We would all like to believe that increased adherence to preventive care recommendations will lower overall, long-term spending. It may or may not, but it almost certainly improves patient health and health outcomes. One important part of preventive care is screening for certain diseases, like cancer, in at-risk populations. How to encourage patients to follow preventive care guidelines, including disease screenings, is the subject of much recent research and is covered by two articles in the Journal of the American Medical Association regarding colon cancer screening. (JAMA Article) Two methods of colon cancer screening, colonoscopy and fecal immunochemical test, were used in the study, which was conducted at a safety net hospital in Texas. Patients either got usual care, or were assigned to an intervention group for one of the two screening methods. Those in the intervention groups got more intensive help to complete the screening and were nagged to get the screening done or scheduled.
The study covered about 6000 people. 38.4% of those in the colonoscopy outreach group got a screening, 28.4% of those in the FIT group completed that test, and 10.7% in the usual care group. Apparently people find the idea of taking a stool sample more unpleasant than having a colonoscopy, with the prep that involves. Having had a colonoscopy, I beg to differ. The low rates of screening across all groups is concerning. Colon cancer can be a hideous disease and early detection makes it much less so. And in fact a significant number of participants in the study had some sort of colon growth that needed to be addressed. It is encouraging, however, that these pretty inexpensive interventions did substantially boost screening rates. In the second study, conducted in France, using physicians to communicate with patients about the need to complete screenings for colon cancer had a small effect on FIT use, but no effect on colonoscopy rates.