Primary care reminders, outreach boosted overdue cancer screening follow-up
Electronic reminders alone did not increase follow-up rates for abnormal breast, cervical, colorectal, or lung cancer screening test results, but adding outreach by letter and phone did, a study found.
Electronic health record (EHR) reminders and patient outreach with or without the addition patient navigation improved timely follow-up of overdue abnormal cancer screening test results, a study found.
To improve rates of timely follow-up of overdue abnormal breast, cervical, colorectal, and lung cancer screening results, researchers conducted a pragmatic, cluster-randomized clinical trial at 44 primary care practices within three U.S. health networks. Patients had at least one abnormal cancer screening test result not yet followed up between August 2020 and December 2021: 69% for colorectal cancer, 22% for cervical cancer, 8% for breast cancer, and 1% for lung cancer.
Primary care practices were randomized in a 1:1:1:1 ratio to provide usual care; EHR reminders prompting follow-up actions and times for abnormal screening results; EHR reminders and outreach by a letter at week 2 and a phone call at week 4; or EHR reminders, outreach, and navigation after an additional four weeks (a follow-up call by a patient navigator that assessed social barriers to care across nine domains and connected patients with needed services).
The study's primary outcome was completion of recommended follow-up within 120 days of study enrollment. Secondary outcomes included completion of recommended follow-up within 240 days of enrollment and completion of recommended follow-up within 120 days and 240 days for specific cancer types and levels of risk. Results were published Oct. 10 in JAMA.
The adjusted proportion of patients who completed recommended follow-up within 120 days was 31.4% in the EHR reminders, outreach, and navigation group (n=3,455), 31.0% in the EHR reminders and outreach group (n= 2,569), 22.7% in the EHR reminders group (n=3,254), and 22.9% in the usual care group (n=2,702). The adjusted absolute difference between the EHR reminders, outreach, and navigation group versus usual care was 8.5% (95% CI, 4.8% to 12.0%; P<0.001). The results were similar on the secondary outcome of completing recommended follow-up within 240 days and by subgroups of cancer type and level of risk of the abnormal screening result.
The study authors noted that systems-based outreach in primary care settings can improve timely follow-up of abnormal cancer screening results, but gaps in follow-up care need to be addressed to obtain the full benefits of preventive cancer screening. For example, patients might need education about the meaning of test results and what follow-up procedures are involved.
“Even though active outreach by population health coordinators or patient navigators resulted in improved proportions of follow-up completion, many patients did not complete follow-up, which may in part reflect care disruptions resulting from the COVID-19 pandemic,” the authors wrote. “However, studies conducted prior to the pandemic also show many patients do not complete recommended follow-up, highlighting the need to understand factors associated with not completing follow-up that go beyond reminder efforts.”