Impact of Patient Reminders on Papanicolaou Test Completion for High-Risk Patients Identified by a Clinical Decision Support System

Abstract

Background A clinical decision support system (CDSS) for cervical cancer screening identifies patients due for routine cervical cancer screening. Yet, high-risk patients who require more frequent screening or earlier follow-up to address past abnormal results are not identified. We aimed to assess the effect of a complex CDSS, incorporating national guidelines for high-risk patient screening and abnormal result management, its implementation to identify patients overdue for testing, and the outcome of sending a targeted recommendation for follow-up. Methods At 3 primary care clinics affiliated with an academic medical center, a reminder recommending an appointment for Papanicolaou (Pap) testing or Pap and human papillomavirus co-testing was sent to high-risk women age 18 through 65 years (intervention group) identified by CDSS as overdue for testing. Historical control patients, who did not receive a reminder, were identified by CDSS 1 year before the date when reminders were sent to the intervention group. Test completion rates were compared between the intervention and control groups through a generalized estimating equation extension. Results Across the 3 sites, the average completion rate of recommended follow-up testing was significantly higher in the intervention group at 23.7% (61/257) than the completion rate at 3.3% (17/516) in the control group (P<.001). Conclusions A CDSS with enhanced capabilities to identify high-risk women due for cervical cancer testing beyond routine screening intervals, with subsequent patient notification, has the potential to decrease cervical precancer and cancer by improving adherence to guidelines-compliant follow-up and needed treatment.

Clinicians’ perceptions of barriers to cervical cancer screening for women living with behavioral health conditions: a focus group study

“…Supporting evidence supports our findings that clinicians lack systems to support identification of patients who are due for cervical screening and follow-up [ 63 ]. Patient reminders in the form of letters, text messages, using mobile applications are strategies that have been found to increase cervical cancer screening and follow-up rates [ 64 – 66 ]. Provision of communication tools alone is insufficient to overcoming barriers to communicating.…”

Understanding Perceived Barriers to Colposcopy Follow-Up Among Underserved Women at an Urban Teaching Hospital: A Qualitative Study

“…These include: 1) Aim to have staff members that speak the patient's preferred language, 2) Providers set clear expectations with patients about the format of the colposcopy clinic, 3) Providers aim to improve consistency, following patients longitudinally when possible, and reminding patients; we keep a thorough electronic medical record to ensure appropriate care, 4) Use of electronic, automated systems that can identify patients in need of more frequent follow-up, and 5) Incorporation of telephone and electronic reminders. 11,24 Previous studies have shown that racially and ethnically diverse patient navigators can also be particularly useful in helping underserved patients successfully follow up for health care appointments; however, not all clinics have access to these resources. 3,25 Using the major themes and feedback that emerged during patient interviews, we collaborated with the Patient-Activated Learning System (PALS, PALSforHealth.com) to create a web-based educational intervention that intends to address the major knowledge gaps demonstrated among our participants.…”

Improved guideline adherence in oncology through clinical decision-support systems: still hindered by current health IT infrastructures?

“…In a retrospective cohort study on patients with colon cancer, the CDSS improved guideline-adherent surveillance recommendations (77.4 vs. 84.6%; P < 0.001) [60]. Likewise, a CDSS for cervical cancer screening identified high-risk women due for cervical cancer testing beyond routine screening intervals and significantly increased the completion rate of recommended follow-up tests when compared with a historical control group (3.3– 23.7%; P < 0.001) [61]. CDSSs further contributed to the guideline-compliant selection of patients for imaging examinations in low-risk prostate cancer [62] and hepatocellular carcinoma [63].…”