The Effectiveness of the FLU-FOBT Program in Primary Care A Randomized Trial
ABSTRACT 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.
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.
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).
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.
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.
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.
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.
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ABSTRACT: The objective of the study was to determine the extent to which the FLU-FOBT Program, a colorectal cancer screening (CRCS) intervention linking the provision of fecal occult blood tests (FOBT) to the time of annual influenza vaccination, resulted in practice changes in six primary care clinics 1 year after it was introduced in a randomized controlled trial (RCT). We assessed CRCS rate changes for influenza vaccine recipients, administered brief serial clinic staff surveys and interviewed clinic leaders 1 year after the RCT. CRCS rates for influenza vaccination recipients between the ages of 50 and 75 years were 42.5% before the RCT, 54.5% immediately after the RCT and 55.8% 1 year after the RCT (P < 0.001 for difference between baseline and 1 year after RCT). Many FLU-FOBT Program components were maintained in most clinics at 1-year follow-up. Only 63% of clinic staff survey respondents (26 of 41) continued offering FOBT with influenza vaccines, but 85% (35 of 41) continued to provide mailing kits with FOBT. Many patient education materials were maintained and staff satisfaction with the intervention remained high. Clinic leaders acknowledged barriers to maintenance but also observed several beneficial practice changes. Many components of the FLU-FOBT Program were maintained, with beneficial outcomes for participating practices.Health Education Research 05/2012; 27(5):886-94. DOI:10.1093/her/cys063 · 1.66 Impact Factor
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ABSTRACT: To determine the effect of common components of primary care-based colorectal cancer (CRC) screening interventions on fecal occult blood test (FOBT) completion within rural and urban community clinics, including: (1) physician's spoken recommendation, (2) providing information or education about FOBTs, and (3) physician providing the FOBT kit; to determine the relative effect of these interventions; and to compare the effect of each intervention between rural and urban clinics. We conducted structured interviews with patients aged 50 years and over receiving care at community clinics that were noncompliant with CRC screening. Self-report of ever receiving a physician's recommendation for screening, FOBT information or education, physician providing an FOBT kit, and FOBT completion were collected. Participants included 849 screening-eligible adults; 77% were female and 68% were African American. The median age was 57; 33% lacked a high school diploma and 51% had low literacy. In multivariable analysis, all services were predictive of rural participants completing screening (physician recommendation: P = .002; FOBT education: P = .001; physician giving FOBT kit: P < .0001). In urban clinics, only physician giving the kit predicted FOBT completion (P < .0001). Compared to urban patients, rural patients showed a stronger relationship between FOBT completion and receiving a physician recommendation (risk ratio [RR]: 5.3 vs. 2.1; P = .0001), receiving information or education on FOBTs (RR: 3.8 vs 1.9; P = .0002), or receiving an FOBT kit from their physician (RR: 22.3 vs. 10.1; P = .035). Participants who receive an FOBT kit from their physician are more likely to complete screening.The Journal of Rural Health 06/2012; 28(3):306-11. DOI:10.1111/j.1748-0361.2011.00402.x · 1.77 Impact Factor
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ABSTRACT: OBJECTIVE:: To increase influenza vaccination rates among industrial employees and their families through a campaign at a large corporation. METHODS:: This prospective, multisite study used employee surveys and claims data to evaluate an evidence-based worksite vaccination program. RESULTS:: Vaccination rates among insured employees and dependents (N = 13,520) increased significantly after the intervention (P < 0.001). More than 90% of vaccinated employees received vaccine at employer-sponsored events. There was a strong association between employee and family vaccination status. Primary reasons for receiving the vaccine were economic (free 84%; convenient 80%; avoid absenteeism 82%), rather than health-related. Knowledge was associated with vaccination, but customized education did not change beliefs. CONCLUSIONS:: Worksite programs can demonstrably increase vaccination rates among industrial employees and families. Consideration should be given to repositioning vaccination from medical treatment to community initiatives offered with other worksite health promotion programs.Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 10/2012; 55(2). DOI:10.1097/JOM.0b013e3182717d13 · 1.80 Impact Factor