Effect of a Patient Decision Aid and Academic Detailing for Increasing Colorectal Cancer Screening a

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Effect of a Patient Decision Aid and Academic
Detailing for Increasing Colorectal Cancer
Screening among Members of a Managed Care Plan
A Controlled Trial

• C. Lewis M. Pignone L.A. Schild T. Scott
• A. Winquist B. Rimer K. Glanz.
• Grant support Centers for Disease Control and
  Prevention
• Grant PH000018

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Background

• CRC screening has been shown to decrease disease
  specific mortality
• CRC screening still underutilized
• 40 U.S. population NOT up to date in 2006

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Barriers to CRC Screening

• Patient level barriers
• System level barriers
• Provider and practice level barriers
• Interventions targeted at multiple levels may be
  more effective

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Combined Intervention

• Patient level
• Patient decision aid for CRC screening
• Activated patients and facilitated test choice
• Provider and practice level
• Academic detailing/Organizational change
• Used to educate providers and change preventive
  care delivery processes

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Aim

• To evaluate the effectiveness of a combined
  intervention on CRC screening test completion in
  health plan members.

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Overview of Methods

• Controlled trial of primary care practices
  participating in Aetna HMO health plans
• Practice level allocation of patients to
  intervention and usual care groups

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Practices

• List of primary care physicians from Aetna
  Southeast Region participating in HMO
• Targeted geographical areas that included
  Atlanta, Tampa, and Orlando
• Minimum of 50 Aetna members ages 52 to 75
• Recruitment
• 210 contacted practices and enrolled 32

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Patients

• Identified potentially eligible Aetna members
  with available claims data
• Ages 52 to 80
• Not current with CRC screening per claims or
  eligibility survey
• Excluded those at high CRC risk and with medical
  co-morbidities

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Provider/Practice Level Intervention

• Two visits to each intervention practice
• Team consisted of two physician investigators and
  RA
• Initial visit
• Presented about CRC screening and decision aid
• Developed a plan to accommodate and facilitate
  patient requests for specific CRC tests
• Second visit to address problems

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Patient Level Intervention

• Mailed package containing the following
• CRC screening decision aid video
• Three brochures based on stages of change
• Aetna co-payment and practice specific referral
  information
• Chart summarizing CRC screening test options
• Decision Aid Survey

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Patient Decision Aid
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Stage-targeted Brochures

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Measures

• Main outcome
• CRC screening test completion
• Secondary outcomes
• Talked to doctor
• Perceptions about adequacy of information
• Knowledge about CRC screening

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Analyses

• Intention to treat
• Logistic regression to account for practice
  clustering and baseline differences

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Patient Surveys
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Results
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Baseline Survey Demographics
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Main Outcome CRC Screening
OR Unadjusted (95 CI) 1.3 (0.82.0)
OR Adjusted (95 CI) 1.6 (0.9 2.7)
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Secondary Outcomes
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Proportion Screened by Decision Aid Use n149
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Conclusions

• Intervention may have had a modest effect on
  screening test completion
• Improvement in some secondary outcomes
• No effect attributable to use of the decision aid
  materials

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Limitations

• Allocated at the practice level
• Large number of practices and members contacted
  for participation
• Cannot separate effects of practice level
  intervention from the patient level intervention

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Implications

• Intervention materials may have served as a
  reminder instead of facilitating decision making
• Effect worth the cost?

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CHOICE Team

• Karen Glanz, PhD MPH
• Tracy Scott, PhD
• Raquel Vázquez, MPH
• Laura Friedman, MS
• Kati Cooper
• Renata Hilson, MPH
• Nicole Dubruiel, MPH
• Randi Williams
• Jonathan Hawley
• Laura Schild
• Murty Cassoobhoy, MD
• Lisa Bernstein, MD

• Michael Pignone, MD MPH
• Carmen Lewis, MD MPH
• Alison Brenner MPH
• Barbara Rimer, DrPH

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Extra slides
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Interaction Between Intervention and Education

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Screening Test TypesReported on Year 1 Survey
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Knowledge by Decision Aid Use


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Knowledge by Decision Aid Use


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Knowledge by Decision Aid Use
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Knowledge by Decision Aid Use

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