The Women’s First Learning Workshop focused on Breast Cancer Screening, here is the wrap-up of the Lismore workshop.
We hope the notes from the group work will help your practice or AMS service decide on the first small changes you would like to try.
Your Quality Improvement Practice Support Team will be happy to help you begin to implement your ideas.
In addition you can contact our population health team on 02 6618 5400 if you have any questions or would like to provide some feedback.
The first step is the most important one. Don’t forget, get your team involved and aim to take small steps continuously rather than tackling too much all at once! And remember you don’t need to be perfect; just give things a go and see what you learn from the experience.
We asked participants to brainstorm what they would need to think about in terms of how they manage their data and their recall and reminder systems to effectively remind different types of women about breast cancer screening, here is what they said:
A woman aged 50 with a strong family history
- Family history coded
- No idea when/if BreastScreen NSW has sent a reminder letter
- Can create in invitation to screen letter
- Database issues regarding actively entering mam. Letter
Add to recall @ age 50
- Mammogram recording
- No searchable record of screening history
- Flagged in BP for annual screen
- SMS – text or letter?
- Health assessment
- Letter of invitation – include BreastScreen number and/or invite to visit the practice
- 2.5-3 year reminder set
- 1. Phone call 2. Text 3. Letter (registered)
- Searching history (in the ‘reason’ field)
A woman aged 60 who had breast cancer and has been under the care of her surgeon for five years
- Inactive past history coded
- On recall list already
- Patient details up to date – mobile and email
- Add after 5 years
- Refer back to BreastScreen
- Aware of screening importance already
- Care plan established
- Email-SMS – letter – phone call ?
- Find out from Medical Director of Best Practice about noting screening
A healthy women aged 55 with no family history of breast cancer
A woman aged 50 with an intellectual disability
- Coded as having an intellectual disability (is that the norm?)
- If had never been invited to screen would cup up with data search older than 50
- Annual health assesment note family history but only flag in database)
- Health literacy assessment and review
- Use UNSW ‘Be a Healthy Woman’ guides to talk with patients
A woman who wants to opt out
We asked participating General Practices and Aboriginal Medical Services to think about who they would consider their top three at-risk for under-screening groups to be.
Here is what they said:
- 50-60 year olds
- Women who the practice doesn’t see regularly
- Lower SES
- Well women who are working, time poor, aged 50-55 years
- Indigenous women
- Lots of comorbidities e.g history of drug/alcohol, mental health issues and/or active chronic disease
- Retired well women
- Culturally and Linguistically Diverse Women/Non-English speaking background (especially Indian women due to cultural concerns)
- Aboriginal and Torres Strait Islander women
- 40-55 year old age group
- At risk (family history)
- Bus (not private) – travel to Lismore
- Women who prefer alternative therapies (fear of radiation)
- Busy working women
The Women’s Cancer Screening Second Learning Workshop focused on Cervical Cancer Screening, here is the wrap-up of the Lismore workshop held 29 June 2017.
Like our other workshops, there was some great discussions and sharing of ideas.
What’s been a challenge?
- System challenges
- Making the information accessible to extract – had to move results from “Correspondence In” to “Investigations” in order to extrapolate and collate the information .
- Staff changes – hard to have consistent management of the work being done
- Data extraction and input
- Finding the time required from staff
- Accreditation – upcoming, time consuming
- Getting women in
- Coming back to see female doctors
- The volume of data cleansing and re-coding required
- Setting up recalls and reminders
- Finding time to do it
- Change of process for the staff
- Getting the data
- Procedure – working out new procedures
- Putting new procedures into practice
What’s worked well?
- IT Medical training
- BP queries to support extracting data
- Data cleanups
- Brainstorming with staff (including nurses, admin and doctors)
- Getting patients on-board
- Keeping up to date
- Our close proximity to the Lismore BreastScreen fixed site
- Our upcoming women’s health clinic (scheduled for 15 July 2017)
- Good team approach once we got set up
- New recall system that integrates with Best Practice – HOT DOCS
- Good excuse for data cleansing
- Recalls and reminders
- The program has raised awareness, making it more likely the subject of cancer screening is brought up
- Data cleansing
- Data entry from BreastScreen
- New procedure for entering mammogram dates
Who are your cervical under-screeners?
Mum with young babies (no paps in between the birth of children)
- Most age groups (younger age groups may be slightly better)
- Patients who go to other clinics for their Paps
- Busy young Mums (time poor)
- Grey nomads – just retired, transient (60-75 years old)
- Older women who don’t know when to stop screening
- Women from lower socioeconomic backgrounds – may lack insight into the risk/benefits of screening
- Young people 18-25
- Busy young Mums (forget)
- 60-75 year olds (not sure when to stop_
- Mental health patients
- Younger women (under 25)
- Older women (may not understand what age to stop screening)
- Women with bad experience from past screens
Women with intellectual disabilities
Young women 18-25
Women form low socioeconomic backgrounds
Now that you have had a chance to review your data, would you change who you view us under-screened in relation to breast cancer screening?
Not as yet, but we expect it to change as we further clean the data.
No changes identified yet.
To be determined once we have completed further data cleaning.
No, we identified older women and the data supported this.
- Women with intellectual disabilities
- need for greater education about screening
- Privately screened patients
What are your 3 priorities for action when you get back your your practice/service?
- Try harder
- Allocate time
- Employ an extra nurse (this will support the above two points)
- Undertake quality improvement projects jointly with other Aboriginal Medical Services to improve screening rates
- Get breast screening properly coded in our clinical software
- Identify and follow up women who have not had a Pap in the past four years (there is a patient outcome benefit but also revenue benefit via the practice incentive payment)
- Identify and follow up women with no recorded breast screen
- Identify women who haven’t had a cervical screen in the last 4 years = SWPE payment incentive
- Aim to push our Pap screening rate above our current 66.3% to over 70% to achieve the Practice Incentive Outcome Payment for cervical screening
- Improve on the fact that 40-80% medical information is forgotten immediately – waiting room TV medical education
- Identify women who are under-screened (more than four years) or never screened for their Pap smear
- Recall these patients
- Undertake patient education (brochures, FAQs, Doctor and Nurse education)
- Data cleansing
- Clinical education for staff
- Increase % of Practice Incentive Payments achieved
- Data cleansing and ensuring appropriate coding
- Explore SMS/letter options for recall and reminders
- Run women’s clinics
- Recall system
- Patient education about the new procedure (for cervical screening)
- Explore how to maximise screening via self-swabbing (from December 2017)