Completion of Colonoscopy After Positive Fecal Occult Blood Test Screening at a Community Health Center

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• Colorectal cancer screening, including fecal occult blood testing (FOBT), is crucial for reducing mortality.
• Positive FOBT results necessitate colonoscopy for diagnosis and treatment.
• Barriers to colonoscopy completion after positive FOBT require investigation, particularly within community health center (CHC) settings.

Purpose of the Study:

• To identify factors influencing colonoscopy completion rates among CHC patients following a positive FOBT.
• To analyze the impact of demographics, insurance status, and travel distance on colonoscopy adherence.

Main Methods:

• Retrospective chart review of CHC patients with positive FOBT results between 2018 and 2021.
• Descriptive analysis and logistic regression modeling to determine predictors of colonoscopy completion.
• Stepwise and model selection methods (Akaike Information Criterion, Wald tests) to identify significant covariates.

Main Results:

• Only 50% of patients completed colonoscopy after a positive FOBT; the average time to completion was over 230 days.
• Health insurance status was a significant predictor, with insured patients being over 221% more likely to complete the procedure.
• Increased age positively correlated with colonoscopy completion likelihood, while greater distance to the colonoscopy site decreased it.

Conclusions:

• Colonoscopy completion rates after positive FOBT are suboptimal, with significant delays.
• Health insurance emerges as the most critical factor for colonoscopy adherence, even with financial aid programs.
• Geographic accessibility to colonoscopy services is a key determinant in patient follow-through.