290 Exploring Interventions to Improve the Efficacy of Fecal Immunochemical Testing in an Ambulatory Care Clinic for the Underserved Population

Abstract

INTRODUCTION: We previously conducted an initial analysis on the effectiveness of fecal immunochemical test (FIT) screening at our Ambulatory Care Clinic (ACC) for the underserved population during the first year of FIT implementation and first year of patient follow up. Although we met our initial goal of FIT completion of >60% (actual 81.8%), the follow up rate for repeat FIT testing was only 18% for patients with an initial negative FIT test (Figure 1). Recognizing these shortcomings, we implemented interventions to improve the follow-up FIT completion rate for those with initial negative testing. METHODS: All patients with initial negative FIT testing without a repeat FIT test after 1 year of follow-up were sent a letter notifying them of need for a repeat FIT test, which could be picked up from the front desk of the clinic (Figure 2). After two months, patient compliance was re-assessed and those who had still not completed the FIT test were given individualized phone calls with the same information. FIT completion rates were then assessed 1 month after these phone calls. RESULTS: A summary and patient flow diagram is shown (Figure 3). Among the 49 remaining active patients at the start of the intervention period, 9 patients (18%) completed a FIT test within 2 months of receiving the letter. No patients completed a FIT test within one month of receiving a phone call. CONCLUSION: 1. Neither intervention significantly increased the rate of repeat FIT completion, although our 18% FIT completion at two months after the letter is near the published 23.5% completion rate. 1 2. Significant patient dropout occurred, adding up to 120 patients (71%) during a 6-month window immediately prior to our intervention period. This predominately occurred due to patients becoming inactive at the clinic over lack of follow-up or patients qualifying for insurance through the Virginia Medicaid expansion which started in January 2019. 3. There is clear need to refine our follow-up interventions and consider alternative tools, such as mailing FIT tests, automated text messaging, or incorporating FIT testing into well visits or existing clinic navigation tools. Additionally, the low rates of follow-up in this patient population will need to be monitored closely, as this may be a limiting factor for FIT testing which requires annual screening compared to other screening measures with longer interval screening periods.