Implementation of on-site screening sigmoidoscopy positively influences utilization by primary care providers

Abstract

Background and Aims: Sigmoidoscopy is an effective screening strategy for colorectal cancer that is not widely used by primary care providers. The aim of this study was to assess the impact of 'academic detailing' in the form of an outreach educational seminar combined with implementation of on- site sigmoidoscopy services performed by university-based gastroenterologists on provider compliance. Methods: A controlled trial was initiated at 9 urban neighborhood health centers, including 4 intervention and 5 comparison sites. Baseline data on provider attitudes and practice patterns were collected using a validated questionnaire. Outcome measures included a year 1 follow- up survey of provider attitudes and quarterly review of screening sigmoidoscopy referrals using appointment logs to assess utilization. Results: Overall self-reported compliance rates for screening sigmoidoscopy increased by 36% (baseline, 24%; year 1, 60%) for the intervention group vs. only 7% (baseline, 19%; year 1, 26%) for the comparison group (P = 0.001). When stratified by site, compliance rates increased at each intervention site (range, 7%-92%) but at only 2 control sites. Use of screening sigmoidoscopy was also significantly greater at the intervention sites (47% vs. 4%; P ≤ 0.001). Conclusions: An outreach educational seminar combined with implementation of on-site sigmoidoscopy services is an effective strategy for enhancing provider utilization of screening sigmoidoscopy.