What is the evidence supporting the use of patient portal outreach to improve breast cancer screening adherence in primary care?

Patient Portal Outreach Effectively Improves Breast Cancer Screening Adherence in Primary Care

Patient portal outreach is an effective strategy to improve breast cancer screening adherence in primary care settings, but should be combined with in-person support and designed to address usability barriers for optimal results. 1

Evidence Supporting Patient Portal Outreach for Breast Cancer Screening

Effectiveness of Portal-Based Interventions

Patient portals represent a promising tool for improving breast cancer screening adherence, with approximately 90% of U.S. healthcare systems offering portal access to patients 1. However, the evidence reveals several important considerations:

• Portal utilization for preventive services shows variable uptake, with studies reporting that only 15-30% of patients use even a single portal feature 1
• Cancer screening modules delivered through patient portals have demonstrated some success, with one study showing that 21% of portal users started a screening module, though only 8% completed it 1
• Portal users were more likely to complete health screenings (76% vs 66% in one depression screening study), suggesting potential for breast cancer screening improvement 1

Implementation Strategies for Success

Research indicates that successful patient portal outreach for breast cancer screening requires:

1. Tailored outreach programs:

   • Studies show that tailored portal outreach programs that include educational content in both English and Spanish can improve uptake 1
   • Mammogram-specific reminders are more effective than general preventive service reminders, with birthday letters showing 22-76% lower adherence compared to mammogram-specific reminders 2

2. In-person support:

   • Studies demonstrate more favorable portal uptake when incorporating in-person enrollment and training for patients 1
   • Programs utilizing staff (such as medical students) to meet patients before visits to review portal purpose and assist with enrollment showed improved engagement 1

3. Addressing workflow challenges:

   • Clinicians report a lack of workflows to support patient use of portals in routine practice 1
   • Successful implementation requires adapting clinical workflows to complement portal use and developing team-based approaches to manage portal communications 1

Barriers to Portal Use for Breast Cancer Screening

Several barriers may limit the effectiveness of patient portal outreach for breast cancer screening:

• Digital literacy and access: Digital literacy, device ownership, and broadband access significantly impact portal use, with a persistent digital divide among low-income and older adults 1
• Health literacy: Patients need support understanding medical content presented through portals 1
• Usability issues: Cumbersome interfaces and complex navigation can discourage portal use, particularly among disadvantaged populations 1
• Privacy concerns: Some patients express security and privacy concerns about portal use 1

Best Practices for Patient Portal Breast Cancer Screening Outreach

Based on the evidence, the following approach is recommended for implementing patient portal outreach for breast cancer screening:

1. Design mammogram-specific reminders:

   • Use mammogram-specific reminders rather than general preventive service messages 2
   • Time outreach around mammogram due dates for optimal effectiveness 2

2. Provide in-person support:

   • Incorporate in-person enrollment and training for portal use 1
   • Consider using staff to assist patients with portal registration during clinic visits 1

3. Address usability barriers:

   • Improve portal interfaces with simplified log-ins and navigation 1
   • Include audiovisual and improved graphical representations of content 1

4. Supplement with additional outreach methods:

   • For patients who remain non-adherent, telephone scheduling assistance can be effective, with one study showing 41% of previously non-adherent women completing mammograms after navigator calls 3
   • Direct discussion of breast cancer screening status between provider and patient can significantly increase compliance, improving rates from 64.7% to 76.6% in one study 4

Implementation Considerations

When implementing patient portal outreach for breast cancer screening:

• Target appropriate populations: Portal outreach may be less effective for women who are already overdue for screening, requiring more intensive interventions 2
• Consider patient characteristics: Lower portal use is observed among women without prior cancer screening, Hispanic patients, Asian patients, non-English-speaking patients, and uninsured patients 1
• Develop clinical workflows: Create workflows that support electronic communication and ensure messages are directed to appropriate team members 1
• Measure outcomes: Track screening adherence rates before and after implementation to evaluate effectiveness 4

Patient portal outreach represents a valuable tool for improving breast cancer screening adherence when implemented thoughtfully with attention to usability, patient support, and workflow integration.