SCREENING COLONOSCOPY REFERRALS DURING THE SARS-COV-2 PANDEMIC: IMPACT OF GASTROENTEROLOGIST RECOMMENDATION FOR FECAL IMMUNOHISTOCHEMICAL TESTING AS A PREFERRED COLORECTAL CANCER SCREENING METHOD AT A VA HEALTHCARE SYSTEM

ABSTRACT

Background: During the early stages of the SARS-CoV-2 pandemic, many endoscopic colorectal cancer (CRC) screening programs were temporarily halted, including at the Veteran's Administration (VA). The VA instituted triage and prioritization of endoscopic procedures, and fecal immunohistochemical testing (FIT) was recommended as the preferred CRC screening option over colonoscopy. We sought to determine impact of gastroenterologist (GI) recommendation to primary care providers (PCPs) to offer FIT testing to veterans who were referred for screening colonoscopy. Methods: Veterans referred for average risk screening colonoscopy, verified by GI chart review, between 3/11/2020 and 12/29/2020 at the VA Pittsburgh Health Care System (VAPHS) were included. Referring PCPs were sent standardized communication regarding assignment of a low priority to the screening colonoscopy request, and recommendation of FIT testing as the preferred CRC screening strategy. Recommendation was active, by requiring PCP acknowledgement of the FIT recommendation, or passive, by adding a comment to the procedure referral. We reviewed the charts of veterans to collect demographic information, then determine if FIT ordered, subsequently completed, or if colonoscopy was completed. Results: Eighty one screening colonoscopy requests were identified. Minimum follow-up from initial procedure consult order to chart review was 10 months with a median of 16 months. A total of 40 FIT were ordered (49.4%). Among those with FITs ordered, 24 (60.0%) were completed, 5 underwent screening colonoscopy (12.5%), and screening outcome was not available for 11 (27.5%). For veterans whom FIT was not ordered (n = 41), 15 (36.6%) underwent screening colonoscopy, and screening outcome was not available for 26 (63.4%). PCP ordering of FIT was not related to mean patient age (58.7 vs 57.2, p = 0.91), clinic location (academic urban vs urban vs satellite, c2 = 0.47), intervention type (active vs passive, c2 = 0.47), or phase of the pandemic (early vs late, c2 = 0.90). Overall veteran CRC screening completion was significantly greater for those whom FIT was ordered by their PCP vs those who did not have FIT ordered (72.5% vs 36.6%, c2 = 0.01). Conclusions: During the 2020 SARS-CoV-2 pandemic, when there were limitations on access to colonoscopy, gastroenterologist recommendation to PCPs to order FIT as an alternative to screening colonoscopy was successful half the time. FIT ordering was independent of veteran age, clinic location, intervention type, or pandemic phase. When ordered, veteran completion of FIT was 60%. There was wide variation in veteran CRC completion rate by PCP FIT ordering, suggesting either that FIT enhanced access to CRC screening, or, veteran factors influenced FIT ordering. This will inform future interventions aimed at increasing FIT utilization as an alternative to colonoscopy.(Figure Presented)