254543 Effectiveness of providing home colorectal cancer screening tests to diverse flu shot clinic attendees at Kaiser Permanente: A multisite randomized trial

Wednesday, October 31, 2012

Michael Potter, MD , Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
Vicky Gomez, MPH , Division of Research, Kaiser Permanente, Oakland, CA
Lynn Ackerson, PhD , Division of Research, Kaiser Permanente, Oakland, CA
Judith Walsh, MD, MPH , Division of General Internal Medicine and Women's Health Clinical Research Center, University of California, San Francisco, San Francisco, CA
Lawrence W. Green, DrPH , Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
Carol Somkin, PhD , Division of Research, Kaiser Permanente, Oakland, CA
Background: Providing easy access to colorectal cancer screening (CRCS) remains a challenge in most primary care settings. We tested the effectiveness of offering home fecal immunochemical tests (FIT) during flu shot clinics serving diverse patients at Kaiser Permanente Northern California (KPNC).

Setting: KPNC flu shot clinics in Fresno, Redwood City, Richmond, South San Francisco, and Union City.

Methods: Randomized Clinical Trial. On randomly selected dates, clinic staff either offered FIT to eligible patients aged 50-75 (intervention arm) or did not offer FIT (control arm) with their flu shots. We compared CRCS rates achieved in each group.

Results: Of 28,436 patients aged 50-75 who received flu shots on study dates, 6235 (21.9%) were due for CRCS (3351 in the intervention arm, and 2884 in the control arm). In the intervention arm, flu shot clinic staff successfully provided FIT to 53.9% (1805/3351) of eligible patients. Three months after receiving flu shots, 26.9% of all eligible patients in the intervention arm (900/3351) had completed FIT compared to 11.7% (336/2884) in the control arm (p<0.0001). In bivariate analyses, the effectiveness of the intervention was significant at each site and for patients regardless of gender, age, ethnicity, primary language, or healthcare utilization. In multivariate analyses, the adjusted odds ratio for completing FIT within 3 months in the intervention group versus the control group was 2.75 (95% confidence interval 2.40-3.16).

Conclusions: The intervention increased CRCS in diverse KPNC patient populations attending flu shot clinics and is a promising strategy to address CRCS disparities in other settings.

Learning Areas:
Clinical medicine applied in public health
Diversity and culture
Implementation of health education strategies, interventions and programs
Provision of health care to the public
Public health or related nursing
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. Describe the results of a multisite randomized clinical trial demonstrating an effective approach to increase colorectal cancer screening for ethnically diverse patients within an integrated healthcare setting. 2. Assess the potential benefits and challenges of bundling cancer screening with other routinely offered preventive health activities in diverse clinical settings.

Keywords: Cancer Screening, Preventive Medicine

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Vicky Gomez served as project coordinator for the research study and participated in implementation, data collection, and data analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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