Community Community Pharmacists' Role in Pharmacists' Role in Colorectal Cancer Colorectal Cancer ScreeningScreening

ACCN Research RoundtableHershey, PASeptember 28, 2007

Co-Investigators:

Cathy A. Coyne, MPH, PhDDivision of Community HealthLehigh Valley HospitalAllentown, Pennsylvania

Lesley-Ann Miller, PhDDrug Use Policy and PharmacoeconomicsMD Anderson Cancer CenterUniversity of Texas

Linda Jacknowitz, MLSCristina Demian, MD, MPHMary Babb Randolph Cancer CenterCancer Prevention and ControlWest Virginia University

MethodologyMethodology

Mailed survey Mailed survey (9-pages)(9-pages)

Random sample of 1000 licensed Random sample of 1000 licensed pharmacists in West Virginiapharmacists in West Virginia

Notification letter sent, following Notification letter sent, following by survey with coverletterby survey with coverletter

Reminder postcard, replacement Reminder postcard, replacement survey, telephone follow-upsurvey, telephone follow-up

ResultsResults

333 pharmacists not eligible to participate333 pharmacists not eligible to participate2 deceased2 deceased

15 retired15 retired 45 surveys returned, address unknown45 surveys returned, address unknown 58 not practicing in West Virginia58 not practicing in West Virginia 213 did not have direct contact with patients213 did not have direct contact with patients

Total eligible sample: 667Total eligible sample: 667 Respondents: 337 (50.5% response rate)Respondents: 337 (50.5% response rate)

Respondent Characteristics

Gender (% male) 55.5

Mean age (yrs) 43.9

Degree (% respondents)

BS 86.4

MS 0.6

PharmD 8.0

More than one 3.9

Pharmacy Setting (Percentage of respondents)

Independent Pharmacy 32.0

National Chain Pharmacy 27.6

National Chain Grocery/Supermarket 8.3

National Chain Department Store 7.1

Regional Chain Pharmacy 4.7

Type of county where pharmacist works (urban/rural)

70.3/36.7

Own pharmacy/store 14.5

Percentage reporting proactive counseling services

Diabetes 82.2

Blood pressure screening 75.7

Smoking cessation 75.4

Hormone replacement therapy 40.7

Colorectal cancer screening 13.6

Prostate cancer screening 12.2

20.4

30.6

45.9

30.3

0

20

40

60

80

100

Per

centa

ge o

f re

spondents

Lack of reimbursement

Lack of time

Lack of patient interest

Lack of pharmacistknowledge

Percentage of Community Pharmacists reporting potential barriers to patient counseling

80.7

51.9

36.831.2

0

20

40

60

80

100

Perc

enta

ge o

f re

spondents

"very

eff

ect

ive"

Colonoscopy

Flex Sig

FOBT

DCBE

Community pharmacists’ perceived effectivenessof colorectal cancer screening tests

for average risk patients 50+ year of age

Pharmacists don’t have role in cancer prevention counseling

78.6% disagree

Pharmacists should only have responsibility to counsel about medications

77.2% disagree

8.3

41.2

17.5

24.9

7.7

0

10

20

30

40

50

Perc

enta

ge o

f re

spondents

Strongly agree

Agree

Undecided

Disagree

Strongly disagree

Community pharmacists’ agreement to statement indicating that they are confident in their

ability to instruct patients on proper FOBT use

FOBT kits for sale in pharmacy 22.7%

None sold 24%

1-5 kits sold/month 52%

85.7

95.5 92.6

0

20

40

60

80

100

Per

centa

ge o

f re

spondents

Screening is cost effective

CRC is a serious publichealth problem

CRC screening is asimportant as otherscreenings

Potential facilitators to pharmacists’ counseling patients about colorectal cancer screening

74.6

37.1

95.8 94.7

40.5

0

20

40

60

80

100

Perc

enta

ge o

f re

spondents

FOBT

Sigmoid/ colonoscopy

Smoking cessation

Sun screen use

PSA

Pharmacist attitudes regarding counseling responsibilities - Percentage that agree it is pharmacists’ responsibility to counsel patients about…

44.2

57

44.2

0

20

40

60

80

100

Perc

enta

ge o

f re

spondents

Physicians are responsible

Pharmacists uncomfortable

Too busy

Potential barriers to pharmacists’ counseling Patients about colorectal cancer screening

82.8

76.4

90.386.1

89.4

81.9 82.2

76.8

95.8

0

20

40

60

80

100

120

Perc

enta

ge o

f re

spondents

Counseling- FOBT kit use

Counseling-Sigmoid/ colonoscopy

Counseling -diabetes management

Counseling -Smoking cessation

Guidelines-CRC

Counsel-skin cancer prevention

Guidelines-breast cancer screening

Guidelines-prostate cancer screening

Guidelines-cervical cancer

Likelihood of participating in training