2017 Articles

Primary care visit use after positive fecal immunochemical test for colorectal cancer screening

Hillyer, Grace A.; Jensen, Christopher D.; Zhao, Wei K.; Neugut, Alfred I.; Lebwohl, Benjamin; Tiro, Jasmin A.; Kushi, Lawrence H.; Corley, Douglas A.

Background: For some patients, positive cancer screening test results can be a stressful experience which can affect future screening compliance and increase the utilization of healthcare services unrelated to medically-indicated follow-up.

Methods: Among 483,216 individuals, aged 50–75 years, who completed a fecal immunochemical test to screen for colorectal cancer at a large integrated health care setting between 2007 and 2011, we evaluated whether a positive test was associated with a net change in outpatient primary care visit use in the year following screening. We used multivariable regression models to evaluate the relationship between test result group and net changes in primary care visits following fecal immunochemical test.

Results: In the year following the fecal immunochemical test, utilization increased by 0.60 clinic visits for true positives. The absolute change in visits was largest (3.00) among test positive patients diagnosed with colorectal cancer but significant small increases were also found for polypectomy/no neoplasia (0.36) and normal exam/no polypectomy (0.17). Groups that demonstrated an increase in net visit use compared to the true negative group included true positives (OR 1.60, 95% CI 1.54–1.66), and positive groups with colorectal cancer diagnosis (OR 7.19, 95%CI 6.12–8.44), polypectomy/no neoplasia (OR 1.37, 95%CI 1.27–1.48) and normal exam/no polypectomy groups (OR 1.24, 95%CI 1.18–1.30).

Conclusion: Given the large size of outreach programs, these small changes can cumulatively generate thousands of excess visits and have substantial impacts on total health care utilization and thus should be included in colorectal cancer screening cost models and their causes investigated further.