Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

Schapira, Marilyn M.; Sprague, Brian L.; Klabunde, Carrie N.; Tosteson, Anna N.A.; Bitton, Asaf; Chen, Jane S.; Beaber, Elisabeth F.; Onega, Tracy; MacLean, Charles D.; Harris, K. A.; Howe, Kathleen; Pearson, Loretta H.; Feldman, Sarah; Brawarsky, Phyllis; Haas, Jennifer S.

doi:10.1007/s11606-016-3726-y

Cited by 20 publications

(16 citation statements)

References 41 publications

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“…Of the 2,475 physicians surveyed in the 2006–2007 National Survey of Primary Care Physicians’ Recommendations and Practices for Breast, Cervical, Colorectal, and Lung Cancer Screening, less than 10% reported using all identified systems strategies for cancer screening identified by the study authors (26). In a survey of 385 primary care clinicians in 2014, only 17.7% reported access to clinic systems capable of generating an automated prompt at an appointment for women overdue for follow-up of abnormal Pap results (27). …”

Section: Discussionmentioning

confidence: 99%

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

MacLaughlin

Kessler

Elayavilli

et al. 2018

Journal of Women's Health

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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.

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Section: Discussionmentioning

confidence: 99%

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

MacLaughlin

Kessler

Elayavilli

et al. 2018

Journal of Women's Health

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“…PCPs may have limited time, skills, or tools for engaging in individualized discussions of the harms and benefits of screening. 21,22 Thus, screening may become a default option, especially with electronic health record (EHR) clinical decision support prompting clinicians to screen. This work supports the need for better and more EHR-integrated tools for informed decisionmaking to help patients and providers discuss and consider the benefits and harms of screening, particularly for women in their 40s and those over the age of 75, where personal decisionmaking may be most important.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to protocol reminders in EHRs for annual screening, recommendations and reminders to patients from radiology centers could also influence screening use. 22,27 This underscores the importance of reconciling guideline recommendations for mammography across specialties and implementing systems for individualized screening reminders in EHRs. This work supports prior studies showing that provider demographic characteristics, particularly gender, may influence patients' use of cancer screening, but are not dominant factors, 15,16 and that financial productivity incentives are not associated with mammography use.…”

Section: Discussionmentioning

confidence: 99%

Primary Care Providers’ Beliefs and Recommendations and Use of Screening Mammography by their Patients

et al. 2017

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“…4 Their findings provide insights that may help focus future implementation efforts. The authors report that about half of practices use EHR reminders, the most common systems-level intervention.…”

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confidence: 97%

Capsule Commentary on Schapira et al., Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

Richman

2016

J GEN INTERN MED

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A bout 30 % of women aged 50-64 years have not had a recent mammogram and 20 % of women 21-65 are not up to date on cervical cancer screening.1 Targeted interventions like patient letters, electronic health record (EHR) reminders, and comparative performance reports can help to narrow this gap.2, 3 We have tools that work. So are we doing all we can to ensure patients receive recommended preventives services?In this issue of JGIM, Schapira and colleagues quantify the use of systems to support cancer screening in primary care and examine the correlates of these systems on both the provider and practice level. 4 Their findings provide insights that may help focus future implementation efforts. The authors report that about half of practices use EHR reminders, the most common systems-level intervention. Many fewer use more complex strategies like identifying patients who have missed screenings or offering providers' feedback on their practice patterns.Who uses these systems? Practices that are part of a patientcentered medical home (PCMH) are more likely to use certain systems-level interventions such as comparative performance reports or automated reports of patients overdue for screening. This finding is not surprising, given both the goals and requirements for the PCMH model. It is reassuring, though, that PCMH practices are indeed doing things differently. Perhaps more intriguingly, provider -level characteristics were strongly associated with some systems-level interventions. In particular, obstetricians were less likely to have access to some systems-level supports and non-physician providers were less likely to receive comparative performance reports.These findings have direct implications for health policy and health care delivery improvement efforts. Above all, these findings suggest that we have more work to do in incorporating evidence-based tools and systems that can facilitate cancer screening. PCMH practices may lead the way and likely have valuable lessons to share about how to implement these interventions. In addition, we should ensure that all primary care providers have adequate systems in place to facilitate screening, regardless of specialty or discipline. Building specific systems to engage patients and providers in cancer screening will allow us to offer screening to all who may benefit.

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Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

Cited by 20 publications

References 41 publications

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

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

Primary Care Providers’ Beliefs and Recommendations and Use of Screening Mammography by their Patients

Capsule Commentary on Schapira et al., Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

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