The effectiveness of the FLU-FOBT Program in primary care: A randomized trial

Department of Family and Community Medicine, University of California San Francisco School of Medicine, 94143-0900, USA. .
American journal of preventive medicine (Impact Factor: 4.53). 07/2011; 41(1):9-16. DOI: 10.1016/j.amepre.2011.03.011
Source: PubMed


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.
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