BACKGROUND AND PURPOSE:

• Underuse of screening is well known
  • One possible explanation that has been suggested is that as PCPs fall behind later in the day, there may be more rushed appointments and ‘decision fatigue’
• Hsiang et al. (JAMA Network Open, 2019) sought to determine whether clinic appointment time is related to clinician ordering and patient completion of breast or colorectal cancer screening

METHODS:

• Retrospective, quality improvement study
• Participants
  • Adults eligible for breast or colorectal cancer screening in primary care facilities
• Exposures
  • Clinic appointment time during each patient’s first primary physician visit
• Primary outcome
  • Clinician ordering of the screening test during the visit
• Secondary outcome
  • Patient completion of the tests within 1 year of visit

RESULTS:

Breast Cancer Screening

• 19,254 patients were eligible
  • Mean age: 60.2 years
• Screening test order rates based on appointment time
  • 8 am: 63.7%
  • 11 am: 47.8%
  • Noon: 56.2%
  • 5 pm: 47.8%
  • Adjusted odds ratio (OR) for overall trend: 0.94 (95% CI, 0.93-0.96; P < .001)
• Screening test completion rates based on appointment time
  • 8 am: 33.2%
  • 5 pm: 17.8%
  • Adjusted OR: 0.95 (95% CI, 0.94-0.97; P < .001)

Colorectal Cancer Screening

• 33,468 patients were eligible for colorectal cancer screening
  • Mean age: 59.6 years
  • Female: 55.8%
• Screening test order rates based on appointment time
  • 8 am: 36.5%
  • 11 am: 31.3%
  • Noon: 34.4%
  • 5 pm: 23.4%
  • Adjusted OR: 0.94 (95% CI, 0.93-0.95; P < .001)
• Screening test completion rates based on appointment time
  • 8 am: 28.0%
  • 5 pm: 17.8%
  • Adjusted OR: 0.97 (95% CI, 0.96-0.98; P < .001)

CONCLUSION:

• The ordering of screening tests and completion by patients both declined as the day progressed  
• Future research and interventions to increase screening should take appointment times into account

Learn More – Primary Sources:

Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening

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