Navigation Programs Most Effective in Increasing Follow-up Colonoscopy

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Patient navigation programs can effectively improve the rate of follow-up testing in patients with positive fecal blood test results.
Patient navigation programs can effectively improve the rate of follow-up testing in patients with positive fecal blood test results.

Follow-up colonoscopy rates are higher in patients with positive fecal immunochemical test results if they are enrolled in patient navigation programs, or if their providers are given performance data or reminders to take action, a study published in the Annals of Internal Medicine has shown.

Although fecal immunochemical testing is a highly effective and frequently used preventive measure to detect colorectal cancer (CRC) worldwide, poor rates of timely follow-up with colonoscopy even after receiving positive test results dull the benefit of early detection and have implications on CRC prognosis.

For this review, the authors analyzed 23 studies that evaluated various interventions that could potentially improve follow-up colonoscopy completion rates. Eleven studies assessed interventions at the patient level, 5 assessed provider-level interventions, and 7 studies assessed interventions at the system-level.

Trials performed at the patient level evaluated 3 intervention strategies: changes to invitation to undergo screening, providing patients with test results or follow-up appointments, and use of patient navigators.

The only intervention on the patient level that demonstrated benefit was patient navigation. Two studies provided moderate evidence that supported an improvement in the rate of test-positive patients receiving screening colonoscopies.

One study did not reach statistical significance but demonstrated an improvement of 80.8% to 91.0% of patients completing colonoscopy, and reached the investigator-determined threshold of clinical importance. In the second study, researchers randomly assigned test-positive patients to a patient navigation program or no program, which led to 79% of patients in the intervention group completing a follow-up test compared with 58% in the control group.  

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