Fecal occult blood testing completion in a VA population: Low and strongly related to race
Objective: To assess the proportion of subjects who complete an ordered fecal occult blood test (FOBT) and to determine predictors of FOBT card return in the Veterans Affairs (VA) health care system. Design: Retrospective medical record review. Setting: Single VA facility. Participants: 500 consecutive patients who had screening FOBT ordered. Measurements: Patient demographics and FOBT completion. Results: The sample was 97% men and had a mean age of 64 years. The racial distribution was 62% white, 30% African American, 6% race unknown, and < 1% "other." Approximately 46% of the patients had previously completed an FOBT. Only 46% of the patients had returned the FOBT cards at 9 months. 51% of whites returned FOBT cards compared with 37% of African-American patients. The adjusted odds (95% confidence intervals) of FOBT return were 2.6 (1.8-3.8) for those with a prior completed FOBT and 1.6 (1.1-2.5) for whites compared with African-American patients. Logistic regression showed no significant association with returned FOBT cards and age, urban/rural status, or having a post office box. Conclusions: The benefit of colorectal cancer screening was lost by over half the study sample because the FOBT cards were not returned. Prior FOBT completion predicted current FOBT adherence. White patients were almost twice as likely to return FOBT cards. The poor return rate, particularly for African-American patients, inflates estimates of colorectal cancer screening utilization in our facility.
Fisher, DA; Johnson, MR; Shaheen, NJ
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