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Improving Prevention Screenings

Prevention screening is effective and consistently recommended in many clinical practice guidelines, however, rates for many screening procedures, such as mammography, Pap smears (also known as Pap tests) and colonoscopies, are less than optimal. Barriers such as patient refusal, forgetfulness or simply a lack of time, can all lead to missed opportunities for critical prevention and early detection. 

Health Net Federal Services, LLC (HNFS) needs you to help us. We are striving to help our beneficiaries get healthy and stay healthy by making sure they get the preventive care they need, when they need it. On average, Americans visit a physician’s office three times per year.1 While many of these visits are for acute problems or urgent needs, patients still have an expectation they will receive information and assistance regarding preventive health issues from their health care provider.2 As practitioners, you are probably already aware your recommendation is the single most influential factor in persuading individuals to be screened or tested.

Beyond making a recommendation, there are a number of other interventions which may be employed, either individually or in combination, to further increase screening compliance. A few examples are listed below:

  • Recommend: Consistently recommend screening to appropriate patients according to accepted guidelines and your office policy.3, 4 Engage patients in one-on-one conversations that explain the importance of prevention services.  
  • Create an office policy: Make sure staff are aware of the policy and know how to implement it.5 Policies should include information about local health care resources, as well as steps for follow-through on diagnostic work-ups with positive findings. 
  • Have a reminder system:6, 7 Reminder systems may include electronic flags, chart prompts or labels, audits, ticklers, logs or staff assignments, and they may be directed at patients, providers and office staff.
  • Educate: Many patients have preferences when there is a reasonable choice to be made. Assess a patient's stage of readiness, engage in shared decision making and be respectful of patient preferences. Use educational handouts, videos, social media or fliers.
  • Reduce barriers: Make it easy for patients to schedule appointments by having convenient test locations, making phone calls to arrange services or allowing patients to make appointments via the Internet. 

(Note: These interventions are not intended to provide specific guidance as to which intervention or set of interventions is most appropriate for a given population or setting, nor do they guarantee interventions will be effective under all circumstances.)

Lastly, be aware the doctor-patient relationship matters. Patients who have an ongoing relationship with their doctor or practice, or who regularly complete health check-ups, are more likely to complete recommended screenings. Help our beneficiaries maintain and improve their health by making sure your practice does everything you can to engage and educate.  

For additional information on evidence-based interventions for breast, cervical and colorectal cancer screenings, visit The Community Guide website.

Stay Healthy With Health Net Federal Services!

Intervention Description/Examples


Letters, postcards or phone calls – any effort directed toward patients that encourages them to adhere to aspects of self-care or appointments.


Small rewards such as trinkets, cash or coupons – any direct or indirect awards tied to a specific action of a patient.
Media Small media: videos and printed materials such as letters, brochures, newsletters.
Mass media: television, radio, newspapers, magazines and billboards.
Group education: inform, encourage and motivate; provided in person or via telephone or Web.
One-on-one education: inform, encourage and motivate; provided in person or via telephone or Web.
Reduce Costs Vouchers, reimbursements, reduction in copays.


Assessment and Feedback Evaluate performance in providing screening services, compared with a goal or standard.
Reminders and Recall Systems Reminders inform providers it is time for a patient's screening test or that a patient is overdue for screening. These can be delivered in patient charts or by email.
Provider Education Educational workshops, meetings (traditional continuing medical education and lectures – live or computer based), educational outreach visits or distribution of educational materials.
Organizational Change Changes in the structure or delivery of care designed to improve clinical care, for example, redesign of jobs, changes in clinical procedures, other personnel or team changes, the use of telemedicine.
Structural Interventions Reduce time or distance between service delivery settings and target populations.
Modify hours of service to meet patient needs.
Offer services in alternative or non-clinical settings (mobile mammography vans at worksites or in residential communities).
Eliminate or simplify administrative procedures and other obstacles (scheduling assistance, transportation, dependent care, translation services, limiting number of other clinic visits).

Source: The Community Guide: www.thecommunityguide.org/cancer.

1. Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2000. Advance data from vital and health statistics, no. 328. Hyattsville MD: National Center for Health Statistics, 2002.
2. Kottke TE, Solberg LI, Brekke ML, Cabrera A, Marquez M. Will patient satisfaction set the preventive services implementation agenda? Am J Prev Med 1997;13:309–16.
3. Levy BT, Nordin T, Sinift S, Rosenbaum M, James PA. Why hasn't this patient been screened for colon cancer? An Iowa Research Network study. J Am Board Fam Med. 2007; 20: 458–468.
4. Sohl SJ, Moyer A. Tailored interventions to promote mammography screening: a meta-analytic review. Prev Med. 2007; 45: 252–261.
5. Sarfaty, Mono, MD. How to Increase Screening Rates in Practice: A Primary Care Clinician’s Evidence-Based Toolbox and Guide (2008).
6. S. McPhee, J. Bird, D. Fordham, J. Rodnick and E. Osborn. Promoting cancer prevention activities by primary care physicians. JAMA 1991; 266: 538-544.
7. D.K.Litzelman, R.S. Dittus, M.E. Miller, W.M. Tierney. Requiring physicians to respond to computerized reminders improves their compliance with preventive care. J. Gen Intern Med. 1993; 8: 311-317.