A three-year audit of the effectiveness of family physician reminders on cervical screening uptake amongst non-responders in a UK family medicine setting

Abstract

Background: Cervical cancer screening is offered to all women in the United Kingdom (UK) between the ages of 24.5 and 64 years of age. The majority of screening is performed in primary care settings and the coverage rate remains stubbornly below 80%, despite an automated national invitation system. Objective: To audit the effectiveness of physician reminders during patient-booked telephone or face-to-face family medicine appointments upon non-responders to automated invitations. Methods: One physician in a primary healthcare centre opportunistically administered a three-step verbal invitation to all individuals identified as non-responders during their appointments with him. Patients seen face-to-face were also given a fourth invitation, a written slip to give to the receptionist to help them book an appointment. A code was entered into the patient’s notes to indicate that this patient had received the invitation. The invitation was continued for three years. The rate of screening uptake in the invitation arm was then compared to the rest of the non-responder population who received other non-structured reminders. Results: 122 patients in the invitation arm and 602 in the control arm met the inclusion criteria. Cervical screening uptake was 11.1% greater in the invitation arm than the control arm (p < 0.0001; RR 1.188: CI 1.04 to 1.36). Patients receiving the fourth invitation in face-to-face appointments booked screening appointments 60 days earlier (mean = 110.8 days, n = 66) than those who received the verbal invitation only (mean = 170.4 days, n = 19, p = 0.08). Conclusion: There is evidence to support the use of both a verbal invitation followed by a written invitation by physicians in a family medicine setting in the UK for patients who are non-responders to cervical screening to increase uptake. The cost per extra cervical screening accepted in this non-responder population is £14.35. Both of these factors support the use of physician invitations to increase screening rates. Keywords cervical cancer screening, primary health care, non-responder, increasing uptake, invitations