Fecal immunochemical testing is undermined when patients fail to obtain a follow-up colonoscopy after positive test results. However, researchers identified two methods that improve follow-up rates, according to a study published in the Annals of Internal Medicine.
Kevin Selby, MD, of Oakland, Calif.-based Kaiser Permanente Division of Research, and colleagues conducted randomized and nonrandomized studies reporting colonoscopy follow-up intervention rates on asymptomatic adults with positive fecal tests.
Researchers analyzed 23 studies, of which five examined provider-level interventions, including reminders or performance data and seven examined system-level interventions, including automated referral, precolonoscopy telephone calls, patient registries and quality improvement efforts. The rest surveyed the effectiveness of patient-level interventions including changes to invitation, provision of results or follow-up appointments and patient navigators.
Here's what they found:
1. Moderate evidence supported the use of patient navigators and provider reminders.
2. System level interventions were ineffective.
3. Seventeen studies reported the proportion of test-positive patients who completed colonoscopy compared to a control with a difference of -7.4 percentage points to 25 percentage points.
Researchers concluded, "Patient navigators and giving providers reminders or performance data may help improve colonoscopy rates of asymptomatic adults with positive fecal blood test results. Current evidence about useful system-level interventions is scant and insufficient."