TABLE 2—
System Strategies for and Barriers to Colorectal Cancer Screening in Federally Qualified Health Centers in 4 Midwestern States: 2012
| All States (n = 44) |
Iowa (n = 12) |
Minnesota (n = 12) |
South Dakota (n = 6) |
Wisconsin (n = 14) |
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| Strategy/Barrier | No. (%) or % ±SD | Valid Responses, No. | No. (%) or % ±SD | Valid Responses, No. | No. (%) or % ±SD | Valid Responses, No. | No. (%) or % ±SD | Valid Responses, No. | No. (%) or % ±SD | Valid Responses, No. |
| Policy for CRC screening in place | 27* (61) | 44 | 5 (42) | 12 | 11 (92) | 12 | 4 (67) | 6 | 7 (50) | 14 |
| Written policy | 14 (52) | 27 | 2 (40) | 5 | 7 (64) | 11 | 3 (75) | 4 | 2 (29) | 7 |
| EMRs used | 34 (79) | 43 | 6 (50) | 12 | 11 (92) | 12 | 5 (100) | 5 | 12 (86) | 14 |
| EMR can query patients due for CRC screening | 23 (68) | 34 | 5 (83) | 6 | 8 (73) | 11 | 3 (60) | 5 | 7 (58) | 12 |
| EMR can query whether patients are up-to-date for CRC screening | 19 (61) | 31 | 5 (83) | 6 | 7 (70) | 10 | 2 (50) | 4 | 5 (45) | 11 |
| Items routinely checked during patient visits | ||||||||||
| CRC screening completed | 25 (61) | 41 | 8 (73) | 11 | 5 (45) | 11 | 4 (67) | 6 | 8 (62) | 13 |
| History of ulcerative colitis or Crohn’s disease | 10 (25) | 40 | 3 (30) | 10 | 3 (27) | 11 | 2 (33) | 6 | 2 (15) | 13 |
| Immediate family with CRC or polyps | 27 (66) | 41 | 9 (82) | 11 | 7 (64) | 11 | 5 (83) | 6 | 6 (46) | 13 |
| Distant relative with CRC or polyps | 18 (44) | 41 | 7 (64) | 11 | 4 (36) | 11 | 3 (50) | 6 | 4 (31) | 13 |
| Clinic personnel help to encourage screening | 26 (59) | 44 | 9 (75) | 12 | 7 (58) | 12 | 2 (33) | 6 | 8 (57) | 14 |
| CRC screening offered to patients aged ≥ 50 y | ||||||||||
| FOBT | 34 (77) | 44 | 11 (92) | 12 | 10 (83) | 12 | 5 (83) | 6 | 8 (57) | 14 |
| FIT | 18* (41) | 44 | 1 (8) | 12 | 5 (42) | 12 | 4 (67) | 6 | 8 (57) | 14 |
| Flexible sigmoidoscopy | 5 (11) | 44 | 2 (17) | 12 | 2 (17) | 12 | 0 (0) | 6 | 1 (7) | 14 |
| Colonoscopy | 28 (64) | 44 | 7 (58) | 12 | 9 (75) | 12 | 3 (50) | 6 | 9 (64) | 14 |
| FOBT or FIT provided to patients aged ≥ 50 y | 41 (93) | 44 | 9 (75) | 12 | 12 (100) | 12 | 6 (100) | 6 | 14 (100) | 14 |
| Test return tracked | 26 (63) | 41 | 6 (67) | 9 | 7 (58) | 12 | 5 (83) | 6 | 8 (57) | 14 |
| Patient called if test not returned | 12 (34) | 35 | 3 (38) | 8 | 5 (63) | 8 | 1 (17) | 6 | 3 (23) | 13 |
| Patient contacted by mail if test not returned | 9 (26) | 35 | 3 (38) | 8 | 3 (38) | 8 | 1 (17) | 6 | 2 (15) | 13 |
| Patient offered colonoscopy after positive test | 38 (97) | 39 | 9 (100) | 9 | 11 (100) | 11 | 5 (100) | 5 | 13 (93) | 14 |
| System in place to offer FOBT annually | 20 (54) | 37 | 3 (43) | 7 | 6 (55) | 11 | 3 (60) | 5 | 8 (57) | 14 |
| CRC screening offered to patients aged ≤ 50 y if risk factors present | 38 (86) | 44 | 10 (83) | 12 | 11 (92) | 12 | 5 (83) | 6 | 12 (86) | 14 |
| FOBT | 25* (66) | 38 | 9 (90) | 10 | 6 (55) | 11 | 5 (100) | 5 | 5 (42) | 12 |
| FIT | 14 (37) | 38 | 1 (10) | 10 | 4 (36) | 11 | 3 (60) | 5 | 6 (50) | 12 |
| Flexible sigmoidoscopy | 4 (11) | 38 | 2 (20) | 10 | 0 (0) | 11 | 1 (20) | 5 | 1 (8) | 12 |
| Colonoscopy | 26 (68) | 38 | 7 (70) | 10 | 7 (64) | 11 | 3 (60) | 5 | 9 (75) | 12 |
| Patients referred for colonoscopy | 43 (98) | 44 | 12 (100) | 12 | 12 (100) | 12 | 6 (100) | 6 | 13 (93) | 14 |
| Main barriers to providing CRC screening | ||||||||||
| Lack of time | 18 (41) | 44 | 7 (58) | 12 | 3 (25) | 12 | 2 (33) | 6 | 6 (43) | 14 |
| Lack of funding for FOBT | 7 (16) | 44 | 4 (33) | 12 | 0 (0) | 12 | 0 (0) | 6 | 3 (21) | 14 |
| Lack of time for personnel to explain test | 10 (23) | 44 | 5 (42) | 12 | 1 (8) | 12 | 0 (0) | 6 | 4 (29) | 14 |
| Language | 12* (27) | 44 | 6 (50) | 12 | 4 (33) | 12 | 2 (33) | 6 | 0 (0) | 14 |
| Lack of appropriate patient education material | 12 (27) | 44 | 4 (33) | 12 | 4 (33) | 12 | 1 (17) | 6 | 3 (21) | 14 |
| Inability to provide colonoscopy for patients with positive FOBT or FIT | 26 (59) | 44 | 9 (75) | 12 | 6 (50) | 12 | 2 (33) | 6 | 9 (64) | 14 |
| Inability to provide colonoscopy for patients with colon symptoms | 24 (55) | 44 | 7 (58) | 12 | 6 (50) | 12 | 2 (33) | 6 | 9 (64) | 14 |
| No CRC screening tracking system | 18 (41) | 44 | 7 (58) | 12 | 2 (17) | 12 | 2 (33) | 6 | 7 (50) | 14 |
| Patients with up-to-date CRC screening | 34.94 ±21.01 | 33 | 30.27 ±21.33 | 11 | 34.0 ±22.70 | 8 | 38.0 ±25.15 | 5 | 39.78 ±19.17 | 9 |
Note. CRC = colorectal cancer; EMR = electronic medical record; FIT = fecal immunochemical test; FOBT = fecal occult blood test. Denominator for all percentages is respective number of valid responses.
*P ≤ .05 (Fisher exact test).