Assign Designated Staff to Follow Up by Various Methods

A major focus for patient management is to empower and prepare patients to manage their healthcare. The most successful practices use a collaborative approach, one in which physician, designated office staff (e.g., nurse), and patient work together to define and solve problems, establish preventive health and treatment plans, set priorities, and establish goals. Patients may need reminders to become effective managers of their own health.

Key Points for Implementing an Office Practice Patient Follow-up Process

  • Select office staff who are competent and comfortable with assuming patient follow-up roles
  • The frequency of office follow-up will vary with the test used for screening. Annual testing for CRC is necessary for patients 50 to 75 years if FOBT is the only screening test used by the patient. Patients 50 to 75 years at average risk for CRC who have a colonoscopy should only need testing every 10 years. Patients who are at higher risk for CRC or who are screened by sigmoidoscopy or imaging studies will need to follow other frequency recommendations:1
    • Flexible sigmoidoscopy every 5 years or
    • Colonoscopy every 10 years or
    • Double contrast barium enema every 5 years or
    • Computed tomographic (or virtual) colonography every 5 years
    • Annual high sensitivity guaiac-based fecal occult blood test or
    • Annual fecal immunochemical test with high test sensitivity for cancer or
    • Stool DNA test with high sensitivity for cancer, interval unknown
  • Develop standing orders
  • Plan the follow-up approach, including who will contact patients, how, and when
  • Test follow-up mechanisms, such as calendar or tickler file. If the office is computerized, try using electronic guideline prompts. If not computerized, chart stickers may be effective
  • Use phone, E-mail, and/or mailings for follow-up
  • Develop scripts for phone follow-up
  • Educate staff about the importance of not "lecturing" patients and letting patient concerns lead the discussion
  • Start on a small scale

Resources

  1. Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA: A Cancer Journal for Clinicians. 134(5): 1570-1595.