Time to Follow-up After Colorectal Cancer Screening by Health Insurance Type

Breen, Nancy; Skinner, Celette Sugg; Zheng, Yingye; Inrig, Stephen; Corley, Douglas A.; Beaber, Elisabeth F.; García, M. Lombarte; Chubak, Jessica; Doubeni, Chyke A.; Quinn, Virginia P.; Haas, Jennifer S.; Li, Christopher I.; Wernli, Karen J.; Klabunde, Carrie N.

doi:10.1016/j.amepre.2019.01.005

Cited by 14 publications

(7 citation statements)

References 47 publications

(52 reference statements)

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“… 4 - 6 However, in community-based studies, colonoscopy follow-up is much lower, with rates of 30% to 65% reported. 7 - 12 Patient barriers to completing colonoscopy after a positive FIT include costs of the procedure, comorbid conditions taking precedence or increasing procedural risk, social or logistic barriers such as transportation or finding someone to accompany them to the procedure, fear or anxiety, and belief that the test was a false positive (eg, hemorrhoids). 13 , 14 Provider and system failures have also been reported, including not contacting the patient and lack of referral.…”

Section: Introductionmentioning

confidence: 99%

Low Rates of Colonoscopy Follow-up After a Positive Fecal Immunochemical Test in a Medicaid Health Plan Delivered Mailed Colorectal Cancer Screening Program

Green

Baldwin

West

et al. 2020

J Prim Care Community Health

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Background Follow-up colonoscopy after a positive fecal immunochemical test (FIT) is necessary for colorectal cancer (CRC) screening to be effective. We report colonoscopy follow-up rates after a positive FIT overall and by population characteristics in the BeneFIT demonstration pilot, a Medicaid health insurance plan-delivered mailed FIT outreach program. Methods In 2016, 2 health insurance plans in Oregon and in Washington state mailed FIT kits to Medicaid patients who, based on claims data, were overdue for CRC screening. We report follow-up colonoscopy completion rates after positive FIT, and differences in completion rates by age, sex, race, ethnicity, preferred language, and number of primary care visits in the prior year. This research was human subjects approved with a waiver of consent for data collection. Results The FIT positivity rates in Health Plan Oregon and Health Plan Washington were 7.9% (39/488) and 14.6% (125/857), respectively. Colonoscopy completion rates within 12 months of the positive test were 35.9% (14/41) in Health Plan Oregon and 32.8% (41/125) in Health Plan Washington. Colonoscopy completion rates were higher among individuals who preferred a language other than English (Non-English speakers 70.0%, English speakers 31.3%, P = .04). Conclusion In a health plan-delivered mailed FIT outreach program, follow-up colonoscopy rates after a positive test were low. Additional interventions are needed to assure colonoscopy after a positive FIT test and to reap the benefits of screening.

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Section: Introductionmentioning

confidence: 99%

Low Rates of Colonoscopy Follow-up After a Positive Fecal Immunochemical Test in a Medicaid Health Plan Delivered Mailed Colorectal Cancer Screening Program

Green

Baldwin

West

et al. 2020

J Prim Care Community Health

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“…Prior studies examining the impact of health insurance type on follow‐up adherence in different medical fields vary, but many report that patients with private insurance were more likely to attend follow‐up appointments. For instance, Patel et al demonstrated that patients with private health insurance were more likely to attend postoperative appointments for tympanostomy tube insertion, while Breen et al showed that those with Medicaid were less likely to complete follow‐up colonoscopy after positive fecal occult blood tests 16,17 . Although those with private insurance are thought to have greater coverage and access to care, other factors could impact adherence to surveillance in our patient group.…”

Section: Discussionmentioning

confidence: 83%

Patient Characteristics Impacting Adherence to Serial Observation for Vestibular Schwannomas

Wang,

Asfour,

Yang

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveTo examine patient characteristics that impact serial observation adherence among vestibular schwannoma (VS) patients.Study DesignRetrospective chart review.SettingSingle tertiary care center.MethodsWe selected for VS patients from 201 to 2020 who elected for serial observation as initial management. Patients under 18, with previous management, bilateral or intralabyrinthine VS, and neurofibromatosis type 2 were excluded. Demographics, tumor characteristics, and follow‐up status were extracted. Single and multiple logistic regression was used to identify patient characteristics impacting follow‐up.ResultsWe identified 507 VS patients who chose serial observation as initial management. Most were female (56.0%), white (73.0%), and married (72.8%). The mean age was 59.3 and most had private insurance (56.4%). Median Charlson Comorbidity Index was 2.00. Mean pure tone audiometry (PTA) average was 41.7 Hz. Average tumor size was 9.04 mm. Of 507 patients, 358 (70.6%) returned for at least one follow‐up. On multiple logistic regression analysis, patients with private insurance (odds ratio [OR]: 0.39, confidence interval [CI]: 0.22‐0.68; P = .001), racial minority background (OR: 0.54, CI: 0.35‐0.83; P = .005), worse PTA averages (OR: 0.99, CI: 0.98‐1.00; P = .044), and older age at diagnosis (OR: 0.97, CI: 0.95‐1.00; P = .038) were less likely to follow‐up.ConclusionPrivate health insurance, racial minority background, worse PTA average, and older age were associated with decreased follow‐up among adult VS patients electing serial observation. Patients with these characteristics may require additional support to ensure serial observation adherence.

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“…Regarding follow-up, among those with abnormal results (n = 125), only 19 (15.2%) had adequate follow-up. This low follow-up rate might relate to participants coming from medically underserved communities; research indicates ethnic minorities, uninsured/underinsured individuals, or those with lower education often experience inadequate follow-up [31][32][33]. However, these factors cannot fully explain the low follow-up rates among Asian men because, in the POP study, 46.7% of the non-Asian men with abnormal results had adequate follow-up despite being from medically underserved communities.…”

Section: Discussionmentioning

confidence: 85%

A Community-Based Prostate Cancer Screening and Education Program for Asian American Men in Medically Underserved Communities

Cho,

Gor,

Hwang

et al. 2024

IJERPH

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This study analyzed data from a community-based prostate cancer (PCa) education and screening program (Prostate Outreach Project; POP) to enhance PCa-related knowledge among medically underserved Asian American men. It also examined PCa screening history, clinical abnormalities based on prostate-specific antigen (PSA) tests and digital rectal examination (DRE) results, and follow-up and PCa diagnosis rates. Participants—521 Asian men (251 Vietnamese, 142 Chinese, and 128 South Asians)—were offered PCa screening using PSA tests and/or DRE and an educational session on PCa. Of these men, 277 completed PCa-related knowledge surveys before and after viewing an educational video. Significant between-group differences in PCa-related knowledge were found at pre-assessment (p < 0.001) but not at post-assessment (p = 0.11), at which time all groups showed improved PCa-related knowledge. Most participants (77.9%) had never received PCa screening, but Vietnamese men had the lowest previous screening rate (17.3%). Chinese men had elevated PSA values and the highest abnormal DRE rates. Of the 125 men with abnormal screening outcomes, only 15.2% had adequate follow-up. Of the 144 men diagnosed with PCa in POP, 11.1% were Asians (seven Chinese, six Vietnamese, and three South Asian). Despite the ethnic heterogeneity among Asian men, a community outreach program may successfully enhance their PCa-related knowledge.

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Time to Follow-up After Colorectal Cancer Screening by Health Insurance Type

Cited by 14 publications

References 47 publications

Low Rates of Colonoscopy Follow-up After a Positive Fecal Immunochemical Test in a Medicaid Health Plan Delivered Mailed Colorectal Cancer Screening Program

Low Rates of Colonoscopy Follow-up After a Positive Fecal Immunochemical Test in a Medicaid Health Plan Delivered Mailed Colorectal Cancer Screening Program

Patient Characteristics Impacting Adherence to Serial Observation for Vestibular Schwannomas

A Community-Based Prostate Cancer Screening and Education Program for Asian American Men in Medically Underserved Communities

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