Barrier | Intervention component(s) to address barrier |
---|---|
No clinical systems in place to identify patients who need repeat screening, unless they present for care | EHR query to identify patients due for repeat screening; outreach to patients (half randomized to intervention) |
No personal systems in place for patients to track when preventive services are due | Automatic phone/text reminders to remind patients they are due for screening |
Low adherence to repeat screening because of financial and/or logistical barriers | Mail FOBT kits to patients |
Patients forget to return FOBT | Automatic phone/text reminders to patients who do not return FOBT within 2Â weeks |
Low priority and/or risk perception for CRC | Call from CRC Screening Coordinator at 3Â months to patients who do not complete FOBT to explain need for screening |
Change of phone number and/or address makes initial reminders unsuccessful | When CRC Screening Coordinator calls at 3Â months, he can use updated information (i.e., from a recent visit) |
Patients do not understand instructions | Mailed FOBT kits include plain language information, instructions, and direct phone number for CRC Screening Coordinator |
Lack of understanding of polyps, CRC, and recommendation for FOBT screening | Call from CRC Screening Coordinator at 3 months to patients who do not complete FOBT to explain why they need repeat screening, answer questions, and mail another FOBT if requested; letter from CRC Screening Coordinator when FOBT results are negative to remind patients to repeat screening in 1–2 years and give due date |