Alerts in electronic medical records to promote a colorectal cancer screening programme: a cluster randomised controlled trial in primary care
Open accessAbstract
BACKGROUND: Participation rates in colorectal cancer screening are below recommended European targets. AIM: To evaluate the effectiveness of an alert in primary care electronic medical records (EMRs) to increase individuals' participation in an organised, population-based colorectal cancer screening programme when compared with usual care. DESIGN AND SETTING: Cluster randomised controlled trial in primary care centres of Barcelona, Spain. METHOD: Participants were males and females aged 50-69 years, who were invited to the first round of a screening programme based on the faecal immunochemical test (FIT) (n = 41 042), and their primary care professional. The randomisation unit was the physician cluster (n = 130) and patients were blinded to the study group. The control group followed usual care as per the colorectal cancer screening programme. In the intervention group, as well as usual care, an alert to health professionals (cluster level) to promote screening was introduced in the individual's primary care EMR for 1 year. The main outcome was colorectal cancer screening participation at individual participant level. RESULTS: In total, 67 physicians and 21 619 patients (intervention group) and 63 physicians and 19 423 patients (control group) were randomised. In the intention-to-treat analysis screening participation was 44.1% and 42.2% respectively (odds ratio 1.08, 95% confidence interval [CI] = 0.97 to 1.20, P = 0.146). However, in the per-protocol analysis screening uptake in the intervention group showed a statistically significant increase, after adjusting for potential confounders (OR, 1.11; 95% CI = 1.02 to 1.22; P = 0.018). CONCLUSION: The use of an alert in an individual's primary care EMR is associated with a statistically significant increased uptake of an organised, FIT-based colorectal cancer screening programme in patients attending primary care centres.
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Prior studies found that CDS alerts, if addressed properly, were able to improve adherence to clinical guidelines.
“Prior studies found that CDS alerts, if addressed properly, were able to improve prescribing behaviors and medication safety4,63 and adherence to clinical guidelines.6,8”
From Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling (2025) · cites this paper as [6]
The Per-protocol analysis (page unavailable) found significantly higher colorectal cancer screening uptake among eligible patients attending primary care after adjustment. The Implications for research and practice section (page unavailable) says improving professionals’ responses to alerts could increase their benefits, but overall uptake did not increase significantly. The study measured screening uptake, not adherence to clinical guidelines generally or the effect of alerts being ‘addressed properly.’ (LLM, conf=0.86)
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- Authors
- Guiriguet, C., Muñoz-Ortiz, L., Burón, A., Rivero, I., Grau, J., Vela-Vallespín, C., Vilarrubí, M., Torres, M., Hernández, C., Méndez-Boo, L., Toràn, P., Caballeria, L., Macià, F., & Castells, A.
- Affiliations
- Institut Català de la Salut (ES)
- Hospital Del Mar (ES)
- Hospital Clínic de Barcelona (ES)
- Universitat de Barcelona (ES)
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (ES)
- Venue
- British Journal of General Practice
- Published
- 2016-06-06
- Volume
- 66
- Issue
- 648
- Pages
- e483-e490
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC4917051
- OpenAlex
- W2408925063
- Cited by
- 47
- References
- 36
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 5 · 2020: 6 · 2019: 6 · 2018: 4 · 2017: 2 · 2016: 1
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- European Commission
- Institut Català de la Salut
- Instituto de Salud Carlos III (PI10/01994)
- European Regional Development Fund
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- colorectal cancer screening, electronic health records, clinical alerts, fecal immunochemical test, screening uptake, primary care, population-based screening program
- MeSH terms
- Aged, Female, Health Promotion, Humans, Male, Mass Screening, Middle Aged, Occult Blood, Primary Health Care, Spain, Colorectal Neoplasms, Cluster Analysis, Reminder Systems, Early Detection of Cancer, Electronic Health Records
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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