Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, US.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
BMC Health Serv Res. 2023 Aug 23;23(1):892. doi: 10.1186/s12913-023-09828-3.
The United States Preventive Services Task Force (USPSTF) lists 32 grade A or B recommended preventive services for non-pregnant United States (US) adults, including colorectal cancer screening (CRC). Little guidance is given on how to implement these services with consistency and fidelity in primary care. Given limited patient visit time and competing demands, primary care providers (PCPs) tend to prioritize a small subset of these recommendations. Completion rates of some of these services, including CRC screening, are suboptimal. Expanding delivery of preventive services to other healthcare providers, where possible, can improve access and uptake, particularly in medically underserved areas or populations. Fecal immunochemical testing (FIT) (at-home, stool-based testing) for CRC screening can be distributed and resulted without PCP involvement. Pharmacists have long delivered preventive services (e.g., influenza vaccination) and may be a good option for expanding CRC screening delivery using FIT, but it is not clear how PCPs would perceive this expansion.
We used semi-structured interviews with PCPs in North Carolina and Washington state to assess perceptions and recommendations for a potential pharmacy-based FIT distribution program (PharmFIT™). Transcripts were coded and analyzed using a hybrid inductive-deductive content analysis guided by the Consolidated Framework for Implementation Research (CFIR) to elucidate potential multi-level facilitators of and barriers to implementation of PharmFIT™.
We completed 30 interviews with PCPs in North Carolina (N = 12) and Washington state (N = 18). PCPs in both states were largely accepting of PharmFIT™, with several important considerations. First, PCPs felt that pharmacists should receive appropriate training for identifying patients eligible and due for FIT screening. Second, a clear understanding of responsibility for tracking tests, communication, and, particularly, follow-up of positive test results should be established and followed. Finally, clear electronic workflows should be established for relay of test result information between the pharmacy and the primary care clinic.
If the conditions are met regarding pharmacist training, follow-up for positive FITs, and transfer of documentation, PCPs are likely to support PharmFIT™ as a way for their patients to obtain and complete CRC screening using FIT.
美国预防服务工作组（USPSTF）为非孕妇的美国成年人列出了 32 项 A 级或 B 级推荐的预防服务，包括结直肠癌筛查（CRC）。在初级保健中，如何一致和忠实地实施这些服务的指导很少。鉴于患者就诊时间有限且存在竞争需求，初级保健提供者（PCP）往往会优先考虑这些建议中的一小部分。这些服务的完成率，包括 CRC 筛查，并不理想。在可能的情况下，将预防服务扩展到其他医疗保健提供者，可以改善获得和接受度，特别是在医疗服务不足的地区或人群中。粪便免疫化学检测（FIT）（家庭、粪便检测）可用于 CRC 筛查，且无需 PCP 参与即可进行检测和出结果。药剂师长期以来一直提供预防服务（例如，流感疫苗接种），并且可能是使用 FIT 扩大 CRC 筛查的一个不错的选择，但 PCP 如何看待这种扩展尚不清楚。
我们使用北卡罗来纳州和华盛顿州的 PCP 半结构式访谈来评估对潜在药房 FIT 分发计划（PharmFIT™）的看法和建议。使用以实施研究综合框架（CFIR）为指导的混合归纳演绎内容分析对转录本进行编码和分析，以阐明 PharmFIT™ 实施的潜在多层次促进因素和障碍。
我们在北卡罗来纳州（N=12）和华盛顿州（N=18）完成了 30 次 PCP 访谈。两个州的 PCP 对 PharmFIT™ 基本持接受态度，但也有一些重要的考虑因素。首先，PCP 认为药剂师应该接受适当的培训，以确定有资格和需要进行 FIT 筛查的患者。其次，应明确建立并遵循跟踪测试、沟通以及特别是阳性测试结果的随访的责任。最后，应建立清晰的电子工作流程，以便在药房和初级保健诊所之间传递测试结果信息。
如果满足药剂师培训、对阳性 FIT 的随访以及文件转移的条件，PCP 很可能支持 PharmFIT™，将其作为患者使用 FIT 进行 CRC 筛查的一种方式。
