CDC COMMUNITY GUIDE: Colorectal Cancer Prevention & Control, Provider-Oriented Screening Interventions: Provider Reminder & Recall Systems

Multicomponent interventions to increase colorectal cancer screenings have the greatest effects on community health. Multicomponent interventions include: increasing community demand, access, and screening procedures and delivery in communities. Other approaches include:

• Interventions to increase community demand for cancer screening: client reminders, client incentives, small media, mass media, group education, and one-on-one education
• Interventions to increase community access to cancer screening: reducing structural barriers and reducing client out-of-pocket costs
• Interventions to increase provider delivery of screening services: provider assessment and feedback, provider incentives, and provider reminders

Reminders inform health care providers it is time for a client's cancer screening test (called a "reminder") or that the client is overdue for screening (called a "recall"). The reminders can be provided in different ways, such as in client charts or by e-mail.

The Community Preventive Services Task Force recommends provider reminder systems based on strong evidence of their effectiveness in increasing:
• Colorectal cancer screening by colonoscopy or fecal occult blood test (FOBT)

Additionally, it is recommended to design interventions that address and reduce structural barriers:
• Reducing administrative barriers
• Assisting with appointment scheduling
• Setting up alternative screening sites
• Adding screening hours
• Addressing transportation barriers
• Providing language translation services
• Offering child care

The goal of incorporating multicomponent interventions for cancer screenings is to increase colorectal cancer screenings, colonoscopies, and FOTB in communities.

Multicomponent interventions that include strategies that reduce and address structural barriers increase colorectal cancer screening rates by the largest margins and evidence shows that these interventions are also cost-effective.

Results from the systematic review:
• Between January 2004 - November 2013 56 studies related to colorectal cancer were evaluated on the intervention effects related to screening services.
• Multicomponent interventions to increase screening for colorectal cancer are cost-effective and interventions led to cost savings from averted treatment costs that exceed intervention costs:

• Overall, the median cost per participant was $37.63 (43 study arms).
• The median cost per participant for interventions that increased community demand was $44.07 (3 study arms).
• The mean cost per participant for interventions that increased provider delivery was $366.51 (2 study arms).
• The median cost per participant for interventions that increased both community demand and access was $31.72 (34 study arms).