Methods to increase participation in organised screening programs: a systematic review

Camilloni, Laura; Ferroni, Eliana; Cendales, Beatriz Jimenez; Pezzarossi, Annamaria; Furnari, Giacomo; Borgia, Piero; Guasticchi, Gabriella; Rossi, Paolo Giorgi

doi:10.1186/1471-2458-13-464

Cited by 176 publications

(186 citation statements)

References 92 publications

(142 reference statements)

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“…Patient reminders have been shown to be effective in increasing breast and cervical cancer screening rates. [29][30][31][32] Reported NCQA recognition as a PCMH also was associated with increased use of comparative performance reports and automated reports to alert providers of patients due for cancer screening outside the context of the clinical visit. Theoretical and empirical evidence supports the efficacy of physician audits and feedback in improving cancer screening.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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BACKGROUND: Despite substantial resources devoted to cancer screening nationally, the availability of clinical practice-based systems to support screening guidelines is not known. OBJECTIVE: To characterize the prevalence and correlates of practice-based systems to support breast and cervical cancer screening, with a focus on the patientcentered medical home (PCMH). DESIGN: Web and mail survey of primary care providers conducted in 2014. The survey assessed provider (gender, training) and facility (size, specialty training, physician report of National Committee for Quality Assurance (NCQA) PCMH recognition, and practice affiliation) characteristics. A hierarchical multivariate analysis clustered by clinical practice was conducted to evaluate characteristics associated with the adoption of practice-based systems and technology to support guideline-adherent screening. PARTICIPANTS: Primary care physicians in family medicine, general internal medicine, and obstetrics and gynecology, and nurse practitioners or physician assistants from four clinical care networks affiliated with PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium research centers. MAIN MEASURES: The prevalence of routine breast cancer risk assessment, electronic health record (EHR) decision support, comparative performance reports, and panel reports of patients due for routine screening and follow-up. KEY RESULTS: There were 385 participants (57.6 % of eligible). Forty-seven percent (47.0 %) of providers reported NCQA recognition as a PCMH. Less than half reported EHR decision support for breast (48.8 %) or cervical cancer (46.2 %) screening. A minority received comparative performance reports for breast (26.2 %) or cervical (19.7 %) cancer screening, automated reports of patients overdue for breast (18.7 %) or cervical (16.4 %) cancer screening, or follow-up of abnormal breast (18.1 %) or cervical (17.6 %) cancer screening tests. In multivariate analysis, reported NCQA recognition as a PCMH was associated with greater use of comparative performance reports of guidelineadherent breast (OR 3.23,

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Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…This simple, affordable intervention is acceptable to many and similar print interventions have increased uptake of cancer screening. 35 Given that some participants cited lack of GP advice on screening as a reason for not wanting screening advice, general practitioner endorsement may increase the acceptability of receiving screening advice.…”

Section: Implications For Public Healthmentioning

confidence: 99%

Prevalence of appropriate colorectal cancer screening and preferences for receiving screening advice among people attending outpatient clinics

Dodd

Mansfield

Carey

et al. 2018

Australian and New Zealand Journal of Public Health

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Objective: To examine among people attending outpatient clinics aged 50-74 at average risk of colorectal cancer (CRC): 1) The proportion who report: a) faecal occult blood test (FOBT) within the past two years; and b) colonoscopy within the past five years, including the reasons for undergoing colonoscopy; 2) characteristics associated with under-screening; 3) For those who are under-screened, the proportion who are: a) willing to receive help and the acceptability of different methods of receiving help, and; b) unwilling to receive help and reasons for this. Methods:Cross-sectional survey of 197 participants attending a major regional hospital in New South Wales, Australia. Multivariable logistic regression was used to determine correlates of under-screening.Results: A total of 59% reported either FOBT in the past two years or colonoscopy in the past five years. Of those reporting colonoscopy in the past five years, 21% were potentially overscreened. Males were more likely than females to be under-screened. Of those under-screened (41%), fewer than half were willing to receive screening advice. Conclusions and implications for public health:A significant proportion of people attending outpatient clinics are under-screened for CRC, with some people also over-screened. There is a need to explore strategies to overcome both under-and over-screening.

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“…Camilloni et al 32 recently updated the landmark review by Jepson et al, 33 focusing on methods to increase uptake of screening for breast, cervical or colorectal cancer. The review suggested that postal reminders in addition to the initial invitation could significantly increase uptake, whereas the evidence for telephone reminders was largely favourable, although some primary studies did not demonstrate significant effects.…”

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confidence: 99%

“…32 Kumar et al 35 compared health check uptake by patients offered only a booked appointment with uptake by patients offered a choice of a booked appointment or attending a drop-in clinic. Uptake rates for the two groups separately are not reported, but the authors suggested that use of drop-in clinics may be less costly.…”

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Enhanced invitation methods and uptake of health checks in primary care: randomised controlled trial and cohort study using electronic health records

McDermott

Wright

Cornelius

et al. 2016

Health Technol Assess

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BackgroundA national programme of health checks to identify risk of cardiovascular disease (CVD) is being rolled out but is encountering difficulties because of low uptake.ObjectiveTo evaluate the effectiveness of an enhanced invitation method using the question–behaviour effect (QBE), with or without the offer of a financial incentive to return the QBE questionnaire, at increasing the uptake of health checks. The research went on to evaluate the reasons for the low uptake of invitations and compare the case mix for invited and opportunistic health checks.DesignThree-arm randomised trial and cohort study.ParticipantsAll participants invited for a health check from 18 general practices. Individual participants were randomised.Interventions(1) Standard health check invitation only; (2) QBE questionnaire followed by a standard invitation; and (3) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by a standard invitation.Main outcome measuresThe primary outcome was completion of the health check within 6 months of invitation. Ap-value of 0.0167 was used for significance. In the cohort study of all health checks completed during the study period, the case mix was compared for participants responding to invitations and those receiving ‘opportunistic’ health checks. Participants were not aware that several types of invitation were in use. The research team were blind to trial arm allocation at outcome data extraction.ResultsIn total, 12,459 participants were included in the trial and health check uptake was evaluated for 12,052 participants for whom outcome data were collected. Health check uptake was as follows: standard invitation, 590 out of 4095 (14.41%); QBE questionnaire, 630 out of 3988 (15.80%); QBE questionnaire and financial incentive, 629 out of 3969 (15.85%). The increase in uptake associated with the QBE questionnaire was 1.43% [95% confidence interval (CI) –0.12% to 2.97%;p = 0.070] and the increase in uptake associated with the QBE questionnaire and offer of financial incentive was 1.52% (95% CI –0.03% to 3.07%;p = 0.054). The difference in uptake associated with the offer of an incentive to return the QBE questionnaire was –0.01% (95% CI –1.59% to 1.58%;p = 0.995). During the study period, 58% of health check cardiovascular risk assessments did not follow a trial invitation. People who received an ‘opportunistic’ health check had greater odds of a ≥ 10% CVD risk than those who received an invited health check (adjusted odds ratio 1.70, 95% CI 1.45 to 1.99;p < 0.001).ConclusionsUptake of a health check following an invitation letter is low and is not increased through an enhanced invitation method using the QBE. The offer of a £5 incentive did not increase the rate of return of the QBE questionnaire. A high proportion of all health checks are performed opportunistically and not in response to a standard invitation letter. Participants receiving opportunistic checks are at higher risk of CVD than those responding to standard invitations. Future research should aim to increase the accessibility of preventative medical interventions to increase uptake. Research should also explore the wider use of electronic health records in delivering efficient trials.Trial registrationCurrent Controlled Trials ISRCTN42856343.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 84. See the NIHR Journals Library website for further project information.

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Methods to increase participation in organised screening programs: a systematic review

Cited by 176 publications

References 92 publications

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

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

Prevalence of appropriate colorectal cancer screening and preferences for receiving screening advice among people attending outpatient clinics

Enhanced invitation methods and uptake of health checks in primary care: randomised controlled trial and cohort study using electronic health records

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