1. Interventions including patient navigators and provider reminders may be associated with improved follow-up for positive fecal blood tests.
2. There is low evidence to support system-level interventions following colonoscopy screening.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Colorectal screening programs are important public health initiatives, as they have been shown to reduce mortality and morbidity from colorectal cancer. These screening programs involve fecal occult blood testing in adults aged 50 to 75 years, annually or biennially. Despite these screening initiatives, colonoscopy follow-up is challenging as it involves the interaction of several levels of care and multiple healthcare providers. The authors of this systematic review aimed to compare the interventions in place to improve rates of follow-up colonoscopy for adults after a positive fecal occult blood test. Generally, the results showed increased evidence for patient navigators and provider reminders after a positive test. This study has several limitations. First, the studies had heterogeneous designs and outcomes measurements; therefore, a meta-analysis could not be performed. Second, there was a high or very high risk of bias in over half of the studies included in the analysis.
In-Depth [systematic review]: Data was obtained from the Cochrane Central Register of Controlled Trials, PubMed, and Embase from database inception through June 2017. Studies were included that were randomized and nonrandomized, focusing on colonoscopy as a follow-up of positive results on fecal blood tests. Two independent reviewers extracted data and performed a quality assessment. Of the 23 studies included in the review, there was low-evidence for system-level interventions and moderate evidence for patient navigators and provider reminders or performance data. There were proportions for test-positive patients who had follow-up colonoscopy with and without the intervention in 17 of the studies. Absolute differences were -7.4 percentage points (95% CI, -19 to 4.3 percentage points) to 25 percentage points (CI, 14 to 35 percentage points).
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