The role of family physicians in increasing annual fecal occult blood test screening coverage: A prospective intervention study

Background: Colorectal cancer is the second leading cause of cancer mortality in Israel. Unfortunately, compliance with annual fecal occult blood testing is very low. Objective: To assess the effectiveness of interventions to increase FOBT screening in primary care clinics in Israel. Methods: A prospective, randomized study included all 50-75 year old enrollees of six family physicians in two primary care clinics. The register of two physicians, one from each clinic, was allocated to one of three groups. Two FOBT reminder strategies were tested: a physician reminder (753 patients), and a patient reminder that was either a phone call (312 patients) or a letter (337 patients). The control group (913 patients) of physicians continued administering their regular level of care. The main outcome measure was the percentage of patients undergoing FOBT screening in each study arm at the conclusion of the one year study period. Results: In the intervention groups 14.3% (201/1,402) were screened using the FOBT over the course of the study year. Using an intent-to-screen analysis, the screening rate in the physician and patient reminder groups was significantly higher than in the control group (16.5 and 11.9%, vs. 1.2% respectively, P < 0.0001). Phone reminders were significantly more effective than letters (14.7 vs. 9.2%, P = 0.01). Conclusions: Various reminder systems for FOBT are beneficial, especially those centered around the family physician. Further research should focus on this area, in conjunction with other novel approaches.