The effects of teamwork and system support on colorectal cancer screening in primary care practices

Background: While cancer screening is generally increasing in the U.S., colorectal cancer (CRC) screening remains low. Most CRC screening interventions focus either on patients or individual clinicians without examining the office context in which CRC screening is implemented. This study examines whether primary care practices that involve staff in general forms of health education have higher CRC screening rates than practices that do not. Methods: Cross-sectional data from 22 New Jersey and Pennsylvania family medicine practices were analyzed. Data include chart audits for 795 men and women eligible for CRC screening (age 50-70) and practice information surveys for each practice. Generalized estimating equations were used to determine CRC screening correlates. Results: Overall, 31.3% (n = 249) of patients received CRC screening. Practices that reported using nursing or health educator staff to provide behavioral counseling to patients on topics such as diet, exercise or tobacco use were significantly more likely to also have higher CRC screening rates (z = 7.30, p < 0.0001). Their patients had 2.96 times increased odds of CRC screening than those in other practices (95% C.I., 2.21-3.96). Reminder system use was also associated with higher CRC screening (z = 4.96, p < 0.0001). In practices that used reminder systems, patients had 2.57 times increased odds of CRC screening than others (95% C.I., 1.77-3.74). Conclusions: These findings suggest that interventions to achieve better CRC screening rates do not need to focus solely on CRC. Higher CRC rates may be achieved by capitalizing on the enhancing contributions of non-physician practice members providing more general health behavior change patient education. (c) 2007 International Society for Preventive Oncology. Published by Elsevier Ltd. All rights reserved.