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Evaluation of interventions to improve breast screening uptake in London Judith Offman, Stephen Duffy Wolfson Institute of Preventive Medicine Sarojini Ariyanayagam, Zoraida Colorado, Martin Sharp, Matthew Cruice, Anna Garner, Sukhjit Sanghera, Susan Shiel, Maggie Luck, Maxine Farmer, Claire Bailey, Anna O'Neill, Debbie Brazil, Tim Baker, Louise Wilkinson, Gillian Holdsworth, Tamara Djuretic, Rorie Jefferies, Kathie Binysh
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Breast Cancer Screening
Women from age 50 to 70 invited for mammogram every 3 years Women invited by post Attendance UK wide 73% Attendance in London always lower ~ 63% Attendance rates shown to be lower for certain ethnic groups, specifically Black and South Asians women in the UK
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Projects in London to increase screening
Considerable activity Numerous interventions over the past five years For example South West London: trial of pre-invitation reminder letters Newham post-invitation telephone reminders project Next slide summary of all London projects, but but will focus on Newham telephone reminders
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Summary of interventions in improve breast screening uptake in London
All CELBSS PCTs – Practice staff update and training – beginning to see GP update data increase City and Hackney – DNA Project (13 practices) – ???? Look up!! Brent – 2nd timed appointments for DNA women – increase in total uptake by 4% City & Hackney- Local Enhanced Services (LES): 18 practices; DNA project: 5 practices; Media campaigns - Uptake increased from 49.1 to 53.3% compared to the previous round SWLBSS – phone survey of non-attenders with appointment scheduling offer– 505 appointments made, 46% attended City & Hackney- New specifications for Local Enhanced Services (LES): 10/12 practices; In-round and 2nd timed reminder calls - Uptake increased from?? to ??? compared to the previous round SWLBSS – pre-invitation letter pilot– 3 surgeries, ½ of women were sent letters, ~ 5% increase in uptake in group with pre-invitation letter compared to without Camden – DNA project (Oct 09) – more than 50% of women could not be contacted; 50% of women contacted attended screening Lewisham / Lambeth / Southwark – Phone calls and letters to DNA women – 10% of DNA attend a new appointment Newham - iPlato text reminders – 11 surgeries, 10% of women reached, 77% attendance rate amongst women texted Tower Hamlets – women known to CELBSS are called to remind them about their appointments including second time appointments– 23/27 practices had improved breast screening coverage, with 11 practices gaining more than 3% increase in coverage. Newham – Reminder calls for breast screening appointments pilot – very successful at increasing uptake and coverage Camden – pink party pilot (jan 09) – 54 / 56 booked appointment Camden - Welcome screening information pack – uptake increase Newham - iPlato text reminders – 6 surgeries, 20% of women reached, 56% attendance rate amongst women texted Camden – Data reconciliation and contact strategy pilot (Sep 10 – Mar 11) for women who DNA’d or have never been screened (number of interventions including telephone contact and OOH clinics) – 76% of DNA women contacted were subsequently screened, resulting in total uptake of 64% for the project Newham - Invitation letter re-design pilot (3 months) – no negative impact Borough of Tower Hamlets - Talking invitation – only impact in Bangladeshi women 2009 2008 2011 2010
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Summary of interventions in improve breast screening uptake in London
All CELBSS PCTs – Practice staff update and training – beginning to see GP update data increase City and Hackney – DNA Project (13 practices) – ???? Look up!! Brent – 2nd timed appointments for DNA women – increase in total uptake by 4% City & Hackney- Local Enhanced Services (LES): 18 practices; DNA project: 5 practices; Media campaigns - Uptake increased from 49.1 to 53.3% compared to the previous round Newham – Reminder calls for breast screening appointments pilot – very successful at increasing uptake and coverage SWLBSS – phone survey of non-attenders with appointment scheduling offer– 505 appointments made, 46% attended City & Hackney- New specifications for Local Enhanced Services (LES): 10/12 practices; In-round and 2nd timed reminder calls - Uptake increased from?? to ??? compared to the previous round SWLBSS – pre-invitation letter pilot– 3 surgeries, ½ of women were sent letters, ~ 5% increase in uptake in group with pre-invitation letter compared to without Camden – DNA project (Oct 09) – more than 50% of women could not be contacted; 50% of women contacted attended screening Lewisham / Lambeth / Southwark – Phone calls and letters to DNA women – 10% of DNA attend a new appointment Newham - iPlato text reminders – 11 surgeries, 10% of women reached, 77% attendance rate amongst women texted Tower Hamlets – women known to CELBSS are called to remind them about their appointments including second time appointments– 23/27 practices had improved breast screening coverage, with 11 practices gaining more than 3% increase in coverage. Newham – Reminder calls for breast screening appointments pilot – very successful at increasing uptake and coverage Camden – pink party pilot (jan 09) – 54 / 56 booked appointment Camden - Welcome screening information pack – uptake increase Newham - iPlato text reminders – 6 surgeries, 20% of women reached, 56% attendance rate amongst women texted Camden – Data reconciliation and contact strategy pilot (Sep 10 – Mar 11) for women who DNA’d or have never been screened (number of interventions including telephone contact and OOH clinics) – 76% of DNA women contacted were subsequently screened, resulting in total uptake of 64% for the project Newham - Invitation letter re-design pilot (3 months) – no negative impact Borough of Tower Hamlets - Talking invitation – only impact in Bangladeshi women 2009 2008 2011 2010
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Newham Breast Screening Take-up Project
Commissioned Community Links to improve uptake Community Links recruited local ‘callers’ to telephone invitees from their general practice after invitation Culture and language sensitive Confirm receipt of invitation Offer information / answer questions Call women who did not attend their appointment to remind to reorganise appointment
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Project design No control group- aim to cover as many invitees as possible Numbers contacted varied substantially from practice to practice Gives opportunity to study the relationship between the proportion of the target contacted and the screening attendance in the practice
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Telephone calls made and responses
Number of telephone calls made Reason Invitees will attend 4467 Re-scheduled 888 Holidays 260 Had one recently 182 Unwell 61 Fear or result 11 Didn't received letter 29 Not attending, No reason 220 Too Painful 27 Advocacy Needed 33 Feels Fine Left Practice 43 Wrong address 4 total women reached 6236 Phone contact attempted Invitees Invitees (%) Reached 6236 64% Could not be reached 3541 36% Total contact attempted 9777 100%
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Overall improvement Attendance rates improved from 51% to 67% between 2007 and 2010 screening invitations In the reminder project a median of 61% of invitees were contacted Small number of women sent text reminder Only data by GP practice available
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Attendance rate by GP practice
Comparing attendance in 2010 with 2007 The more women reached at each practice the bigger the increase in attendance
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Effect of intervention
Greater increase in uptake between 2007 and 2010 was observed in practices which contacted larger numbers of invitees (p=0.001) Around 20% of the improvement was estimated to be attributable to the intervention
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Ethnicity by GP practice in Newham
Large proportion of South Asian women
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Increase in attendance rate by ethnicity
The higher the proportion of South Asian women for a GP practice, the higher the increase in attendance rate
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Acknowledgements Centre for Cancer Prevention Barts and The London Medical School Prof Stephen Duffy Jonathan Myles Community Links Zoraida Colorado Centre for Primary Care & Public Health, Blizard Institute, QMUL Martin Sharp London Breast Cancer Screening Services and former London PCTs Sarojini Ariyanayagam Matthew Cruice Anna Garner Sukhjit Sanghera Susan Shiel Maggie Luck Maxine Farmer Claire Bailey Anna O'Neill Debbie Brazil Tim Baker Louise Wilkinson Gillian Holdsworth Tamara Djuretic Rorie Jefferies Kathie Binysh
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