Improving uptake of colorectal cancer screening by complex patients at an academic primary care practice: a feasibility study.

Autor:	Desponds C; University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Vaud, Switzerland., Ducros C; University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Vaud, Switzerland., Rochat C; University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Vaud, Switzerland., Galassini L; University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Vaud, Switzerland., Bodenmann P; University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Vaud, Switzerland.; Chair of medicine for vulnerable populations, University of Lausanne, Lausanne, Vaud, Switzerland., Grazioli VS; University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Vaud, Switzerland.; Chair of medicine for vulnerable populations, University of Lausanne, Lausanne, Vaud, Switzerland., Plys E; University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Vaud, Switzerland., von Plessen C; University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Vaud, Switzerland., Gouveia A; University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Vaud, Switzerland.; Harvard Medical School, Boston, Massachusetts, USA., Selby K; University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Vaud, Switzerland kevin.selby@unisante.ch.
Jazyk:	angličtina
Zdroj:	BMJ open quality [BMJ Open Qual] 2024 Aug 28; Vol. 13 (3). Date of Electronic Publication: 2024 Aug 28.
DOI:	10.1136/bmjoq-2024-002844
Abstrakt:	Background: Regular screening reduces mortality from colorectal cancer (CRC). The Canton of Vaud, Switzerland, has a regional screening programme offering faecal immunochemical tests (FITs) or colonoscopy. Participation in the screening programme has been low, particularly among complex patients. Patient navigation has strong evidence for increasing the CRC screening rate. Design and Objective: This feasibility study tested patient navigation performed by medical assistants for complex patients at an academic primary care practice. Baseline Measurements: A review of 328 patients' medical charts revealed that 51% were up-to-date with screening (16% within the programme), 24% were ineligible, 5% had a documented refusal and 20% were not up-to-date, of whom 58 (18%) were complex patients. INTERVENTION FEBRUARY 2023 TO MAY 2023: We tried to help complex patients participate in the screening programme using either in-person or telephone patient navigation. Each intervention was piloted by a physician-researcher and then performed by a medical assistant. Based on the reach, effectiveness, adoption, implementation, maintenance framework, we collected: Intervention participation and refusal, screening acceptance and completion and both patients and medical assistant acceptability (ie, qualitative interviews). Results: Only 4/58 (7%) patients participated in the in-person patient navigation test phase due to scheduling problems. All four patients accepted a prescription and 2/4 (50%) completed their test. We piloted a telephone intervention to bypass scheduling issues but all patients refused a telephone discussion with the medical assistant. At two months after the last intervention, the proportion of patients up-to-date increased from 51% to 56%. Conclusion: Our overall approach was resource-intensive and had little impact on the overall participation rate. It was likely not sustainable. New approaches and reimbursement for a specific patient navigator role are needed to increase CRC screening of complex patients. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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