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Do Primary Care Provider Strategies Improve Patient Participation in Colorectal Cancer Screening?

Baxter, Nancy N, MD, PhD1,2,3,4; Sutradhar, Rinku, MSc, PhD3,4; Li, Qing, MMath3; Daly, Corinne, MSc1; Honein-AbouHaidar, Gladys N, MPH, PhD1; Richardson, Devon P, MD, MSc2; Del Giudice, Lisa, MD, MSc5; Tinmouth, Jill, MD, PhD3,4,6; Paszat, Lawrence, MD, MSc3,4,6; Rabeneck, Linda, MD, MPH3,4,7

American Journal of Gastroenterology: April 2017 - Volume 112 - Issue 4 - p 622–632
doi: 10.1038/ajg.2017.4

Objectives: Screening rates for colorectal cancer (CRC) remain suboptimal. The impact of provider strategies to enhance screening participation in the population is uncertain. The objective of this study was to determine the effect of provider strategies to increase screening in a single-payer system.

Methods: A population-based survey was conducted in primary care providers (PCPs) linked to patients using administrative data in Ontario, Canada. Patients were due for CRC screening from April 2012 to March 2013. Patients were followed up until 31 March 2014. We determined time to become up-to-date with CRC screening. Cox proportional hazards models examined the association between PCP strategies and uptake of screening, adjusted for physician and patient factors.

Results: A total of 717 PCPs and their 147,834 rostered patients due for CRC screening were included. Most physicians employed strategies to enhance screening participation, including electronic medical record use, reminders, generation of lists, audit and feedback reports, or designating staff responsible for screening. No single strategy was strongly associated with screening. For those >1 year overdue, a systematic approach to generate lists of patients overdue for screening was weakly associated with screening uptake (hazard ratio (HR)=1.14, 95% CI: 1.03–1.26,P=0.04 >5 years overdue vs. <1 year overdue). The use of multiple PCP strategies was associated with screening participation (HR=1.27, 95% CI: 1.16–1.39,P<0.0001 for PCPs using 4–5 vs. 0–1 strategies). Practice-based strategies were self-reported.

Conclusions: In practice, while individual PCP strategies have little effect, the use of multiple strategies to enhance screening appears to improve CRC screening uptake in patients.

1Department of Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Canada

2Department of Surgery, University of Toronto, Toronto, Canada

3Institute for Clinical Evaluative Sciences, Toronto, Canada

4Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada

5Department of Family and Community Medicine, University of Toronto, Toronto, Canada

6Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada

7Department of Medicine, University of Toronto, Toronto, Canada

Correspondence: Nancy N. Baxter, MD, PhD, Division of General Surgery, St Michael’s Hospital, 040-16 Cardinal Carter Wing, 30 Bond Street, Toronto, Ontario, M5B 1W8 Canada. E-mail:

Received 06 July 2016; accepted 06 December 2016

The authors declare no conflict of interest.

SUPPLEMENTARY MATERIAL is linked to the online version of the paper at

© The American College of Gastroenterology 2017. All Rights Reserved.
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