Primary Care Visits Result in More Colorectal Cancer Screening, Better Follow-up
- Many health systems are using aggressive outreach strategies that don’t require a face-to-face doctor visit to initiate cancer screening.
- Patients who saw their primary care providers an average of one or more times per year were twice as likely to be screened for colorectal cancer, and these individuals were 30% more likely to undergo a colonoscopy after receiving a positive stool blood test.
People who visit their primary care physicians are more likely to get potentially life-saving colon cancer screenings and follow-up on abnormal stool blood test results—even in health systems that heavily promote mail-in home stool blood tests that don’t require a doctor visit, a study involving UT Southwestern population health researchers shows. These findings were published by Halm et al in the Journal of General Internal Medicine.
Given the growing interest in population health, many health systems are aggressively using outreach strategies that don’t require a face-to-face doctor visit to initiate cancer screening.
“These findings help underscore the continued importance and effectiveness of visits with primary care physicians in a brave new world of virtual care and population health outreach,” said Ethan Halm, MD, Director of UT Southwestern’s Center for Patient-Centered Outcomes Research and a member of the Harold C. Simmons Comprehensive Cancer Center. “This result is important because screening for colon cancer can result in an early diagnosis and improved survival.”
The study, which involved nearly 1 million people from four different health-care systems in the United States, found that people who had more primary care visits had more screenings and more follow-up colonoscopies when initial tests indicated potential problems than when primary care physicians were not involved. The result held true even in mature, integrated health systems with well-insured patients and aggressive “population health outreach.” These systems mail patients home stool blood test kits and have highly organized infrastructures for follow-up on abnormal results. Individuals don’t have to come in to see a doctor to get a cancer screening test or follow-up.
Many accountable care organizations are using population outreach approaches to promote cancer screening without a primary care provider visit, while other groups have questioned whether patients need to have annual health checkup visits with their primary care provider if they are feeling well, said Dr. Halm.
Colon cancer screening rates remain suboptimal, despite decades of public health campaigns, public reporting on screening rates, and preventive service reminders in electronic health records, the researchers said, prompting a growing number of private and public health systems to promote options that do not require a face-to-face primary care visit.
National guidelines recommend periodic colorectal screening via colonoscopy, flexible sigmoidoscopy, fecal immunochemical tests, or high-sensitivity guaiac fecal occult blood tests. The stool-based tests are inexpensive, easy to mail, and simple for patients to complete. However, their effectiveness requires that positive results be followed up by a diagnostic colonoscopy, and this latest research suggests that primary care providers may play an important role in getting the follow-up diagnostic tests completed, said Dr. Halm. Researchers undertook the study to see whether that was the case.
Researchers examined records from 968,072 patients aged 50 to 74 years who were not up to date with colorectal cancer screening in four integrated health-care systems in the National Cancer Institute–funded Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. Three of the systems had screening outreach programs using fecal immunochemical test kits.
The research team found that patients who saw their primary care providers an average of one or more times per year were twice as likely to be screened for colorectal cancer and that these individuals were 30% more likely to undergo a colonoscopy after receiving a positive stool blood test.
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