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The Colorectal Cancer Screening Programme in the Basque Country: obtaining a good performance by means of professional collaboration

Authors:

Isabel Portillo ,

Osakidetza/General Direction.The Basque Health Service, ES
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Isabel Idigoras,

Osakidetza/General Direction.The Basque Health Service, ES
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Isabel Bilbao,

Osakidetza/General Direction.The Basque Health Service, ES
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Jose Luis Hurtado,

Araba University Hospital, ES
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Jose Luis Bilbao,

Osakidetza/General Direction.The Basque Health Service, ES
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Eunate Arana-Arri,

BioCruces Research Institute, ES
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Euskolon Team

Osakidetza/Health Department, ES
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Abstract

Introduction: The Basque Health Service approved the Colorectal Cancer (CRC) screening programme in 2008; targeted at residents (50 to 69 years old) estimated 598,201 by biennial faecal immunochemical test (FIT) and colonoscopy in positive cases. Planning, organization and evaluation are managed by the Programme Coordinating Centre (PCC). Collaboration among and implication of professionals and specialists in Information Technology (IT) is the main key.

Methodology: Specific software was linked to medical records and cancer registries. Invitations arranged by the Primary Health Centres (PHC) in coordination with hospitals.  After a first letter of invitation, people received by post a kit with an individualized identification code. The PHCs’ tasks: reinforcing information; collection of kits and registration; sending to the laboratory; evaluation and referral of patients with positive test for a colonoscopy; appropriate cleansing instructions and colonoscopy surveillance. Laboratory tasks: process and validation of samples. Endoscopy Units and Pathology are in charge of: performing colonoscopies, biopsy analysis and recommendations following European Guidelines1. The process is available in medical records by the linked ITs. The PCC team codes and analyzes data. Results are shown in the official website and disseminated via meetings and before the next round of invitations. 120 professionals are involved in multidisciplinary teams and research groups to improve quality assurance.

Results: 1,422,534 valid invitations were registered between 2009 and 2017, there was a significant increase in participation rate (58.1% to 72.4%), higher among women. Adherence to colonoscopy was 95% and appropriate colonic cleansing 89%. Variability was found between organizations. 21,490 Advanced Adenomas and 2,856 CCRs were detected, with a decrease in the detection rate in successive rounds (Advanced Adenomas 26.8‰ to 16.7‰ and for CRC 4.4 to 2.0‰ by participants), significantly higher among men. 69.2% of CRC were diagnosed in initial stages. Sensitivity and Specificity of FIT to detect CRC were 88.4% (87.2-89.5) and 94.2% (94.2-94.3), respectively. 

Discussion: The programme showed a high participation rate, important indicator to guarantee a good balance in cost-effectiveness. The strategies to obtain the results (mailing the kit, involving GPs). ITs played a key role in coordinating the staff and checking the process following CANCON recommendations2.

Conclusions: The involvement of professionals, active coordination in the multidisciplinary team and IT support were integral to programme results.

Lesson Learned: In public health programmes, the active involvement and coordination of staff is necessary to ensure a positive impact.

Limitations: Enhancing professional and organizational characteristics in the light off results.

Suggestions: Qualitative and quantitative studies are needed to link professional variables and programme results.

References:

1- Segnan N, Patnick J, von Karsa L (eds). European Guidelines for Quality Assurance in Colorectal Cancer Screening and Diagnosis. 2010 First Edition. Luxembourg: European Commission, Publications Office of the European Union, 2011.

2- Albreht T, Kiasuwa R, Van den Bulcke (eds). EUROPEAN guide on quality improvement in comprehensive cancer control. Cancer Control Joint Action. National Institute of Public Health (Slovenia) and  Scientific Institute of Public Health (Brussels), 2017.

How to Cite: Portillo I, Idigoras I, Bilbao I, Hurtado JL, Bilbao JL, Arana-Arri E, et al.. The Colorectal Cancer Screening Programme in the Basque Country: obtaining a good performance by means of professional collaboration. International Journal of Integrated Care. 2019;19(4):166. DOI: http://doi.org/10.5334/ijic.s3166
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Published on 08 Aug 2019.

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