Primary care visits result in more colon cancer screening, better followups

The results are important because screening for colon cancer -- the third most common cancer and the second leading cause of cancer deaths in the United States -- is underutilized in the U.S. Given the growing interest in population health, many health systems are aggressively using outreach strategies that don't require a face-to-face doctor visit to initiate cancer screening.

"These findings help underscore the continued importance and effectiveness of visits with primary care physicians in a brave new world of virtual care and population health outreach," said Dr. Ethan Halm, Director of UT Southwestern's Center for Patient-Centered Outcomes Research, and a member of the Harold C. Simmons Comprehensive Cancer Center. "This result is important because screening for colon cancer can result in an early diagnosis and improved survival."

The study, which involved nearly 1 million people from four different health care systems in the U.S., found that people who had more primary care visits had more screenings and more follow-up colonoscopies when initial tests indicated potential problems than when primary physicians were not involved. The result held true even in mature, integrated health systems with well-insured patients and that do a lot of aggressive 'population health outreach.' These systems mail patients home stool blood test kits and have highly organized infrastructures for following up abnormal results. Individuals don't have to come in to see a doctor to get a cancer screening test done or followed up.

Many accountable care organizations are using 'population outreach' approaches to promote cancer screening without a primary care provider visit, while other groups have questioned whether patients need to have annual health checkup visits with their primary care provider if they are feeling well, said Dr. Halm, Professor of Internal Medicine and Clinical Sciences, and holder of the Walter Family Distinguished Chair in Internal Medicine in Honor of Albert D. Roberts, M.D.

Colon cancer screening rates remain suboptimal, despite decades of public health campaigns, public reporting on screening rates, and preventive service reminders in electronic health records, the researchers said, prompting a growing number of private and public health systems to promote options that do not require a face-to-face primary care visit.

National guidelines recommend periodic colorectal screening via colonoscopy, flexible sigmoidoscopy, fecal immunochemical tests known as FIT, or high-sensitivity guaiac occult blood tests called FOBT. The FIT and FOBT tests are inexpensive, easy to mail, and simple for patients to complete. However, their effectiveness requires that positive results be followed up by a diagnostic colonoscopy and this latest research suggests the primary care providers may play an important role in getting the follow-up diagnostic tests completed, said Dr. Halm, Chief of the William T. and Gay F. Solomon Division of General Internal Medicine. Researchers undertook the study to see whether that was the case.

Researchers examined records from 968,072 patients ages 50-74 years who were not up to date with CRC screening in four integrated health care systems in the NCI-funded Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. Three of the systems had screening outreach programs using FIT kits. The research team found that patients who saw their primary care providers an average of one or more times a year were twice as likely to be screened for CRC, and that these individuals were 30 percent more likely to undergo a colonoscopy after receiving a positive stool blood test.

The study appears in the Journal of General Internal Medicine.