Finding non-traditional allies for CRC screening

Gloria D. Coronado, PhD

Beverly B. Green, MD, MPH

Policy-makers

Community Partners

Clinic staff Patients

Key messagesMulti-stakeholder teams can be effective;Know your audience --- evidence can help engage, inform action, and manage expectations.

Policy-makers

Community Partners

Clinic staff Patients

2014 Oregon passed legislation that requires insurance companies to treat to colonoscopy as a screening colonoscopy, even if polyps are removed. This means that patients who go in for a screening colonoscopy and have polyps removed will not be charged co-pays and deductibles.

2015 Oregon passed legislation that prohibits insurance companies from imposing patient co-pays or deductibles for follow-up colonoscopies when a FIT test is positive. This means to there is no financial barrier to follow-up colonoscopy for insured patients.

Policy-makers

Possible partner Role

Community organizations that provide colonoscopy to uninsured

Fund colonoscopies for uninsured patients

GI providers Provide colonoscopy services (sometimes donated)

Medicaid health plans Offer clinic incentives, patient outreach

Advocacy organizations Raise patient awareness, advocate for legislation

Breast, Cervical and Colon Health Programs (CDC)

Fund fecal testing/ colonoscopy for uninsured

Community Partners

Example Role

Clinic leadership Promote buy-in; assign staffing, dedicate resources

Provider Promote CRC screening

Medical Assistant Discuss CRC screening with patients; place standing orders, show videos

Patient Care/ Referral Coordinator

Coordinate referrals; contact patients

Front office staff Respond to patient inquiries; track returned tests

EMR site specialist Generate patient registries and tracking reports

Outreach staff Deliver reminders, live/auto-calls, text messages

Clinic staff

Know your audience

Example 1: Concerns about obtaining colonoscopy for the uninsured.

“…I hear a lot of frustration from doctors that want to have their patient have the colonoscopy and it’s just not happening. It’s really an expensive exam…” (Nurse Practitioner)

“Even if you have insurance … it takes about nine months for a routine colonoscopy in this community. Usually, to get a colonoscopy with any speed, you need some reason.” (Medical director)

Clinic staff

Needed colonoscopies

Anticipated Eligible Patients, CRC Screening, and Needed Follow-up

FQHC N Total patients

aged 50-74 (2012)

N Eligible*(75%)

N reachable(80%)

N obtain FIT(35%)

N need colonoscopy

(4.5-9%)

Clinic 1 975 731 585 205 9 – 18

Clinic 2 1439 1,079 863 302 14 – 28

Clinic 3 672 504 403 141 6 -- 12

*based on OCHIN data from 1/1/2012 – 12/31/2012

Clinic staff

Colonoscopy screening FIT-based screening

FIT reduces colon cancer mortality

Number Needed to Scope to find an advanced adenoma*: Colonoscopy screening scenario: 47.4FIT-based screening scenario: 8.3

*For females aged 50 - 59

Clinic staff

Free FIT vs. Free colonoscopy program

Study included uninsured patients aged 54-64 at the John Peter Smith Health Network, a safety net health system.

Randomized patients into 3 groups: Free FIT (n = 1593) Free colonoscopy (n = 479) Usual care (n = 3898)

Gupta et al. JAMAIM 2013

Clinic staff

Newly insured

Financially challenged

Insured procrastinator / rationalizer

African American

Hispanic

2015 Communications Guidebook, American Cancer Society

Patients

Patient reasons for non-response

Coronado et al. Translational Behavioral Medicine 2015

Pilot findings from Virginia Garcia

Patients

ConclusionMultiple stakeholders can/ should be involved in implementing a CRC screening program. Important to identify internal and external partners.

Understanding and addressing stakeholders’ concerns can build buy-in, expand impact, and help manage expectations.

Policy-makers

Community Partners

Clinic staff Patients

Acknowledgments Funding source: NIH Common Fund

[UH2AT007782 and 4UH3CA188640-02] and Kaiser Permanente Community Benefit

STOP CRC Research Team;

OCHIN; Participating

Clinics STOP CRC

Advisory Board