摘要：Objectives. We tested the effectiveness of offering home fecal immunochemical tests (FITs) during influenza vaccination clinics to increase colorectal cancer screening (CRCS). Methods. In a clinical trial at Kaiser Permanente Northern California influenza clinics in Redwood City, Richmond, South San Francisco, Union City, and Fresno, we randomly assigned influenza clinic dates to intervention (FIT offered) or control (FIT not offered) and compared subsequent CRCS activity. Results. Clinic staff provided FITs to 53.9% (1805/3351) of intervention patients aged 50 to 75 years. In the intent-to-treat analysis, 26.9% (900/3351) and 11.7% (336/2884) of intervention and control patients completed an FIT, respectively, within 90 days of vaccination ( P ≤ .001). The adjusted odds ratio for completing FIT in the intervention versus the control arm was 2.75 (95% confidence interval = 2.40, 3.16). In the per protocol analysis, 35.4% (648/1830) of patients given FIT and 13.3% (588/4405) of patients not given FIT completed FIT within 90 days of vaccination ( P ≤ .001). Conclusions. This intervention may increase CRCS among those not reached by other forms of CRCS outreach. Future research should include the extent to which these programs can be disseminated and implemented nationally. More than 143 000 new cases of colorectal cancer and more than 51 000 colorectal cancer deaths are expected in the US 2012 Census, making it the fourth leading cause of nonskin cancers diagnosed and the second leading cause of all cancer deaths among Americans. 1 Colorectal cancer mortality can be reduced with screening. 1,2 The US Preventive Services Task Force recommends colorectal cancer screening (CRCS) for average-risk adults aged 50 to 75 years using annual high-sensitivity fecal occult blood tests such as fecal immunochemical tests (FITs), flexible sigmoidoscopy every 5 years with interval fecal occult blood testing, or colonoscopy every 10 years. 3 Only 58.6% of US adults aged 50 to 75 years were up to date with guideline-recommended screening in 2010. 4 Achieving high CRCS rates requires evidence-based approaches, such as removal of barriers to obtaining and completing recommended tests, 1-to-1 health care team member interventions, and organized patient reminders. 5 At Kaiser Permanente Northern California (KPNC), a combination of traditional primary care strategies and an organized system of FIT kit mailings has led to a CRCS rate of more than 75.0% for patients aged 50 to 75 years, exceeding the Healthy People 2020 target of 70.5%. 6–8 Nonetheless, even at KPNC, many age-eligible patients remain unscreened. A strategy that may add to these efforts is the FLU-FIT Program, which is designed to allow non–physician-led health care teams to offer FIT kits to eligible patients when they seek annual influenza vaccinations. The program has been tested in safety net settings 9–11 and was pilot tested at KPNC’s Santa Clara facility in 2008. 12 In this new study, we provided a comprehensive test of the effectiveness of the FLU-FIT Program for KPNC influenza vaccination clinic attendees not reached with or responding to other CRCS opportunities.
