Original articleAlimentary tractBarriers to Follow-up Colonoscopies for Patients With Positive Results From Fecal Immunochemical Tests During Colorectal Cancer Screening
Section snippets
Description of Colorectal Cancer Screening Process
The study setting is an integrated network of 12 VA sites in southern California. The majority of patients are screened by either colonoscopy or FIT. For FIT screening, patients receive the Polymedco OC-Auto Micro 80 iFOB FIT kit (Polymedco Inc, Cortland Manor, NY) from PCPs or registered nurses during routine PCP visits. FIT samples are processed only if returned within 14 days of the stool deposit, and the quantitative cut-off value for a positive result is 20 μg hemoglobin/g stool. After a
Descriptive Characteristics of the Sample
During the study period, 10,635 FITs were performed and 916 (8.6%) were positive. The mean age of the cohort was 63.9 years, and 95.9% of patients were male. The cohort was racially/ethnically diverse, with 22.4% blacks and 12.1% Hispanics. In all, 569 (62.1%) patients completed a diagnostic colonoscopy within 6 months, and 73% were performed at the VA. There were no significant differences in uptake of colonoscopy by demographic or clinical factors in bivariate analyses (Table 1).
Time to Colonoscopy Referral and Time to Colonoscopy
Most patients
Discussion
We found that more than one third of Veterans with a positive FIT in a large and diverse VA health care network did not undergo a diagnostic colonoscopy. We also identified several patient-, provider-, and system-level reasons for this lack of follow-up evaluation. Our findings are consistent with prior studies that have suggested a 40% to 60% colonoscopy follow-up rate after a positive FIT in VA and non-VA populations.6, 9, 14 In addition, our findings mirror those of other studies in
Acknowledgments
The authors would like to thank Mark Reid for his assistance with preliminary statistical analyses.
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Conflicts of interest The authors disclose no conflicts.
Funding Supported by a Veterans Affairs Health Services Research and Development Senior Research Career Scientist Award (project RCS 05-195) (E.M.Y.); support for analyses was provided by the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System (project CIN 13-417); and also supported by the VA Greater Los Angeles Healthcare System Department of Medicine and Division of Gastroenterology (F.M.). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.