为 14.7%，p=0.3648）。检测结果不足的参与者总体比例为 5.2%（对照组为 4.9%，干预组为 5.5%，p=0.8516）。两组中所有阳性检测结果的参与者均被转介进行结肠镜检查。