Expanding access to colorectal cancer screening through community pharmacies: The PharmFIT study

Project Abstract (Summary) Medically underserved populations are disproportionately affected by screen-preventable cancers, such as colorectal cancer (CRC). Entities such as the United States Preventive Services Task Force and the American Cancer Society recommend fecal immunochemical testing (FIT) as an effective home-based method for CRC screening. Annual FIT, when followed by a diagnostic colonoscopy for a positive result, can reduce CRC mortality on a population level. CRC screening is traditionally delivered as part of a medical visit. However, due to short visit times and competing demands among providers and patients alike, patients, even those who regularly attend medical visits, may miss out on screening, putting them at a higher risk of serious disease. FITs can be easily distributed in non-traditional healthcare settings and can help bridge the gap in care for underserved populations. Community pharmacies hold promise as a site for CRC screening because of their accessibility and pharmacists’ expanding role in delivering preventive services. Based on our formative and pilot work demonstrating the acceptability, feasibility, and preliminary effectiveness of FIT delivery in pharmacies, our objective is to evaluate the effectiveness and implementation of a pharmacy-based FIT intervention called PharmFIT. Through collaboration with community partners such as the North Carolina Network Consortium (NCNC), the Washington, Wyoming, Alaska, Montana, and Idaho Practice Research Network (WPRN) and the Community Pharmacy Enhanced Services Network (CPESN), our aims are to: 1) evaluate the impact, 2) assess the implementation, and 3) estimate the costs of the PharmFIT intervention. We will conduct a randomized controlled trial to assess the impact of PharmFIT on CRC screening rates in eligible primary care patients who are not up to date. Patients will be individually randomized to a usual care arm or a PharmFIT arm and we will determine whether there are statistically significant differences in CRC screening rates. Concurrently, we will use a mixed-method approach to assess a range of preliminary implementation outcomes and identify barriers and facilitators (i.e., determinants) of those implementation outcomes. Finally, we will calculate the cost of PharmFIT using collaborative process flow diagramming to inform micro-costing and budget impact analysis. We hypothesize that the PharmFIT intervention will increase CRC screening uptake over usual care by providing better access and more opportunities for preventive services through a collaborative pharmacy/primary care approach.