Academic detailing to increase colorectal cancer screening by primary care practices in Appalachian Pennsylvania
<p>Abstract</p> <p>Background</p> <p>In the United States, colorectal cancer (CRC) is the third most frequently diagnosed cancer and second leading cause of cancer death. Screening is a primary method to prevent CRC, yet screening remains low in the U.S. and particularl...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2011-05-01
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| Series: | BMC Health Services Research |
| Online Access: | http://www.biomedcentral.com/1472-6963/11/112 |
| _version_ | 1818264792644714496 |
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| author | Graybill Marie A Kluhsman Brenda C Lengerich Eugene J Curry William J Liao Jason Z Schaefer Eric W Spleen Angela M Dignan Mark B |
| author_facet | Graybill Marie A Kluhsman Brenda C Lengerich Eugene J Curry William J Liao Jason Z Schaefer Eric W Spleen Angela M Dignan Mark B |
| author_sort | Graybill Marie A |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>In the United States, colorectal cancer (CRC) is the third most frequently diagnosed cancer and second leading cause of cancer death. Screening is a primary method to prevent CRC, yet screening remains low in the U.S. and particularly in Appalachian Pennsylvania, a largely rural area with high rates of poverty, limited health care access, and increased CRC incidence and mortality rates. Receiving a physician recommendation for CRC screening is a primary predictor for patient adherence with screening guidelines. One strategy to disseminate practice-oriented interventions is academic detailing (AD), a method that transfers knowledge or methods to physicians, nurses or office staff through the visit(s) of a trained educator. The objective of this study was to determine acceptability and feasibility of AD among primary care practices in rural Appalachian Pennsylvania to increase CRC screening.</p> <p>Methods</p> <p>A multi-site, practice-based, intervention study with pre- and 6-month post-intervention review of randomly selected medical records, pre- and post-intervention surveys, as well as a post-intervention key informant interview was conducted. The primary outcome was the proportion of patients current with CRC screening recommendations and having received a CRC screening within the past year. Four practices received three separate AD visits to review four different learning modules.</p> <p>Results</p> <p>We reviewed 323 records pre-intervention and 301 post-intervention. The prevalence of being current with screening recommendation was 56% in the pre-intervention, and 60% in the post-intervention (p = 0. 29), while the prevalence of having been screened in the past year increased from 17% to 35% (p < 0.001). Colonoscopies were the most frequently performed screening test. Provider knowledge was improved and AD was reported to be an acceptable intervention for CRC performance improvement by the practices.</p> <p>Conclusions</p> <p>AD appears to be acceptable and feasible for primary care providers in rural Appalachia. A ceiling effect for CRC screening may have been a factor in no change in overall screening rates. While the study was not designed to test the efficacy of AD on CRC screening rates, our evidence suggests that AD is acceptable and may be efficacious in increasing recent CRC screening rates in Appalachian practices which could be tested through a randomized controlled study.</p> |
| first_indexed | 2024-12-12T19:40:33Z |
| format | Article |
| id | doaj.art-bef01f4d63f94637841c0c75068b703e |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-12T19:40:33Z |
| publishDate | 2011-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-bef01f4d63f94637841c0c75068b703e2022-12-22T00:14:12ZengBMCBMC Health Services Research1472-69632011-05-0111111210.1186/1472-6963-11-112Academic detailing to increase colorectal cancer screening by primary care practices in Appalachian PennsylvaniaGraybill Marie AKluhsman Brenda CLengerich Eugene JCurry William JLiao Jason ZSchaefer Eric WSpleen Angela MDignan Mark B<p>Abstract</p> <p>Background</p> <p>In the United States, colorectal cancer (CRC) is the third most frequently diagnosed cancer and second leading cause of cancer death. Screening is a primary method to prevent CRC, yet screening remains low in the U.S. and particularly in Appalachian Pennsylvania, a largely rural area with high rates of poverty, limited health care access, and increased CRC incidence and mortality rates. Receiving a physician recommendation for CRC screening is a primary predictor for patient adherence with screening guidelines. One strategy to disseminate practice-oriented interventions is academic detailing (AD), a method that transfers knowledge or methods to physicians, nurses or office staff through the visit(s) of a trained educator. The objective of this study was to determine acceptability and feasibility of AD among primary care practices in rural Appalachian Pennsylvania to increase CRC screening.</p> <p>Methods</p> <p>A multi-site, practice-based, intervention study with pre- and 6-month post-intervention review of randomly selected medical records, pre- and post-intervention surveys, as well as a post-intervention key informant interview was conducted. The primary outcome was the proportion of patients current with CRC screening recommendations and having received a CRC screening within the past year. Four practices received three separate AD visits to review four different learning modules.</p> <p>Results</p> <p>We reviewed 323 records pre-intervention and 301 post-intervention. The prevalence of being current with screening recommendation was 56% in the pre-intervention, and 60% in the post-intervention (p = 0. 29), while the prevalence of having been screened in the past year increased from 17% to 35% (p < 0.001). Colonoscopies were the most frequently performed screening test. Provider knowledge was improved and AD was reported to be an acceptable intervention for CRC performance improvement by the practices.</p> <p>Conclusions</p> <p>AD appears to be acceptable and feasible for primary care providers in rural Appalachia. A ceiling effect for CRC screening may have been a factor in no change in overall screening rates. While the study was not designed to test the efficacy of AD on CRC screening rates, our evidence suggests that AD is acceptable and may be efficacious in increasing recent CRC screening rates in Appalachian practices which could be tested through a randomized controlled study.</p>http://www.biomedcentral.com/1472-6963/11/112 |
| spellingShingle | Graybill Marie A Kluhsman Brenda C Lengerich Eugene J Curry William J Liao Jason Z Schaefer Eric W Spleen Angela M Dignan Mark B Academic detailing to increase colorectal cancer screening by primary care practices in Appalachian Pennsylvania BMC Health Services Research |
| title | Academic detailing to increase colorectal cancer screening by primary care practices in Appalachian Pennsylvania |
| title_full | Academic detailing to increase colorectal cancer screening by primary care practices in Appalachian Pennsylvania |
| title_fullStr | Academic detailing to increase colorectal cancer screening by primary care practices in Appalachian Pennsylvania |
| title_full_unstemmed | Academic detailing to increase colorectal cancer screening by primary care practices in Appalachian Pennsylvania |
| title_short | Academic detailing to increase colorectal cancer screening by primary care practices in Appalachian Pennsylvania |
| title_sort | academic detailing to increase colorectal cancer screening by primary care practices in appalachian pennsylvania |
| url | http://www.biomedcentral.com/1472-6963/11/112 |
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