An evaluation of the Waitemata District Health Board Bowel Screening Pilot is being undertaken to help inform a decision on whether it is feasible to roll out a national bowel screening programme.
This report explores the role and value of general practice (GP) in the pilot and draws on quantitative data from the population and provider surveys, the immersion visit interviews and face-to-face interviews with Māori and Pacific who have completed a bowel screening test as part of the pilot.
The role of general practice in informing participants of their positive bowel screening test result is a unique element of the pilot. Internationally, GP involvement in bowel screening has been variable but has nonetheless had a positive impact on participants.
Purpose
The role of general practice in informing BSP participants of a positive immunochemical faecal occult blood test (iFOBT) is a unique element of the BSP. The findings from the first immersion visit (Litmus 2013) found that while general practitioners (GPs) and practice nurses are generally supportive of the BSP, across general practice there is variation in BSP processes and practices. Internationally, GP involvement in bowel screening has been shown to have a positive impact on iFOBT screening participants, although this is subject to high variability (Federici et al 2006, Koo et al 2010, Power et al 2009).
Given this unique role and noted variation, it was agreed with the Ministry and the Bowel Screening Evaluation Advisory Group, the role and value of general practice in the BSP needed to be more fully understood, particularly with regard to enhancing participants’ experience and in considering general practices’ role if the Pilot was rolled out nationally.
To identify the role and value of general practice in the BSP, this report draws on the quantitative data from the eligible population and provider surveys (Litmus 2014 a & b), the immersion visits interviews with GPs, practice nurses and practice managers as well face-to-face interviews with Māori and Pacific BSP participants.
Key Results
Key findings from across the range of data sources are:
- General practices in WDHB have high levels of awareness, knowledge and support of the BSP. In the main, GPs are undertaking their role in the BSP as intended. Three quarters of BSP participants heard about their positive iFOBT result from their general practice.
- For those BSP participants who did not hear about their positive iFOBT result via their general practice, this can reflect their personal choice and circumstances (i.e. not wanting their GP informed, not having a nominated GP in their practice, or not being contactable within ten days) or incorrect consent form completion.
- Māori and Pacific BSP participants interviewed had very positive experiences along the BSP screening pathway. The process of hearing about their positive iFOBT result via general practice or the Endoscopy Unit was a timely and reassuring experience which ensured they understood the need and process for having a colonoscopy.
- Most BSP participants do not have a strong preference on who informs them about a positive iFOBT result so long as their positive iFOBT results are timely, free and convenient, given in a reassuring manner, their GP is kept informed, and the transition to colonoscopy is well explained, timely and streamlined.
- Māori and Pacific BSP participants interviewed who heard received their results from the Endoscopy Unit perceived this approach as more convenient, potentially cheaper (as no need to take time of work or incur transport costs), timely and aligned with the next step of having a colonoscopy than general practice. However, for these participants it is critical that their GP is aware of their iFOBT result.
- BSP participants who are highly anxious, have other health conditions or are reluctant to have a colonoscopy gained benefit from a consultation with their GP about their positive result.
- General Practice staff have high awareness, knowledge and support of the BSP, although there is concern about the impact of the BSP on symptomatic services particularly wait times for colonoscopy for symptomatic patients.
- Promotion of the BSP by general practice is opportunistic. Currently practices are unaware of the non-responders in their practice as there is no system to inform general practice who has received an iFOBT kit and not returned it. A potential enhancement to general practice’s role is following up non-responders in particular Māori and Pacific non-responders.
- Most (but not all) GPs are aware of their role to notify participants with positive iFOBTs within ten days. How participants are informed by general practice varies from face-to-face consult with GP to phone discussion with practice nurse.
- Most GPs and other staff perceive that having general practice involved in the BSP supports more participants to take part and enhances participant experience. In contrast, a few GPs did not perceive an added value role for general practice, and simply wanted to be kept informed of their patients’ results and interventions.