A recent clinical trial showed that mailing fecal immunochemical tests (FIT) and providing patient navigation significantly increased colorectal cancer screening among rural Medicaid enrollees. The intervention led to a 7.3 percentage point increase in screening compared to usual care. Patient navigation also improved follow-up colonoscopy completion rates for those with abnormal FIT results.

Key Insights

• Increased Screening Rates: The intervention boosted CRC screening rates among rural Medicaid enrollees. In the intervention group, 11.8% completed screening versus 4.5% in the usual care group.
• Improved Follow-Up: Patient navigation increased follow-up colonoscopy completion after abnormal FIT results. In the intervention group, 43.3% completed colonoscopies compared to 15.4% in the usual care group.
• Implementation Challenges: Despite successes, challenges included lower-than-expected FIT return rates and incomplete patient navigation implementation.

Background Context

Colorectal cancer screening is vital for early detection and prevention. Rural areas and Medicaid populations often have lower screening rates due to barriers like access and awareness. The U.S. Preventive Services Task Force recommends CRC screening for adults aged 50 to 75, with updates suggesting starting at age 45. Mailed FIT outreach and patient navigation have improved screening rates in various studies. However, their effectiveness in rural settings has been less explored.

Implications

The findings have significant implications for health economics and outcomes research:

• Cost-Effectiveness: Mailed FIT outreach and patient navigation could be cost-effective. Earlier detection and treatment of CRC may reduce long-term healthcare costs.
• Health Outcomes: Improved colorectal cancer screening rates can lead to better health outcomes. Detecting CRC earlier reduces mortality rates and enhances quality of life.
• Rural Health Equity: Addressing CRC screening disparities in rural areas promotes health equity. It ensures underserved populations receive care comparable to urban populations.
• Future Research Directions: Future studies should optimize implementation strategies and address barriers to follow-up colonoscopy. Additional interventions should enhance screening uptake among Medicaid enrollees without primary care relationships. For a comprehensive analysis, visit the original article.