scholarly journals Integrated implementation of evidence-based interventions to increase colorectal cancer screening through public health-primary care partnerships

2020 ◽  
Author(s):  
Cindy Soloe ◽  
Laura Arena ◽  
Dara Schlueter ◽  
Stephanie Melillo ◽  
Amy DeGroff ◽  
...  
Keyword(s):  
Public Health ◽  
Colorectal Cancer ◽  
Primary Care ◽  
Chronic Disease ◽  
Data Collection ◽  
Quality Data ◽  
Background Information ◽  
Evidence Based ◽  
Primary Care Clinics ◽  
Crc Screening

Abstract Background In 2015, the Centers for Disease Control and Prevention funded the Colorectal Cancer Control Program (CRCCP), which partners with health systems and primary care clinics to increase CRC screening uptake. We interviewed CRCCP stakeholders to explore factors that support an integrated implementation of evidence-based interventions and supporting activities to promote CRC screening with other screening and chronic disease management activities in primary care clinics. Methods Using the Consolidated Framework for Implementation Research, we conducted a literature review and identified constructs to guide data collection and analysis. We purposively selected four CRCCP awardees that demonstrated ongoing engagement with clinic partner sites, willingness to collaborate with CDC and other stakeholders, and availability of high-quality data. We gathered background information on the selected program sites and conducted primary data collection interviews with program staff and partners. We used NVivo QSR 11.0 to systematically pilot-code interview data, achieving a Kappa coefficient of 0.8 or higher, and then implemented a stepwise process to identify site-specific and cross-cutting emergent themes. Results Programs reported that they support clinic partners’ integrated implementation by providing coordinated application processes and braided funding streams, and by funding partner organizations to provide technical assistance to support efficient implementation of evidence-based interventions and supporting activities into existing clinic workflows. These actions, in turn, support clinics in implementing evidence-based interventions and supporting activities that promote both CRC screening and other chronic disease screening and management. Discussion The selected CRCCP programs and their partners implement activities to support the integration of evidence-based interventions and supporting activities with other clinic efforts. These integrated efforts support increased efficiency of clinic workflow, improved coordination of patient care, increased uptake of screening and improved patient outcomes. Conclusions The findings provide insights into how public health programs can support primary care clinics in integrating interventions and activities into existing workflows to support efficient, coordinated delivery of quality patient-centered care.

scholarly journals Assessing Barriers to and Facilitators of Designing a Feasible Colorectal Cancer Screening Program in Mexico City

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 46-46
Author(s):  
Karla Unger-Saldaña ◽  
Minerva Saldaña-Tellez ◽  
Anabelle Bonvecchio ◽  
Michael B. Potter ◽  
Martin Lajous
Keyword(s):  
Public Health ◽  
Colorectal Cancer ◽  
Primary Care ◽  
Health Care ◽  
Mexico City ◽  
Screening Program ◽  
Average Risk ◽  
Culturally Competent ◽  
Educational Materials ◽  
Crc Screening

PURPOSE We undertook a formative qualitative research study to identify optimal participant recruitment, education, and follow-up strategies to facilitate colorectal cancer (CRC) screening in Mexico City. METHODS This study included semistructured individual and focus group interviews with different stakeholders: 36 average-risk laypeople, 16 public health care leaders, 10 primary care personnel, and 4 endoscopy unit personnel. The study protocol was approved by the National Institute of Public Health Institutional Review Board. Written informed consent was obtained from all participants. We analyzed data using the constant comparison method under the theoretical perspectives of the Consolidated Framework for Implementation Research and the Health Belief Model. Tailored CRC screening educational materials—video, postcard, poster, and brochure—were developed on the basis of our findings. Materials were then pretested in 6 additional focus groups and adjusted accordingly. RESULTS We found multiple barriers and facilitators in different dimensions of the CFIR for successful implementation of a FIT-based CRC screening program in this community. The main barriers were the following: inner context related: understaffing and personnel resistance to new programs; individual health care personnel related: CRC misinformation and work overload; outer setting related: underinvestment in primary care and public insecurity; lay individual related: a lack of CRC awareness, low risk perception, and fear of finding out about a serious disease; and intervention related: test costs. Among the principal facilitators were the following: inner setting: a shared perception of a good working environment and strong leadership at the selected clinic; intervention related: FIT test is perceived as easy to do, and potential users liked the idea that the sample can be obtained in the privacy of their homes. Educational materials we tailored on the basis of these findings and were found to be acceptable, understandable, and culturally competent by lay participants. CONCLUSION Our study allowed for the design of a feasible FIT-based CRC screening program and culturally competent materials that will be used to enhance participation.

scholarly journals Development of a multilevel intervention to increase colorectal cancer screening in Appalachia

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Aaron J. Kruse-Diehr ◽  
Jill M. Oliveri ◽  
Robin C. Vanderpool ◽  
Mira L. Katz ◽  
Paul L. Reiter ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
The United States ◽  
Advisory Board ◽  
Community Advisory Board ◽  
Primary Care Clinics ◽  
Crc Screening ◽  
Multilevel Intervention

Abstract Background Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of “Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia,” a 5-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics. Methods Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs. Results Key informant interviews identified multiple barriers to CRC screening, including fear of screening, test results, and financial concerns (patient level); lack of time and competing priorities (provider level); lack of reminder or tracking systems and staff burden (clinic level); and cultural issues, societal norms, and transportation (community level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events, all of which promoted stool-based screening (i.e., FIT or FIT-DNA). Variability among clinics, including differences in EHR systems, was the most salient barrier to EBI implementation, particularly in terms of tracking follow-up of positive screening results, whereas the development of clinic-wide screening protocols was found to promote fidelity to EBI components. Conclusions Lessons learned from year 1 included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years. Trial registration Trial NCT04427527 is registered at https://clinicaltrials.gov and was registered on June 11, 2020.

scholarly journals Development of a Multilevel Intervention to Increase Colorectal Cancer Screening in Appalachia

2020 ◽  
Author(s):  
Aaron J. Kruse-Diehr ◽  
Jill M. Oliveri ◽  
Robin C. Vanderpool ◽  
Mira L. Katz ◽  
Paul L. Reiter ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
The United States ◽  
Advisory Board ◽  
Community Advisory Board ◽  
Primary Care Clinics ◽  
Crc Screening ◽  
Multilevel Intervention

Abstract Background: Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from Year One of ‘Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia,’ a five-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics.Methods: Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs. Results: Key informant interviews identified multiple barriers to CRC screening, including fear of screening , test results, and financial concerns (patient-level); lack of time and competing priorities (provider-level); lack of reminder or tracking systems and staff burden (clinic-level); and cultural issues, societal norms, and transportation (community-level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events. Conclusions: Lessons learned from Year One included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years.

Factors Associated with Participation in Colorectal Cancer Screening Using a Fecal Immunochemical Test (FIT) in Thai Population Aged 45 to 74 years in Namphong District, Khon Kaen Province

2021 ◽  
Vol 104 (7) ◽  
pp. 1067-1072
Keyword(s):  
Public Health ◽  
Colorectal Cancer ◽  
Fecal Immunochemical Test ◽  
Thai Population ◽  
Screening Programs ◽  
Crc Screening ◽  
Factors Associated ◽  
History Of ◽  
Public Health Officials ◽  
Immunochemical Test

Background: Presently, the level of participation in screening programs for colorectal cancer (CRC) with Fecal Immunochemical Test (FIT) is considerably low. Objective: To investigate factors associated with participation in CRC screening using a FIT in the Thai population age 45 to 74 years in the Namphong District of Khon Kaen Province. Materials and Methods: In the present study, the unmatched case-control study design was applied. Three hundred ten participants were equally divided into two groups with 155 participants in the study group and the other 155 in the control group. The data were collected by conducting interviews. Moreover, to explain the association between the factors, multiple logistic regressions were used with adjusted odds ratio (ORadj), a confidence level at 95%, and with p<0.05. Results: It was found that ages were equal to or higher than 60 years (ORadj 2.08; 95%CI 1.19 to 3.63), the lower education level (ORadj 3.70; 95% CI 1.86 to 7.33), a family history of cancer (ORadj 5.25; 95% CI 2.14 to 12.86), receiving advice from public health officials regarding CRC screening (ORadj 3.09; 95% CI 1.81 to 5.27), and high level of knowledge about CRC (ORadj 4.01; 95% CI 2.09 to 7.69) had all been related to participation in the CRC screening program with a statistical significance (p<0.05). Conclusion: The results revealed that receiving advice from public health officials regarding CRC screening and that proper knowledge had been related to participation in screening programs for CRC with the FIT. Thus, to raise awareness and create a greater understanding, public health officers should disseminate knowledge about CRC. Information about the colorectal screening with the FIT should especially be spread to those people who are younger than 60 years of age, have educational levels higher than the primary level, and to those, who have no family history of CRC. Keywords: Colorectal Cancer Screening; Fecal Immunochemical Test (FIT); Thai population

scholarly journals Skills building seminar: How to enhance collaboration between primary care and public health?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Chronic Disease ◽  
Chronic Disease Management ◽  
Communicable Disease ◽  
Communicable Disease Control ◽  
Organizational Models ◽  
Policy Makers ◽  
Public Health Functions ◽  
Successful Collaboration

Abstract Many countries in Europe and beyond have recognized that improved collaboration between public health and primary care can yield substantial benefits to populations and patients (e.g. through improved chronic disease management, communicable disease control, and maternal and child health), but it is in practice unclear how this improved collaboration can be achieved. Furthermore, collaboration is often hampered by the way that both sectors are organized and financed, with substantial differences across and sometimes within countries. In most European countries primary care already performs some public health functions, while public health can help to make the provision of primary care more effective. Screening and immunization, for example, as well as interventions to support healthy lifestyles, are public health functions that are nowadays commonly provided in primary care, although with wide variations between countries in the number of preventive care services provided in primary care. The question is how to expand and further develop existing collaborations. This workshop investigates the types of initiatives that have been undertaken, the factors that can enhance or hinder the collaboration between primary care and public health, and what can be undertaken to increase the chances of successful collaboration. It identifies organizational models of primary care that are conducive to collaboration with public health (e.g. through integrating primary care and public health in the provision of care for individuals), as well as systemic, organizational and interpersonal factors that can hinder or facilitate collaboration. The workshop draws on the findings of a forthcoming Observatory policy brief on enhanced primary care and public health collaboration, covering such areas as community engagement and participation, health promotion, health education, prevention activities, chronic disease management, screening, immunization and communicable disease control, information systems activities, development of best practice guidelines, conducting needs assessments, quality assurance and evaluation, and professional education. The workshop will begin with a presentation of the main findings of the policy brief, followed by a panel discussion involving European experts and policy-makers. In addition to sharing the experience of their countries, panelists will reflect on how generalizable or transferable examples of successful collaboration are and what it takes to overcome existing barriers. The workshop is designed to provide ample opportunity for the audience to comment on and discuss presentations and the contributions of panelists and to consider what lessons can be transferred across countries. It will be of interest to public health researchers, practitioners and policy-makers from across Europe. Key messages The workshop provides a forum for discussing how to enhance collaboration between public health and primary care. It explores innovative approaches, organizational models, and policy options.

scholarly journals Economic Evaluation of Interventions to Increase Colorectal Cancer Screening at Federally Qualified Health Centers

2020 ◽  
Vol 21 (6) ◽  
pp. 877-883
Author(s):  
Florence K. L. Tangka ◽  
Sujha Subramanian ◽  
Sonja Hoover ◽  
Amy DeGroff ◽  
Djenaba Joseph ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Program Implementation ◽  
Cancer Control ◽  
Control Program ◽  
Evidence Base ◽  
Lessons Learned ◽  
Evidence Based ◽  
Crc Screening ◽  
Screening Uptake ◽  
Cancer Control Program

The Centers for Disease Control and Prevention (CDC) has a long-standing commitment to increase colorectal cancer (CRC) screening for vulnerable populations. In 2005, the CDC began a demonstration in five states and, with lessons learned, launched a national program, the Colorectal Cancer Control Program (CRCCP), in 2009. The CRCCP continues today and its current emphasis is the implementation of evidence-based interventions to promote CRC screening. The purpose of this article is to provide an overview of four CRCCP awardees and their federally qualified health center partners as an introduction to the accompanying series of research briefs where we present individual findings on impacts of evidence-based interventions on CRC screening uptake for each awardee. We also include in this article the conceptual framework used to guide our research. Our findings contribute to the evidence base and guide future program implementation to improve sustainability, increase CRC screening, and address disparities in screening uptake.

Evidence-Based Approach for Disaster Preparedness Authorities to Inform the Contents of Repositories for Prescription Medications for Chronic Disease Management and Control

2008 ◽  
Vol 23 (5) ◽  
pp. 447-457 ◽  
Author(s):  
David W. Brown ◽  
Stacy L. Young ◽  
Michael M. Engelgau ◽  
George A. Mensah
Keyword(s):  
Public Health ◽  
Chronic Disease ◽  
Chronic Conditions ◽  
Causes Of Death ◽  
Prescription Medication ◽  
Evidence Based ◽  
Narcotic Analgesics ◽  
Public Health Emergencies ◽  
Drug Classes ◽  
And Control

AbstractIntroduction:Chronic diseases are major causes of death and disability and often require multiple prescribed medications for treatment and control. Public health emergencies (e.g., disasters due to natural hazards) that disrupt the availability or supply of these medications may exacerbate chronic disease or even cause death.Problem:A repository of chronic disease pharmaceuticals and medical supplies organized for rapid response in the event of a public health emergency is desirable. However, there is no science base for determining the contents of such a repository. This study provides the first step in an evidence-based approach to inform the planning, periodic review, and revision of repositories of chronic disease medications.Methods:Data from the 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to examine the prescription medication needs of persons presenting to US hospital emergency departments for chronic disease exacerbations. It was assumed that the typical distribution of cases for an emergency department will reflect the patient population treated in the days after a public health emergency. The estimated numbers of prescribed drugs for chronic conditions that represent the five leading causes of death, the five leading primary diagnoses for physician office visits, and the five leading causes of disease burden assessed by disability-adjusted life years are presented.Results:The 2004 NHAMCS collected data on 36,589 patient visits that were provided by 376 emergency departments. Overall, the five drug classes mentioned most frequently for emergency department visits during 2004 were narcotic analgesics (30.7 million), non-steroidal anti-inflammatory drugs (25.2 million), non-narcotic analgesics (15.2 million), sedatives and hypnotics (10.4 million), and cephalosporins (8.2 million). The drug classes mentioned most frequently for chronic conditions were: (1) for heart disease, antianginal agents/vasodilators (715,000); (2) for cancer, narcotic analgesics (53,000); (3) for stroke, non-narcotic analgesics (138,000); (4) for chronic obstructive pulmonary disease, anti-asthmatics/bronchodilators (3.2 million); and (5) for diabetes, hypoglycemic agents (261,000). Ten medication categories were common across four or more chronic conditions.Conclusions:Persons with chronic diseases have an urgent need for ongoing care and medical support after public health emergencies. These findings provide one evidence-based approach for informing public health preparedness in terms of planning for and review of the prescription medication needs of clinically vulnerable populations with prevalent chronic disease.

scholarly journals Maintaining public health insurance benefits: How primary care clinics help keep low-income patients insured

2017 ◽  
Vol 4 (3) ◽  
pp. 61-69 ◽  
Author(s):  
Rose L Harding ◽  
Jennifer D Hall ◽  
Jennifer DeVoe ◽  
Heather Angier ◽  
Rachel Gold ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Insurance ◽  
Low Income ◽  
Public Health Insurance ◽  
Insurance Benefits ◽  
Primary Care Clinics
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