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

Multicomponent interventions to increase cervical 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:
• Cervical cancer screening by pap smear

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 cervical cancer screenings and pap smears in communities.

Multicomponent interventions that include strategies that reduce and address structural barriers increase cervical 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 20 studies related to cervical cancer were evaluated on the intervention effects related to screening services.
• Multicomponent interventions to increase screening for cervical cancer are cost-effective: Studies reported intervention cost, incremental cost per additional woman screened, and incremental cost per quality adjusted life year (QALY) gained. The majority of these studies were conducted in the United States (4 studies). All monetary values are reported in 2016 U.S. dollars. Overall, the median intervention cost per participant was $159.80 (10 study arms). The median incremental cost per additional woman screened was $159.49 (6 study arms). Two modeled studies with societal perspectives calculated incremental cost per quality-adjusted life year (QALY) gained. Both reported values below the $50,000 threshold, indicating these interventions are cost-effective. The incremental cost-effectiveness ratio per QALY gained was reported as $748 and $33,433 (2 studies).