Reminding Patients and Docs May Improve Colorectal Screening Rates

By Kristina Fiore, Staff Writer, MedPage Today
Published: February 24, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

BOSTON, Feb. 23 -- Reminding both patients and physicians to schedule colonoscopies may improve colorectal cancer screening rates, researchers here said.

Explain that patients who receive mailed reminders for colorectal cancer screening have significantly higher rates of screening. Electronic reminders sent to their physicians tend to increase colonoscopy rates as well.
Patients who received mailed reminders had significantly higher rates of screening. Electronic reminders to their physicians tended to increase colonoscopy rates for some patients as well, Thomas D. Sequist, M.D., of Brigham and Women's Hospital and colleagues reported in the Feb. 23 Archives of Internal Medicine.

"These complementary approaches have the potential to promote the overarching goal of widespread screening to reduce the incidence, morbidity, and mortality of colorectal cancer," the researchers said.

Preventive screening reduces colorectal cancer mortality rates, but only 60% of eligible patients reported that they were up-to-date with screening, the researchers said. Also, physicians may not have enough time during office visits to discuss the growing number of recommended preventive services.

Previous screening studies have focused on either patients or physicians, the researchers said, so they decided to investigate the joint impact of patient mailings and electronic reminders to primary care physicians.

They conducted a randomized controlled trial of patient and physician reminders in 11 ambulatory healthcare centers from April 2006 to June 2007. The study covered 21,860 patients ages 50 to 80 who were overdue for colorectal cancer screening, along with 110 primary care physicians.

The overdue patients received either no written communication at all or a mailing with an educational pamphlet, a fecal occult blood test kit, and instructions for scheduling a flexible sigmoidoscopy or colonoscopy.

Physicians were randomly assigned to receive electronic reminders during office visits with overdue patients, while others got no reminder.

The researchers found that screening rates were higher for patients who received mailings compared with those who did not (44% versus 38.1%, P<0.001).

They also found that the effectiveness of the mailings increased as patients got older: +3.7% for ages 50 to 59, compared to +7.3% for ages 60 to 69 and +10.1% for ages 70 to 80 (P=0.01 for trend).

"Our findings underscore that informed patients can play an active role in completing effective preventive services," the researchers said.

The researchers said that electronic reminders to physicians did not significantly increase overall screening rates.

Rates were similar among patients whose physicians received electronic reminders and the control group (41.9% versus 40.2%), "in part because over one-third of patients had no visits with their primary care physician during the 15-month study period," the researchers said.

However, electronic reminders tended to increase screening rates among patients who had at least three visits to their primary care doctor during the study period (59.5% versus 52.7% P=0.07).

The number of orders for colonoscopy did modestly increase for patients whose physicians were electronically reminded, but there was no corresponding increase in completed procedures. The researchers said that nearly half of patients for whom it was ordered did not complete the procedure.

"This finding underscores the need for more effective communication with patients to encourage them to complete colonoscopy procedures that are scheduled," they said.

Detection of adenomas tended to be greater among patients who received mailings (5.7% versus 5.2%; P=.10) and among patients whose physicians received electronic reminders, compared with controls (5.7% versus 5.2%; P=.10), researchers said.

"Mailed reminders to patients are an effective tool to promote colorectal cancer screening," they concluded, "and electronic reminders to physicians may increase screening among adults who have more frequent primary care visits."

They pointed out that "the generalizability of our study must also be considered. We implemented our intervention within a single group practice using an advanced electronic health record, so our findings may not apply to less structured settings."

The study was supported by a grant from the National Cancer Institute.
The researchers reported no conflicts of interest.

Primary source: Archives of Internal Medicine
Source reference:
Sequist TD, et al "Patient and physician reminders to promote colorectal cancer screening" Arch Intern Med 2009; 169(4): 364-71.