Michael Potter, MD, is a professor in the Department of Family and Community Medicine at the University of California, San Francisco. He is a graduate of Harvard Medical School and the family medicine residency program at San Francisco General Hospital. For the past 20 years, he has divided his time evenly between patient care, teaching, and research. Dr. Potter is Director of the San Francisco Bay Area Collaborative Research Network, which is UCSF's primary health care practice based research network. In this role, he works within UCSF's Clinical and Translational Sciences Institute to promote and lead collaboration between UCSF researchers and community health providers on research projects that can improve primary care systems and clinical outcomes. He is also active within the National Colorectal Cancer Roundtable, having completed 4 years of service on the NCCRT steering committee, and he is currently co-chair of the NCCRT's Professional Education and Practice Committee. Dr. Potter is the developer of the Flu-FIT Program, which is a primary care intervention that focuses on increasing access to colorectal cancer screening by offering annual stool tests to eligible patients during annual flu shot campaigns. The development and dissemination of the Flu-FIT Program has been supported with grants from the American Cancer Society, Centers for Disease Control and Prevention, the HMO Cancer Research Network, and others. The Flu-FIT Program has been featured on the AHRQ, Research to Reality and RTIPS websites, actively promoted by the ACS and many state cancer programs, and has been implemented in many different iterations across the United States. Dr. Potter received the 2013 Annual Prevention Laurel awarded jointly by the Prevent Cancer Foundation, the National Colorectal Cancer Roundtable, and the American College of Obstetricians and Gynecologists. He was a member of NCI's TIDRH faculty in the summer of 2012 and will present his work at NCI-sponsored conferences in Buenos Aires and Paris this fall.
Questions and Answers
Our original idea was the Flu-FOBT and Flu-FIT Programs would be ideal for community health centers that rely on home stool testing for colorectal cancer screening and that had lower than desired colorectal cancer screening rates. Many of these clinics organize teams each year to do flu shot clinics, and it seemed natural to add the offering of FOBT or FIT to eligible patients as part of these activities.
In our initial American Cancer Society (ACS) funded study, we found that nurse-run “flu shot clinics” were an excellent venue to offer colorectal cancer screening, too. In a subsequent CDC-funded study, we learned that Flu-FOBT and Flu-FIT activities can be adapted for primary care in community health centers, as well. For example, nurses can be given standing orders to offer flu shots and colorectal cancer screening to eligible patients during routine primary care visits each fall.
Coupling the activities provides the message that getting colorectal cancer screening is as important as getting a flu shot, and that stool tests must be done every year. In a subsequent ACS study we adapted the Flu-FIT Program for mass vaccination clinics at a large HMO (Kaiser Permanente), and showed that it can work there, too. Finally, we did a pilot study of the program in commercial pharmacies that provide annual flu shots, and we found that many customers are interested in learning about and gaining access to colorectal cancer screening through their pharmacists.
At present, working in pharmacies is more challenging, however, because pharmacies often lack the space to offer preventive counseling, because it is difficult to assess eligibility for colorectal cancer screening without access to electronic health records, and because pharmacies may lack the ability to connect patients to primary care for follow up of abnormal test results. In addition, it may be difficult for pharmacies to capture reimbursement for providing FOBT or FIT in pharmacies. That said, pharmacies within integrated healthcare systems may turn out to be ideal locations for Flu-FOBT Programs (e.g. at Kaiser), since many of these barriers do not exist in these settings.
I have been asked if I thought a Flu-FIT programs could work in community health settings, such as a flu shot clinics run at community health fairs, in churches, or in rural areas for migrant health workers. My response is that these can be excellent settings for education about colorectal cancer screening, but they are problematic for providing screening unless follow up of abnormal tests with colonoscopy can be assured. There is no benefit to screening without being able to assure appropriate follow up with treatment, if needed.
Hopefully many of these barriers will ultimately be overcome with health reform.
I direct a practice-based research network, called the San Francisco Bay Area Collaborative Research Network. Our mission is to promote the collaboration of academic researchers and community-based health care leaders to develop, implement, evaluate, and disseminate interventions that can improve primary health care outcomes. In my own research, I continue to work on Flu-FOBT and Flu-FIT dissemination, but I am also involved a variety of other research projects relating to relatively simple and scalable practice changes that can make a difference in primary care.