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EHR-linked colorectal screening program increased adherence rates
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A centralized, electronic health record-linked program in which automatic reminders were sent to patients doubled the rates of timely colorectal screening over 2 years compared with standard care, study results show.
Previous systematic reviews of effectiveness trials have reported strong evidence that client reminders, one-on-one education and reduction of structural barriers increase colorectal cancer screening rates. However, few trials have tested the incremental benefits of a stepped approach or whether this approach improved patient adherence to screening.
Beverly B. Green
To assess whether interventions using electronic health records (EHRs), automated mailings and stepped increases in patient support improved colorectal cancer screening adherence, Beverly B. Green, MD, MPH, and colleagues from the Group Health Research Institute in Seattle randomly assigned 4,675 adults aged 50 to 73 years to one of four intervention groups:
- Usual careincluded both patient and clinic reminders for those overdue.
- Usual care/automated care included a letter notifying patients they were due for screening, as well as a pamphlet about screening choices and the pros and cons of three screening options recommended by the US Preventive Services Task Force: fecal occult blood testing (FOBT) yearly; colonoscopy every decade; or flexible sigmoidoscopy every 5 years. Patients who did not schedule a colonoscopy or sigmoidoscopy received a mailed FOBT kit with illustrated instructions, as well as a reminder letter 3 weeks later if the kit was not completed.
- Usual care/automated care/assistedcare included a medical assistant asking patients which screening option they preferred and provided simple assistance to facilitate their request, such as sending colonoscopy request to their physician or reviewing FOBT instructions.
- Usual care/automated care/assisted care/“navigated” care included a nurse calling to advise patients and facilitate screening for those who needed assistance making their choice or were not screened after the medical assistant’s call. Patients who chose colonoscopy or sigmoidoscopy received help scheduling an appointment and preparing for the procedure, and they were followed until the test was completed.
Patients in the intervention groups were more likely than those in the usual care group to be current for colorectal cancer screening for both years, with significant increases by intensity (usual care, 26.3%; 95% CI, 23.4-29.2; automated, 50.8%; 95% CI, 47.3-54.4; assisted, 57.5%; 95% CI, 54.5-60.6; and navigated, 64.7%; 95% CI, 62.5-67).
“Traditionally, the onus has been on each primary care doctor to encourage their patients to get health screening tests on schedule,” Green said in a press release, citing an earlier Group Health endeavor that used a centralized registry to remind patients about breast cancer screenings. “We borrowed that approach and applied it to colorectal cancer. We empowered patients to do testing on time by giving them options or sending them a FOBT kit by default if no choice was made.
“We plan to test whether improved adherence persists for more than 2 years,” she said. “We are also testing this intervention in ‘safety-net’ clinics, which serve low-income people.”
Disclosure: The researchers report no relevant financial disclosures.
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