ABSTRACT
Background: In Ontario, an online audit and feedback tool that provides primary care physicians with detailed information about patients who are overdue for cancer screening is underused. In the present study, we aimed to examine the effect of messages operationalizing 3 behaviour change techniques on access to the audit and feedback tool and on cancer screening rates. Methods: During May-September 2017, a pragmatic 2×2×2 factorial experiment tested 3 behaviour change techniques: anticipated regret, material incentive, and problem-solving. Outcomes were assessed using routinely collected administrative data. A qualitative process evaluation explored how and why the e-mail messages did or did not support Screening Activity Report access. Results: Of 5449 primary care physicians randomly allocated to 1 of 8 e-mail messages, fewer than half opened the messages and fewer than 1 in 10 clicked through the messages. Messages with problem-solving content were associated with a 12.9% relative reduction in access to the tool (risk ratio: 0.871; 95% confidence interval: 0.791 to 0.958; p = 0.005), but a 0.3% increase in cervical cancer screening (rate ratio: 1.003; 95% confidence interval: 1.001 to 1.006; p = 0.003). If true, that association would represent 7568 more patients being screened. No other significant effects were observed. Conclusions: For audit and feedback to work, recipients must engage with the data; for e-mail messages to prompt activity, recipients must open and review the message content. This large factorial experiment demonstrated that small changes in the content of such e-mail messages might influence clinical behaviour. Future research should focus on strategies to make cancer screening more user-centred.
Subject(s)
Early Detection of Cancer , Electronic Mail , Mass Screening , Physicians , Primary Health Care , Behavior , Female , Formative Feedback , Humans , Male , Motivation , Problem Solving , Quality Assurance, Health Care , Random AllocationABSTRACT
OBJECTIVE: To quantify and describe the self-treatment existing among users requesting a consultation about an illness which had commenced in the previous 15 days. DESIGN: Observational prospective study. SETTING: Primary care in a semi-rural environment. Family Medicine Unit in Valls (Tarragona). PATIENTS AND OTHERS PARTICIPANTS: The study included all those people who attended the Unit, whose illness had begun during the previous 15 days and who were attending with this illness for the first time. The following variables were recorded: gender, age, symptomatology and whether they had taken self-treatment measures (self-medication and/or non-pharmacological measures). MEASUREMENTS AND MAIN RESULTS: A total of 375 patients were recorded: 59.5% women and 40.5% men. The most common symptoms were pain (50.1%) and temperature (15.2%). 69.9% of the patients (CI 4.75) had treated themselves: there were no significant differences as regards age and gender. An analysis shows that 18.7% used nonpharmacological measures; 75.9% took some drug; and 5.4% used non-pharmacological measures plus a drug. The most used pharmacological groups were analgesics and antipyretics (40.9%, p < 0.001). CONCLUSIONS: Self-treatment is very common in the Primary Care environment. Professionals and health planners will have to bear this very much in mind, in order both to strengthen its positive implications and correct any negative aspects found.
