RESUMEN
The New Mexico Department of Health and the New Mexico Medical Society invited organizations to participate in an initiative to promote clinical preventive services. The Clinical Preventive Initiative (CPI) focuses on the following interventions based on burden of illness, preventability of the condition, cost, current level of services, availability of leadership, and programmatic support: adult pneumococcal vaccination, tobacco use prevention and cessation, mammography screening, colorectal cancer screening, healthier weight, screening and treatment for chlamydia and gonorrhea, screening and intervention for problem drinking, childhood immunization, and prevention of unintended pregnancy. Specific workgroups plan and implement interventions directed at New Mexico medical practices, practitioners, and health-care systems. Several state measures suggest effectiveness of CPI efforts. CPI is a successful public-private collaboration providing an active forum for statewide clinical prevention policy development, an effective mechanism to achieve greater awareness of prevention and improved delivery of preventive services.
Asunto(s)
Servicios Preventivos de Salud/organización & administración , Práctica de Salud Pública , Encuestas de Atención de la Salud , Política de Salud , Humanos , Relaciones Interinstitucionales , Liderazgo , New Mexico , Servicios Preventivos de Salud/economíaRESUMEN
INTRODUCTION: Colorectal cancer screening rates are low throughout the United States. Colonoscopy has been recommended as a cost-effective strategy for colorectal cancer screening and prevention. We evaluated New Mexico's capacity to increase the prevalence of colorectal cancer screening using colonoscopy. METHODS: We identified New Mexican gastroenterologists from state licensing data and from endoscopic manufacturers. We surveyed gastroenterologists on their weekly number of colonoscopies, capacity for additional screening colonoscopies, and barriers to increasing capacity. We used census data, published data on the yield of screening colonoscopy, and professional society guidelines for cancer/polyp surveillance to estimate the additional colonoscopies required to increase the state's prevalence of endoscopic screening. RESULTS: Forty gastroenterologists, representing all 11 group practices in the state, and nine of 12 solo practitioners responded. They estimated that their weekly procedure capacity could be increased by 41%, from 832 to 1174 colonoscopies. We estimated an annual capacity increase of 14,880 procedures, which could increase the prevalence of endoscopic colorectal cancer screening from the current 35% to about 50% over five years. Lack of support staff, space, and physicians were barriers to increasing screening. CONCLUSION: Implementing a screening colonoscopy strategy could achieve the goal of a higher level of colorectal screening. However, achieving more universal screening would require additional testing modalities.