ABSTRACT
Introduction: Colorectal cancer (CRC) screening is a critical preventative service and part of routine patient care. CRC is the second leading cause of cancer death in the US, and yet a third of the eligible population does not undergo routine screening. Endoscopy centers have been stretched thin by both COVID-19 and the recent drop in screening initiation age to 45. Fecal immunochemical testing (FIT), a sensitive and specific CRC screening modality, may be used to reach and risk-stratify more patients to increase the yield for detecting advanced neoplasia and cancer, reducing pressure on colonoscopy centers. Unfortunately, FIT is often suboptimal as patients inconsistently complete and return the test for analysis. Method(s): We performed a retrospective analysis of 5211 individuals at a single internal medicine clinic who had FIT ordered as part of USPSTF recommended care from 01/2017 through 12/2021. Starting in 01/2021 we instituted a dedicated patient navigator to support patients in completing FIT. Chi-square, Fisher exact test, and Student's t-tests were performed for descriptive analyses. Multivariable logistic regression was used to compare FIT kit drop off rates pre- and post-intervention, with the model adjusted by age, gender, race, ethnicity, language, and insurance status. Analysis was performed in SAS version 9.4. (Table) Results: The post-intervention period included 1181 (22.7%) patients. The predominant reasons cited for failure to complete testing were forgot (25%), too busy (13%), and lost kit (11%). Our intervention improved drop off rates from 46.4% to 51.3% at 2 weeks (OR 1.19, 95%CI 1.01-1.41), 56.7% to 73.7% at 1 month (2.14 [1.78-2.58]), 64.7% to 89.7% at 3 months (4.73 [3.66-6.12]), and 78.9% to 98.2% at 1 year (14.39 [8.25-25.12]). Overall, our intervention improved FIT kit drop off rates by 53.4% (1.53 [1.30-1.81]). FIT was positive in 4.9% (p=0.0529). (Figure) Conclusion(s): FIT can increase CRC screening rates, particularly in resource-limited settings, and may decrease the burden on endoscopy centers nationwide by improving the efficiency of colonoscopy in the average risk screening population. The addition of a dedicated patient navigator is a simple intervention that, by providing culturally competent care and personalized attention, improves completion rates and return time, allowing FIT to be a reliable method of screening. The ability to increase screening rates and prioritize patients for diagnostic colonoscopies will ultimately lead to earlier detection and treatment of CRC.
ABSTRACT
BACKGROUND: Latino communities are disproportionately affected by COVID-19. In response, our Johns Hopkins based team of investigators and community health workers expanded access to free COVID-19 testing, and later vaccinations, through trusted community venues in Baltimore, MD. To promote these services, we developed a community-driven culturally congruent social marketing campaign and website. This work was supported by the NIH RADxUP (Rapid Acceleration of Diagnostics - Underserved Populations) initiative. METHODS: The campaign name was chosen using a crowdsourcing open contest, evaluated by community judges and a popular vote. Campaign messaging was informed by prior focus groups and our community advisory board. The reach of the campaign was evaluated through online metrics (Google analytics and Facebook) as well as surveys of individuals obtaining COVID-19 testing or vaccination. Surveys were conducted over a 2-week period (6/25/21-7/9/21) at our main community-based venue, Sacred Heart Church. RESULTS: The campaign was named “Mejor Vive Sin Duda" ("Better to Live Without Doubt") based on the results of the crowdsourcing open contest, after which we developed the social marketing advertisements and website which launched in February 2021. Among 252 individuals surveyed in the 2-week period, 33% of respondents had seen or heard of the Mejor Vive Sin Duda campaign, with Facebook being the most popular means of campaign exposure. From March 1, 2021 to December 31, 2021, we received 9,100 unique visitors to the website and reached 254,910 people through paid social media advertisements. CONCLUSIONS: Social marketing campaigns present an opportunity to promote COVID-19 testing and vaccine uptake among Latino populations who face barriers to traditional healthcare settings. Community partnerships were integral to campaign success. Campaigns must be paired with accessible and culturally competent healthcare services to lead to equitable improvements in health outcomes.
ABSTRACT
Background: The COVID-19 pandemic heightened concerns about the social health of older adults and potential exacerbation of racial disparities in health, well-being, and healthcare access. Methods: We used weighted data for 4282 Kaiser Permanente Northern California (KPNC) members aged 65-85 who responded to the 2020 KPNC Member Health Survey to estimate prevalence of frequent loneliness, lack of social support, financial strains, and other stressors during the prior 12 months. Results: Overall, 5% often felt lonely or socially isolated, and 37% often did not get sufficient social/emotional support (Figure). While approximately 4% had problems “making ends meet”, 10% worried about financial security. Cost led to 2-3% being food insecure, eating less healthy foods, and delaying/foregoing medical care, and 11% delaying/foregoing dental care. Black adults were most likely to report these financial strains, as well as experience harassment/ discrimination and worry about neighborhood violence. Asian/Pacific Islander adults (API) were most likely (57%) and White adults least likely (32%) to report lack of social/emotional support. Conclusions: While many older adults experienced adverse financial and social circumstances during the pandemic, Black adults were more likely than White adults to indicate financial and healthcare access strains. More research is needed on effective screening for financial and other social risks in diverse older adult populations to deliver socially and culturally appropriate care to vulnerable populations.