Table 2 Use of data gathered to define the organizational model.
Question | Experimental evidence/elements from | Organizational choices |
|---|---|---|
Which Organizational framework? | ▪ Literature on organisation topics ▪ RPHA Mission | Disease management as a factor to achieve effectiveness |
Which Screening test? | ▪ Literature evidence ▪ European Commission Recommendation [4] ▪ FOBT has a compliance of 3.1 compared to FS [25] | FOBT as screening test |
Which FOBT type? | ▪ Literature evidence ▪ The immunochemical test had a 20% higher compliance than Guaiac. ▪ Higher variability in the results obtained with the Guaiac test than the immunochemical [21]. | Immunochemical test as FOBT test |
Which FOBT provider? | ▪ The compliance to the FOBT with GPs was 3.4 times higher than compliance with the hospital, independent of the type of test and geographical area [20] | General Practitioners as main provider |
What the GPs think about screening? What they can do? | ▪ GPs currently do not correctly follow up a positive FOBT [18]. ▪ There was high variability among GPs: GPs with a heavy work load and those who incorrectly recommended FOBT for CRCS obtained lower compliance [20] | the GPs are not required to participate in the program, but they receive an economic incentive if they do. |
Reference diagnostic Centre | ▪ Number of CRC cases treated by hospital in the previous 3 yrs plus a guarantee of accessibility in rural areas ▪ A shared system of quality indicators and standards ▪ Attending a re-training course | ▪ Centres belonging to Hospitals that have > 500 patients ▪ Centres complying with quality indicators |
Why people do not respond to screening invitation? | ▪ The first reported reason for non-compliance was "lack of time" (30%). ▪ The major determinant of compliance was the distance from the test provider. [22] | Territorial zoning regardless of administrative borders |
Who manage the follow up of positives? | ▪ GPs undependable for correct follow-up [18] ▪ Gastroenterologists not skilled in managing mass screening criteria [19] ▪ Neither physicians at endoscopy centers nor GPs tend to follow screening guidelines. | ▪ Centralized management ▪ Guidelines-based software |
Which software for screening management? | ▪ Previous breast cancer screening experience about non-efficiency of in-house softwares, different for each Local Health Unit ▪ Mission: disease-management oriented | ▪ Web based software |