Timeliness of Follow-Up to a Positive Fecal Immunochemical Test Result Among Community Health Center Patients

Background/Aims: Colorectal cancer is the fourth most common cancer and the third-leading cause of cancer death in the United States. Fecal testing, including fecal immunochemical testing (FIT), has been proven to reduce mortality from colorectal cancer. Such mortality reductions can only be achieved, however, if those with abnormal test results receive follow-up colonoscopies. Completion rates for follow-up colonoscopy are low, especially in community health centers, where many Hispanics receive care. As part of the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) project, we examined rates of adherence to follow-up colonoscopy, time to colonoscopy completion and characteristics of patients who complete colonoscopy after abnormal FIT results compared to those who do not. Methods: Virginia Garcia Memorial Health Center was the clinic partner in this project. Project staff reviewed charts from patients who had abnormal FIT results following the STOP CRC outreach program. Reviews of electronic medical charts ascertained patient demographic characteristics, referral to colonoscopy (yes/no), date of referral and reason (if not made), colonoscopy completion (yes/no) and date of colonoscopy and reason (if not completed). Bivariate analyses and regression analyses were used to examine associations and complete mediator analysis. Results: A total of 56 patients had abnormal FIT results; 29 (52%) were Hispanic and 31 (55%) were female. Forty-five (80%) patients received referral for colonoscopy, with a median time to referral of 2 days. Of the 56 patients, 32 (57%) had evidence of a completed colonoscopy in their medical charts. Latinos were less likely than non-Latino whites to have completed a colonoscopy (44.8% vs. 70.4%). The median time to colonoscopy completion was 62 days. Females were less likely than males to complete their colonoscopy within 60 days of a positive FIT result (odds ratio: 0.21, 95% confidence interval: 0.05–0.96). Mediation analysis indicated that time to referral was not a mediator between patient-level factors and completion of follow-up colonoscopy. Conclusion: Our findings suggest improvements are needed to increase rates of follow-up colonoscopy completion, especially among females and Hispanic patients. Future research might explore the role that clinic- and patient-level factors play in colonoscopy completion