Colorectal cancer detection increases with notification to nonadherent patients
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The number of colorectal cancer cases detected showed a modest increase in 1 year after general practitioners were provided with a list of their nonadherent patients, according to results published in JAMA.
“Providing general practitioners with a list of their nonadherent patients led to a modest increase in the number of cases of colorectal cancer detected after 1 year compared with usual care,” Héloïse Schmeltz, MD,MSc, and colleagues wrote.
Researchers performed a randomized clinical trial between July 2015 and 2016 of 1,446 general practitioners form 801 practices and 31,229 nonadherent patients. The unit of randomization was the medical practice. Patients who were eligible for screening for colorectal cancer were invited to obtain a fecal immunochemical test kit for their general practitioner. Those who did not return the FIT screening within 3 months were considered nonadherent to screening and received another invitation letter. There were 496 physicians were randomized into the patient-specific reminders group which received list of nonadherent patients, 495 to the generic reminders group which received general information about regional screening adherence and 455 to the usual care group who did not receive reminders.
At 1 year, the patient participation rate was 24.8% in the patient-specific reminder group, 21.7% in the generic reminders group and 20.6% in the usual care group. Investigators noted the difference between the patient-specific reminder group and the other groups reached statistical significance. The rate of colorectal cancer cases detected after 1 year served as a second primary outcome and compared between the three groups with generalized linear mixed model. Medical practices were considered the between random effects.
Results showed in the patient-specific reminders group, 102 patients underwent a colonoscopy (95% CI, 0.79%-1.18%, n= 10,476), 81 patients in the generic reminders group (95% CI, 0.61%-0.95%, n= 10,606) and 66 patients in the usual care group (95% CI,0.50%-0.83%, n =10,147). There were 10 cases of colorectal cancer in the patient-specific reminders group (95% CI, 0.05%-
0.18%), nine cases in the generic reminders group (95% CI, 0.04%-0.16%) and two cases in the usual care group (95% CI, 0.002%-0.07%; global effect of the randomization group on cancer detection, P = .04).
According to researchers, the differences between groups were 0.010% (95% CI,0.08% to 0.10%) for the patient-specific reminders group vs. the generic reminders group, 0.076% (95% CI, 0%-0.15%) for the patient-specific reminders group vs. the usual care group (P = .049), and 0.065% (95% CI, 0.01% to 0.14%) for the generic reminders group vs. the usual care group.
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