Abstract

Colorectal cancer is currently the 3^rd leading cause of cancer death worldwide. For rural, medically underserved populations in the US, and particularly in Appalachia, the burden of this disease is even greater. Elevated colorectal cancer rates in rural populations represents a missed opportunity for early detection through screening. Low screening rates are particularly concerning for Appalachia because of poverty and limited access to healthcare. To address this problem, a 5-year study to increase screening through outreach to rural primary care providers was conducted from 2005 to 2010. Practices were randomised to early or delayed intervention groups and an intervention was provided in personal visits at the practices. The intervention was designed to assist practices in identifying opportunities to increase screening by providing education regarding screening efficacy, clinical performance measures, patient counselling, and creating a screening-friendly practice environment. Evaluation data were collected through medical record reviews before and after intervention delivery. Baseline data for both study groups indicated that healthcare providers had completed screening by any method in 36.7% of the 3906 patient records patient records reviewed. There was no significant difference in screening rates between the early or delayed group practices at baseline. At follow-up, screening rates remained low overall, 37.9%. However, for practices that received the intervention, analyses of follow-up data showed a statistically significance difference in screening rates (p<0.05). These results suggest that outreach to rural primary care practices can be effective in increasing screening for colorectal cancer.