Missed opportunities for screening for Barrett's esophagus in the primary care setting of a large health system.

Abstract

The rate of esophageal adenocarcinoma (EAC) is rising. This is partly due to the lack of identification of Barrett's esophagus (BE), the main risk factor for EAC. Identifying neoplastic BE can allow for endoscopic therapy to prevent EAC. Our aim was to determine how many eligible patients for screening are being screened for BE in the primary care setting of a large health system. A digital search algorithm was constructed using the established gastroenterology guidelines and Kunzmann model for screening for BE. The algorithm was then applied to the electronic medical record of all patients seen in the primary care setting of the health system. A manual review of charts of the identified patients was performed to confirm the high-risk status and determine if screening occurred. Of 936,371 primary care charts analyzed by the algorithm, 3535 patients (0.4%) were determined to be high-risk for BE. Of the 3535 patients, only 1077 (30%) were screened for BE in clinical practice with endoscopy. The algorithm identified 2,458 (70%) additional high-risk patients. Of the patients screened in clinical practice, 105 (10%) were found to have BE (10% with neoplasia). Numerous screening opportunities for Barrett's esophagus are missed in the primary care setting of a large health system. Collaboration between gastroenterology and primary care services is needed to improve the screening rate.