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Prev Med. 2015 Jul;76:115-22. doi: 10.1016/j.ypmed.2015.03.028. Epub 2015 Apr 18.

Lack of follow-up colonoscopy after positive FOBT in an organized colorectal cancer screening program is associated with modifiable health care practices.

Author information

1
Credit Valley Hospital, Trillium Health Partners, Mississauga, Ontario, Canada. Electronic address: adriano.correia@trilliumhealthpartners.ca.
2
Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Cancer Care Ontario, Toronto, Canada. Electronic address: Linda.Rabeneck@cancercare.on.ca.
3
Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Department of Surgery and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: BaxterN@smh.toronto.on.ca.
4
Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Electronic address: lawrence.paszat@ices.on.ca.
5
Institute for Clinical Evaluative Sciences, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Electronic address: Rinku.Sutradhar@ices.on.ca.
6
Institute for Clinical Evaluative Sciences, Toronto, Canada. Electronic address: Lingsong.Yun@ices.on.ca.
7
Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Cancer Care Ontario, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: jill.tinmouth@sunnybrook.ca.

Abstract

BACKGROUND:

ColonCancerCheck (CCC), Ontario's organized colorectal cancer (CRC) screening program, uses guaiac fecal occult blood testing (gFOBT). To reduce CRC-related mortality, persons with a positive gFOBT must have colonoscopy. We identified factors associated with failure to have colonoscopy within 6months of a positive gFOBT.

METHODS:

Population-based, retrospective cohort analysis of CCC participants with positive gFOBT (April 2008 to December 2009) using health administrative data. Patient, physician and health care utilization factors associated with a lack of follow-up colonoscopy were identified using descriptive and multivariate analyses.

RESULTS:

There were 21,839 participants with a positive gFOBT; 14,091 (64%) had colonoscopy within 6months. The strongest factors associated with failure to follow-up were recent colonoscopy (in 2years prior vs. >10years or never, OR: 4.31, 95% C.I.: 3.82, 4.86), as well as repeat gFOBT (OR: 6.08, 95% C.I.: 5.46, 6.78) and hospital admission (OR: 4.35, 95% C.I.: 3.57, 5.26) in the follow-up period.

CONCLUSION:

In the first 18months of the CCC Program, 1/3 of those with a positive gFOBT did not have colonoscopy within 6months. Identification of potentially modifiable factors associated with failure to follow up lay the groundwork for interventions to address this critical quality gap.

KEYWORDS:

Colonoscopy; Colorectal cancer; Fecal occult blood testing; Organized screening

PMID:
25895843
DOI:
10.1016/j.ypmed.2015.03.028
[Indexed for MEDLINE]

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