Effect of provider and patient reminders, deployment of nurse practitioners, and financial incentives on cervical and breast cancer screening rates

• Published in: Canadian family physician 2013-06, Vol.59 (6), p.e282-e289
• Main Authors: Kaczorowski, Janusz, Hearps, Stephen J C, Lohfeld, Lynne, Goeree, Ron, Donald, Faith, Burgess, Ken, Sebaldt, Rolf J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Breast cancer; Breast Neoplasms - diagnosis; Cervical cancer; Early Detection of Cancer - economics; Female; Health Promotion; Humans; Male; Mammography; Medical screening; Middle Aged; Monetary incentives; Nurse practitioners; Nurse Practitioners - utilization; Ontario; Patient Acceptance of Health Care - statistics & numerical data; Patients; Preventive Health Services - economics; Primary Health Care - economics; Primary Health Care - statistics & numerical data; Program Evaluation; Reimbursement, Incentive; Reminder Systems - economics; Uterine Cervical Neoplasms - diagnosis; Vaginal Smears
• ISSN: 0008-350X; 1715-5258

To evaluate the effect of the Provider and Patient Reminders in Ontario: Multi-Strategy Prevention Tools (P-PROMPT) reminder and recall system and pay-for-performance incentives on the delivery rates of cervical and breast cancer screening in primary care practices in Ontario, with or without deployment of nurse practitioners (NPs). Before-and-after comparisons of the time-appropriate delivery rates of cervical and breast cancer screening using the automated and NP-augmented strategies of the P-PROMPT reminder and recall system. Southwestern Ontario. A total of 232 physicians from 24 primary care network or family health network groups across 110 different sites eligible for pay-for-performance incentives. The P-PROMPT project combined pay-for-performance incentives with provider and patient reminders and deployment of NPs to enhance the delivery of preventive care services. The mean delivery rates at the practice level of time-appropriate mammograms and Papanicolaou tests completed within the previous 30 months. Before-and-after comparisons of time-appropriate delivery rates (< 30 months) of cancer screening showed the rates of Pap tests and mammograms for eligible women significantly increased over a 1-year period by 6.3% (P < .001) and 5.3% (P < .001), respectively. The NP-augmented strategy achieved comparable rate increases to the automated strategy alone in the delivery rates of both services. The use of provider and patient reminders and pay-for-performance incentives resulted in increases in the uptake of Pap tests and mammograms among eligible primary care patients over a 1-year period in family practices in Ontario.