The Veterans Health Administration Instituted a National Policy Converting Screening Colonoscopy to FIT During the COVID Pandemic: Was the Policy Followed?
Douglas K. Rex, MD, MASGE, reviewing Adams MA, et al. Gastroenterology 2022 Feb 24.
During the COVID-19 pandemic, the Veterans Health Administration (VHA) instituted a national policy converting screening colonoscopy to fecal immunochemical testing (FIT) to manage reduced access to colonoscopy and decreased screening rates.
This study examined the use of screening colonoscopy in the last 3 months of 2019 (pre-COVID) compared with the last 3 months of 2020 (COVID) in 117 VHA facilities. Of the colonoscopies performed during the study period, 28.2% were for screening purposes. Systemwide, there was a 9.3% decrease in the mean adjusted facility-level proportion of screening colonoscopies in the COVID era compared with the pre-COVID period, whereas monthly FIT volume increased by 7.9%. High-complexity facilities decreased screening colonoscopy use by only 25%.
COMMENTThe reasons VHA facilities could not shut down screening colonoscopy use during COVID are unclear and probably complex. The results suggest that screening colonoscopy is extremely well-embedded in the VHA system, and derailing its use, even for a massive public health problem like COVID, would require an extraordinarily well-coordinated effort at many levels of the health care system.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Adams MA, Kurlander JE, Gao Y, Yankey N, Saini SD. Impact of COVID-19 on screening colonoscopy utilization in a large integrated health system. Gastroenterology 2022 Feb 24. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2022.02.034)
