The effectiveness of the FLU-FOBT program in primary care a randomized trial

Journal Name: 
Am J Prev Med
Authors: 
Potter,M.B.
Walsh,J.M.
Yu,T.M.
Gildengorin,G.
Green,L.W.
McPhee,S.J.
Abstract: 
BACKGROUND: The FLU-FOBT Program is an intervention in which nurses provide home fecal occult blood tests (FOBTs) to eligible patients during annual influenza vaccination (FLU) campaigns. The effectiveness of the FLU-FOBT Program when implemented during primary care visits has not been extensively studied. PURPOSE: The effectiveness of the FLU-FOBT Program was tested as adapted for use during primary care visits in community clinics serving multiethnic patients with low baseline colorectal cancer (CRC) screening rates. DESIGN: Randomized clinical trial. During intervention weeks, nurses routinely initiated the offering of FOBT to eligible patients who were given FLU (FLU-FOBT group). During control weeks, nurses provided FOBT with FLU only when ordered by the primary care clinician during usual care (FLU-only group). SETTING/PARTICIPANTS: The study was conducted in six community clinics in San Francisco. Participants were patients aged 50-75 years who received FLU during primary care visits during an 18-week intervention beginning on September 28, 2009. MAIN OUTCOME MEASURES: The primary outcome was the change in CRC screening rates in the FLU-FOBT group compared to the FLU-only group at the end of the study period, on March 30, 2010. Multivariate logistic regression analysis was used to determine predictors of becoming up-to-date with CRC screening. RESULTS: Data were analyzed in 2010. A total of 695 participants received FLU on FLU-FOBT dates, and 677 received FLU on FLU-only dates. The CRC screening rate increased from 32.5% to 45.5% (+13.0 percentage points) in the FLU-FOBT group, and from 31.3% to 35.6% (+4.3 percentage points) in the FLU-only group (p=0.018 for change difference). For those due for CRC screening, the OR for completing CRC screening by the end of the measurement period was 2.22 (95% CI=1.24, 3.95) for the FLU-FOBT group compared to the FLU-only group. CONCLUSIONS: FLU-FOBT Program participants were twice as likely to complete CRC screening as those receiving usual care. The FLU-FOBT Program is a practical strategy to increase CRC screening in community clinics. TRIAL REGISTRATION #: NCT01211379
7
2011
Volume: 
41
Pages: 
9-16
Keywords: 
2010, Aged, analysis, blood, California, clinical, clinical trial, community, Community Medicine, electronic, Family, Influenza, intervention, Medicine, Nurses, Occult Blood, patient, Patients, primary care, regression, Regression Analysis, Research, Research Support, San Francisco, support, Universities, Vaccination