Poor follow-up rates after positive fecal occult blood test
MedWire News: Less than 50% of elderly patients who have a positive fecal occult blood test (FOBT) result receive complete follow-up care by 1 year after the test, US study results indicate.
"Follow-up after a positive FOBT result was low regardless of age or comorbidity," say the authors.
They add: "Medical chart documentation indicates that failure to complete follow-up is due to problems with screening patients in whom follow-up is not appropriate as well as failing to complete follow-up in patients who should have received follow-up."
In the study, published in the Archives of Internal Medicine, Louise Walter (University of California, San Francisco) and team analyzed the FOBT outcomes of 2410 US veterans aged at least 70 years (98% male).
Three fecal sample "cards" were submitted per patient and a positive test was one in which blood was detected in any of the three cards. Negative tests were those with no occult blood in any card, and inconclusive tests were those in which less than three cards were submitted and no blood was detected among the submissions.
In all, 9% (n=212) of the veterans had positive test results and 3% had inconclusive results.
Of those with a positive test result, only a respective 22% (n=47) and 42% (n=90) received complete colon evaluation, defined as colonoscopy or barium enema plus sigmoidoscopy, within 6 months and 1 year after the test.
Furthermore, 38% of the patients who did not receive complete follow-up evaluation by 1 year post-FOBT had medical documentation stating that they were not suitable for follow-up because of comorbidity or personal preference.
Walter and team report no association between 1 year post-FOBT receipt of complete colon evaluation and age, comorbidity, ethnicity, or socioeconomic level.
However, other factors, such as the number of positive FOBT cards and number of outpatient visits made by each patient, were positively associated with receipt of complete colon evaluation.
Specifically, Walter et al observed that complete colon evaluation was 1.8 times more likely among patients with three positive FOBT cards compared with those with only one positive card. Patients who made at least four outpatient visits after FOBT were 2.5 times more likely to receive complete colon evaluation compared with those who made less than three visits.
The team emphasize that such factors "should not be the major predictors of follow-up. Rather, quality improvement initiatives should encourage clinicians to weigh risks and benefits at each step in the screening process, in the context of a patient's age, comorbidity, and preferences."
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By Lauretta Ihonor