The Effectiveness of the FLU–FOBT Program in Primary Care

A Randomized Trial

Michael B. Potter, MD, Judith M. E. Walsh, MD, MPH, et al.

Background: The FLU–FOBT Program is an intervention in which nurses provide home fecal occult blood tests (FOBTs) to eligible patients during annual influenza vaccination (FLU) campaigns. The effectiveness of the FLU–FOBT Program when implemented during primary care visits has not been extensively studied.

Purpose: The effectiveness of the FLU–FOBT Program was tested as adapted for use duringprimary care visits in community clinics serving multiethnic patients with low baseline colorectal cancer (CRC) screening rates.

Design: Randomized clinical trial. During intervention weeks, nurses routinely initiated the offeringof FOBT to eligible patients who were given FLU (FLU–FOBT group). During control weeks, nurses provided FOBT with FLU only when ordered by the primary care clinician during usual care (FLU-only group). 

Setting/participants: The study was conducted in six community clinics in San Francisco. Participantswere patients aged 50–75 years who received FLU during primary care visits during an 18-week intervention beginning on September 28, 2009. 

Main outcome measures: The primary outcome was the change in CRC screening rates in the FLU–FOBT group compared to the FLU-only group at the end of the study period, on March 30, 2010. Multivariate logistic regression analysis was used to determine predictors of becoming up-todate with CRC screening. 

Results: Data were analyzed in 2010. A total of 695 participants received FLU on FLU–FOBT dates, and 677 received FLU on FLU-only dates. The CRC screening rate increased from 32.5% to 45.5% (+13.0 percentage points) in the FLU–FOBT group, and from 31.3% to 35.6% (+4.3 percentage points) in the FLU-only group (p=.018 for change difference). For those due forCRCscreening, theOR for completing CRC screening by the end of the measurement period was 2.22 (95% CI=1.24,3.95) for the FLU–FOBT group compared to the FLU-only group. 

Conclusions: FLU–FOBT Program participants were twice as likely to complete CRC screening as those receiving usual care. The FLU–FOBT Program is a practical strategy to increase CRC screening in community clinics.

(Am J Prev Med 2011;41(1):9 –16) © 2011 American Journal of Preventive Medicine