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

Abstract

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 patient-centered 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 guideline-adherent breast (OR 3.23, 95 % CI 1.58-6.61) or cervical (OR 2.56, 95 % CI 1.32-4.96) cancer screening and automated reports of patients overdue for breast (OR 2.19, 95 % CI 1.15-41.7) or cervical (OR. 2.56, 95 % CI 1.26-5.26) cancer screening.

Conclusions: Providers lack systems to support breast and cervical cancer screening. Practice transformation toward a PCMH may support the adoption of systems to achieve guideline-adherent cancer screening in primary care settings.

Keywords: breast cancer screening; cervical cancer screening; patient-centered medical home.

Figure 1

System for patient reminders of routine screening due. Providers in a PCMH reported higher use than others of BC patient reminders using verbal prompts (0.008), US Mail (p < 0.001), patient portal (p = 0.003), phone (p < 0.04), and use of a navigator (p = 0.013). Providers in a PCMH also reported higher use of CC patient reminders using verbal prompts (p = 0.015), US Mail (p < 0.001), patient portal (p = 0.003), and phone (p = 0.04). PCMH patient-centered medical home, BC breast cancer, CC cervical cancer.

Figure 2

Patient reminders for overdue follow-up. There were no significant differences in the use of patient reminders between providers in a PCMH and others for overdue follow-up of abnormal screening tests. Providers in a PCMH were more likely to report that another department was responsible for the patient reminders for follow-up of abnormal BC screening tests (p = 0.004). PCMH patient-centered medical home, BC breast cancer, CC cervical cancer