Mailed reminder for appointment keeping for colonoscopy screening

Categories

Categories associated with best practice:

  • PP-icon1
  • Adult (ages 25-64) icon
  • Seniors (ages 65+) icon
  • Cancer Icon 1
  • Health Care Setting

Determinants of Health: Language and culture, Income and social status (including gap between rich and poor), Access to health services

Overview

Objective: This intervention aims to increase colorectal screening (by FOBT, sigmoidoscopy, or colonoscopy), particularly among the poor, racial and ethnic minorities, and individuals with limited English proficiency.

Population/Setting: The intervention study was conducted at Heartland International Health Center (HIHC), a federally qualified health center that provides comprehensive primary care to 
a predominantly low income, uninsured, and racially diverse population on the north side of Chicago, Illinois.
Methods: Participants were adults aged 50-80. Patients in the outreach group (N=104) were mailed a colorectal cancer fact sheet and FOBT kit. Patients in the usual care group (N=98) could be referred for screening during usual clinician visits.
Key Results: Four and twelve months after initiation of the outreach protocol, positive and statistically significant findings were found for the outreach group. The findings suggest that this intervention was efficacious for promoting colorectal cancer screening among this population.

Primary Source Document

M Jean-Jacques, E Kaleba, J Gatta, G Gracia, E Ryan, B Choucair, Program to improve colorectal cancer screening in a low-income, racially diverse population: A randomized controlled trial Annals of Family Medicine, 10(5), 412-17.

Contact information of developer(s) and/or implementer(s)

N/A

Intervention Focus

Intervention Goal / ObjectiveLevel(s) TargetedEquity Focus
Increase completion of colorectal cancer screening (by FOBT, sigmoidoscopy, or colonoscopy) 4 months after initiation of the outreach protocol
  • Individual level
People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.

Health Issue(s) that is/are addressed by the Intervention

Health Promotion

    Risk Reduction

      Specific Activities of the Intervention

      • Educational health information offered
      • Other

      Priority/Target Population for Intervention Delivery

      Life Stage

      • Adults (age 25-64 years)
      • Seniors (age 65+ years)

      Settings

      Educational Settings

        Community Setting

        • Health care setting

        Outcomes

        Outcomes and Impact Chart
        Level of ImpactDescription of OutcomeEquity Focus
        Individual LevelLong-term follow-up (12 months): 38% of patients (40 of 104) assigned to the outreach intervention and 15% (15 of 98) assigned to the usual care group completed a colorectal cancer screening test 12 months after initiation of the outreach protocol (statistically significant).Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.
        Individual Level44% of patients (46 of 104) assigned to the outreach intervention and 49% of patients (48 of 98) assigned to the control group made a clinician visit 4 months after initiation of the outreach protocol (not statistically significant).Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.
        Individual LevelShort-term follow-up (4 months): 30% of patients (31 of 104) assigned to the outreach intervention and 5% of patients (5 of 98) assigned to the usual care group completed colorectal cancer screening 4 months after initiation of the outreach protocol (statistically significant).
        Long-term follow-up (12 months): 38% of patients (40 of 104) assigned to the outreach intervention and 15% (15 of 98) assigned to the usual care group completed a colorectal cancer screening test 12 months after initiation of the outreach protocol (statistically significant).
        Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.
        Individual LevelShort-term follow-up (4 months): 30% of patients (31 of 104) assigned to the outreach intervention and 5% of patients (5 of 98) assigned to the usual care group completed colorectal cancer screening 4 months after initiation of the outreach protocol (statistically significant). Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.

        Adaptability

        Implementation History

        • Implemented once (could be a pilot) - The intervention has been implemented once and is theoretically replicable elsewhere.

        Expertise Required for Implementation within the Context of the Intervention

        • No specialized skills required - The Intervention was designed for use/implementation by individuals or groups without highly specialized training. It can be implemented by volunteers, program staff, themselves, etc.

        Are there supports available for implementation

        No.

        Are there resources and/or products associated with the interventions

        Yes. (a) A colorectal cancer fact sheet from the Centers for Disease Control and Prevention in both English and Spanish; (b) a Hemoccult II SENSA Elite kit (Beckman Coulter, Inc), which is a 3-sample guaiac-based FOBT test, and (c) manufacturer-supplied instructions regarding proper patient preparation, sample collection, and FOBT kit handling.