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

Objective : 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).

Design : 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.

Setting : Southwestern Ontario.

Participants : 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.

Interventions : 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.

Main outcome measures : The mean delivery rates at the practice level of time-appropriate mammograms and Papanicolaou tests completed within the previous 30 months.

Results : 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.

Conclusion : The use of provider and patient reminders and pay-forperformance 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.