Capsule Commentary on Halm et al., Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach
J Gen Intern Med
Capsule Commentary on Halm et al., Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach
Archana Radhakrishnan 0
MHS 0
0 Johns Hopkins University School of Medicine , Baltimore, MD , USA
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he purpose of the study by Halm et al.1 was to evaluate
T the role of primary care physicians (PCP) in colorectal
cancer screening (CRC) and follow-up colonoscopy after
positive fecal immunochemical (FIT) and fecal occult blood
tests (FOBT). The authors looked at four different healthcare
systems, three of which had various levels of organized
screening outreach. Findings showed that patients who saw
PCPs had higher rates of CRC screening and follow-up
colonoscopy after positive FIT or FOBT tests.
Population-based initiatives are gaining popularity as a
means of achieving cancer screening.2 The International
Agency for Research on Cancer provides a framework for
implementing effective population-based cancer screening
programs which includes clearly defined screening
policies, management teams for effective program
implementation, healthcare teams for clinical decision-making,
monitoring for cancer incidence and mortality, and quality
assurance.3 The programs in this study fulfill many of the
criteria; however, it is those patients who also had an
interaction with their PCP who had higher CRC screening
rates and follow-up colonoscopies. It is particularly
notable that patients who saw their PCPs more than once
had nearly twice the odds of undergoing screening.
This study provides important evidence that optimizing
cancer screening rates likely requires a multi-pronged
approach. Population-based programs have the capacity
to reach large numbers of patients, but not at the expense
of PCP involvement. The importance of the patient–PCP
interaction cannot be underestimated. PCPs often have
longitudinal relationships with their patients that naturally
lend themselves to opportunities for educating and
encouraging patients regarding preventive care. Atlas and
colleagues found that patients who were more connected
to their PCP were more likely to receive
guidelineconsistent care, including higher rates of breast and
cervical cancer screening, and chronic illness measures such as
HbA1C and LDL.4 Though patients may receive
systembased reminders encouraging them to complete tests, their
own PCP still remains a trusted source of information
providing individual guidance towards achieving optimal
health outcomes.
1. Halm EA , Beaber EF , McLerran D , Chubak J , Corley DA , Rutter CM , Doubeni CA , Haas JS , Balasubramanian BA . Association between primary care visits and colorectal cancer screening outcomes in the era of population health outreach . J Gen Intern Med. DOI: 10.1007/s11606-016-3760-9
2. Verma M , Sarfaty M , Brooks D , Wender RC . Population-based programs for increasing colorectal cancer screening in the United States . CA Cancer J Clin . 2015 ; 65 ( 6 ): 497 - 510 .
3. dos Santos Silva I. Cancer Epidemiology: Principles and Methods . Lyon, France: IARC Press ; 1999 .
4. Atlas SJ , Grant RW , Ferris TG , Chang Y , Barry MJ . Patient-physician connectedness and quality of primary care . Ann Intern Med . 2009 ; 150 : 325 - 335 . (...truncated)