The Flu-FIT Program: An Effective Colorectal Cancer Screening Intervention

80% by 18 Fourm The Flu-FIT Program: An Effective Colorectal Cancer Screening Intervention Michael B Potter, MD Director, SF Bay Area Collaborative Research Network University of California, San Francisco Sept 17, 2015 Atlanta, GA Presentation of Overview • The role of FIT in achieving US colorectal cancer screening goals • Development and pilot testing of the Flu-FIT Program • Research to demonstrate effective translation into diverse clinical settings • Dissemination and implementation activities In USA, colonoscopy is the most common screening modality, but FOBT remains important Decision modeling studies indicate that when provided annually to average risk patients with appropriate follow up, annual stool testing can provide the same number of life-years gained as colonoscopy-only strategies Zauber AG et.al Ann of Int Med 2008, 149; 659-669 FIT has advantages • • • • Inexpensive and Accessible Can be offered by any member of the health team Can be done in privacy and at home Is non-invasive and has no risk of pain, bleeding, bowel perforation, or other adverse outcomes • Fecal Immunochemical Tests (FIT) are easier and better accepted than other stool-based tests (no changes in diet required, for example) • Only requires colonoscopy if abnormal • Many patients prefer it Doing more FIT is especially important in public health settings (2014 NCCRT analysis of UDS data) Challenges of Implementing FIT Programs in Primary Care • • • • • • • • Select and invest in evidence-based FIT kits Identify eligible patients Organized in-reach and outreach Staff training to educate patients about the importance of screening and how to the test Follow-up to assure test completion Assure high quality test development processes Assure annual test completion if normal Follow up abnormal results with colonoscopy Developing a new screening program The first CLINICAL questions (2004): What primary care colorectal cancer screening outreach program could be a effective for an under-screened population? b acceptable to clinicians and staff? c feasible to implement with limited resources? d complementary to other quality improvement efforts? e sustainable after the researchers leave? f adaptable and scalable for diverse settings? The first RESEARCH questions (2005-6): For average risk adults, is the time of influenza vaccination a missed opportunity to offer colorectal cancer screening? Can we show that a “FLU-FOBT Program” in an influenza vaccination clinic can work? Potential increase in CRC screening for adults eligible if offered with influenza vaccination (Combines CA BRFSS and SF General Hospital Data) Presented at the SF Bay Area Clinical Research Symposium, 2006 San Francisco General Hospital’s Family Health Center Walgreens Pharmacy Pilot Study moving Flu-FIT into community pharmacies Results comparing Flu-FIT vs Flu plus Education/Referral for Screening (J Am Pharm Assoc 2010;50:181-7) Phone Interviews 3-6 months after the Intervention FIT Provided N=86 Education/ Referral N=28 P value Discussed Screening with Physician 20% 50% 8000 page views (average 2-3 pages/session) – Twice as much web traffic as 2014 – Wide geographic distribution: • Visitors from all 50 states • Top 10 states: TX, CA, NY, IL, NJ, FL, VA, PA, NC Summary • Annual influenza vaccination campaigns represent an underutilized opportunity to offer FIT • FluFIT Programs engage clinical teams in offering colorectal cancer screening during annual influenza vaccination campaigns, encouraging and supporting annual colorectal cancer screening of average risk patients not reached by other interventions • FluFIT Programs can be adapted, implemented, and sustained in diverse clinical settings serving diverse patient populations Summary • Keys to success – Identify an important clinical need – Involve end-users in the early development of the intervention – Define core components that are easy to understand, adopt, implement, scale, and sustain – Develop training materials and tools to aid with adaptation and implementation in diverse clinical settings – Engage with the health community on multiple levels to get the word out Collaborators in Flu-FIT Program Development, Evaluation, and Dissemination Very special thanks to these mentors, collaborators, project coordinators, and program supporters • • • • • • • • • Steve McPhee Judith Walsh Carol Somkin Lisa Kroon Larry Green Russ Glasgow Bob Hiatt Larry Dickey James Wu • • • • • • • • • Estie Hudes Ginny Gildengorin Lynn Ackerson TR Levin La Phengrasamy Vicky Gomez Tina Yu Durado Brooks Laura Seef THANK YOU! michael.potter@ucsf.edu http://flufit.org ... Preventable! •Yearly home stool tests are easy to •Yearly home stool tests could save your life •All our doctors and nurses recommend Colon Screening for healthy men and women aged 50 to 79 •When... privacy and at home Is non-invasive and has no risk of pain, bleeding, bowel perforation, or other adverse outcomes • Fecal Immunochemical Tests (FIT) are easier and better accepted than other stool- based. .. UDS data) Challenges of Implementing FIT Programs in Primary Care • • • • • • • • Select and invest in evidence -based FIT kits Identify eligible patients Organized in-reach and outreach Staff training