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Pharmacist Intervention in Colorectal Cancer Screening Initiative (PICCSI)

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Pharmacist Intervention in Colorectal Cancer Screening Initiative (PICCSI)


•Colorectal cancer (CRC) is third most common cause of cancer and death among Americans; yet highly treatable if detected early1
•CRC screening is recommended for those age 50 years at normal risk for for CRC and can be done through2
oStool testing
§High-sensitivity guaiac-based test
§Fecal immunochemistry test (FIT)
§DNA-based testing
oFlexible sigmoidoscopy +/- stool-based testing
oCT colonography
•Introduction of regular CRC screening has reduced mortality rates by 50%2
•Despite this, only 59% of eligible participants will undergo screening2
•Screening rates nationwide and in Connecticut are lower in those with3-5
oLow socioeconomic status
oNo insurance coverage
•Barriers to CRC screening include:6,7
oLack of knowledge about CRC and risk factors
oSkepticism about risk
oFinancial barriers
oPersonal factors (fear or dislike of available tests)
oSystem-level factors (costs, screening accessibility)
•Outreach programs have shown to increase screening rates, yet still have not been optimized, particularly in health disparate populations8
•Developing an inexpensive, novel manner to deliver targeted CRC education and screening strategies to health disparate populations is needed
•Pharmacists are well positioned to offer this service

To evaluate feasibility of using community pharmacists to increase awareness of CRC risk factors and cancer-screening tests and offer cost-effective CRC screening, with follow-up to assure completion.


oNormal risk for CRC  (> 50 yr or > 45 and African American or have > 1 family member with a history of CRC) and no history of inflammatory bowel disease, Alzheimer disease or medications used to treat dementia
oMedicaid, Medicaid/Medicare, or underinsured
oEnglish or Spanish readers/speakers
•Participating Pharmacies/Pharmacists
o5 Independent pharmacies in CT  -  Bridgeport, Hartford, New Haven, Stamford, West Hartford
o10 Pharmacists completed credentialing
•16 participants were assessed for CRC risk and met screening criteria (26%  of planned sample size over 2 yr)
•Of these 16 participants
o87.5% were African American or Latino
o62.5% had a high school education or less
o68.8% were unemployed
o50% of them had a prior screening (7 colonoscopies, 1 FOBT)
•8 of the participants agreed to FIT; 88% completed FIT & mailed correctly
•One FIT was positive with a negative subsequent colonoscopy, the other 6 FIT were negative
•Of the 12 questions assessing baseline CRC knowledge: participants averaged 2.6+1.6 questions wrong (range, 0-6)
•50% completed patient satisfaction survey. Six questions garnered rating of “great”
oLiked pharmacists listening skills, ability to explain concepts, the quality of advice advice, level of friendliness and helpfulness, and ability to answer questions
•Barriers to enrollment occurred due to
oLack of patient interest and ineligibility
oLack of pharmacists engagement because
§Difficult to fit into normal work flow (required 30 min to complete tasks, particularly IRB-related paperwork)
§Lack of reimbursement for service
§Lack of incentive from pharmacy management to offer services
•Of those enrolled, program satisfaction was high and most completed correctly and were negative
•A direct and relational stewardship program like PICCSI, which leverages the respect, knowledge, and accessibility of the pharmacist, may allow provision of both content and screening access in a lower cost setting without sacrifice of quality.
•However, barriers to engagement of pharmacists and patients must be overcome
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