The Utilization of Fecal Occult Blood Testing in the Institutionalized Elderly

Abstract

There is a high prevalence of positive results from FOBT among nursing home patients. In most cases, such results do not cause a change of therapy or result in additional workup. Lack of information on the role of FOBT in nursing home patients contributes to the great diversity in utilization of this test by nursing home physicians.

Using a Multifaceted Approach to Improve the Follow-Up of Positive Fecal Occult Blood Test Results

“…For instance, high-sensitivity fecal occult blood test (FOBT) using the Hemoccult SENSA method is the dominant mode of screening for CRC in the Department of Veterans Affairs (VA),10 but more than 40% of veterans with a positive FOBT may not be receiving timely follow-up with colonoscopies 11. Inadequate follow-up of abnormal FOBT has been also documented in other types of practice settings 1,2,6,12–15…”

Physician Recommendations for Follow-Up of Positive Fecal Occult Blood Tests

“…Unfortunately, patient receipt of CDE after positive FOBTs has been consistently reported to be suboptimal (Morris et al 1991;Klos, Drinka, and Goodwin 1991;Myers et al 1993;Levin, Hess, and Johnson 1997;Lurie and Welch 1999;Myers, Fishbein, et al 2001;Glober et al 1994). For example, in a study of patients who discussed their positive FOBTs with their physician, only 38 percent had a documented recommendation for CDE.…”

Testing for Fecal Occult Blood

“…To the Editor: —I was very interested to read the work of Klos et al, 1 who studied the use of fecal occult blood testing (FOBT) in a nursing home. While this may be the first study in a nursing home population, the study of Mangla et al, 2 which Klos et al referenced, is pertinent and deserves more emphasis.…”