Increasing colorectal cancer screening in rural primary care practices: Results from the Appalachia Community Cancer Network

Background: Colorectal (CRC) cancer is the third most commonly occurring cancer in the U.S. and the third leading cause of cancer-related death. Early detection through periodic screening is recommended for average-risk adults 50-74 years of age because it has been shown to reduce CRC mortality. However, uptake of CRC screening by patients in rural and medically underserved Appalachia is not universal, even among patients in a primary care clinic. The objective of our study was to determine the feasibility of using academic detailing to increase CRC screening in rural primary care practices.

Methods: We developed and implemented clinic-based academic detailing with feedback in four primary care practices, three of which used electronic medical records, in rural Pennsylvania. Academic detailing included education, small media, and practice aids. We measured the uptake of CRC screening before and after detailing by reviewing randomly selected medical charts. We used Key-informant interviews and focus groups for qualitative evaluation.

Results: We reviewed 323 records during the pre-intervention and 301 post-intervention phases. The prevalence of being current with screening recommendation was 56% in the pre-intervention, with 60% being current in the post-intervention (p=0.029), while the prevalence of having been screened in the past year increased from 17% to 35% (p<0.001). Qualitative evaluation reported that the intervention was well received.

Conclusion: The study demonstrates the feasibility of academic detailing with chart review to increase CRC screening in Appalachia, an area that experiences cancer health disparities. Future research should examine the long-term impact of the academic detailing intervention.