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Physician linked correspondence

Physician-Linked Correspondence

Physicians play a crucial role in cancer care and can greatly influence patients’ participation in cancer screening.

Cancer screening letters are a key way to encourage individuals to get screened. Cancer Care Ontario is now offering physician-linked correspondence (PLC), which includes physicians’ names in their rostered patients’ cancer screening letters. The results of a two-phase pilot study conducted by the ColonCancerCheck (CCC) program demonstrated that PLC is an effective way to motivate eligible Ontarians to get screened for cancer. For more details on the study, please refer to the questions and answers below.

PLC is available to all patient enrolment model (PEM) physicians in the province. It will begin with colorectal cancer screening, and will expand to breast cancer and cervical cancer screening in the future.

Physicians are required to provide their consent to enrol in PLC. By enrolling, their screen-eligible patients will receive CCC invitation, recall and reminder letters that include their physician’s name, starting in February 2016. By completing the consent form, physicians will automatically be enrolled when PLC expands to breast cancer and cervical cancer screening.

Consent to enrol today!

PLC provides many benefits to physicians and screen-eligible Ontarians:

  • It is a proven way to get more people screened;
  • Screening maximizes the chances of early cancer detection and reduced mortality;
  • It supports better patient care; and
  • It can reduce administrative burden and help achieve preventive care bonuses.

Physician-Linked Correspondence (PLC): Questions and Answers

Your screen-eligible patients aged 50 to 74 will receive the following ColonCancerCheck (CCC) correspondence sent on your behalf:

  • Invitation letters to patients due for colorectal cancer screening who have not completed a guaiac-based fecal occult blood test (gFOBT) in the past two years, flexible sigmoidoscopy in the past five years or colonoscopy in the past 10 years;
  • Recall letters to past participants who are due to repeat biennial gFOBT screening; and
  • Reminder letters to patients who have not been screened within four months of being mailed an invitation or recall letter.

These letters are sent according to current colorectal cancer screening guidelines, which are subject to change.

CCC result and result reminder letters will continue to be sent, but not on your behalf.

Your patients may also be eligible for our two other cancer screening programs, (Ontario Breast Screening Program—OBSP, Ontario Cervical Screening Program—OCSP). Because these programs do not currently have physician-linked correspondence, your patients will continue to receive correspondence without your name. When physician-linked correspondence is expanded to the OBSP and OCSP, your name will appear on correspondence for those programs. You may opt out of participating in physician-linked correspondence for one or more cancer screening programs at any time (see question 8).


ColonCancerCheck (CCC) correspondence will be sent on your behalf to all eligible patients aged 50 to 74 who are due for colorectal cancer screening (see question 1) and are enrolled to you according to the Client Agency Program Enrolment (CAPE).This excludes individuals who have previously been diagnosed with colorectal cancer, have withdrawn from receiving screening letters, or do not have a valid mailing address registered with us.

Your eligible patients will receive the following CCC letters personalized with your name:

  • Invitation letter: Sent to all patients aged 50 to 74 who are due for colorectal cancer screening, unless they have received an invitation, recall or reminder letter within the last two years
  • Recall letter: Sent to all past CCC program participants who submitted a CCC fecal occult blood test (FOBT) kit to a lab 24 months ago
  • Reminder letter for invitation or recall: Sent to all patients who received an invitation or recall letter four months previously but did not complete colorectal cancer screening, unless their invitation or recall letter was undeliverable

These letters are sent according to current colorectal cancer screening guidelines, which are subject to change.

Please note that your eligible patients will continue to receive Ontario Breast Screening Program (OBSP) and Ontario Cervical Screening Program (OCSP) correspondence without your name. When physician-linked correspondence is expanded to the OBSP and OCSP, your name will appear on that correspondence. You may opt out of participating in physician-linked correspondence for one or more cancer screening programs at any time.


The correspondence sent to your patients will look the same as ColonCancerCheck (CCC) letters sent to all eligible Ontarians. The only difference is that instead of using generic language to encourage people to speak with their healthcare provider about cancer screening, we state that the letter is sent on your behalf and specify your name.

The letters include the following wording on the front page:

Invitation:

We are writing on behalf of Dr. <DR. FIRST NAME> <DR. LAST NAME> to invite you to get checked for colon (bowel) cancer.

Invitation reminder:

You were recently sent a letter on behalf of Dr. <DR. FIRST NAME> <DR. LAST NAME> inviting you to get checked for colon (bowel) cancer. If you have already been checked, please ignore this letter.

Recall:

We are sending this letter on behalf of Dr. <DR. FIRST NAME> <DR. LAST NAME> who would like you to book an appointment to talk about your next colon cancer screening test.

Recall reminder:

We are sending this letter on behalf of Dr. <DR. FIRST NAME> <DR. LAST NAME> who would like you to book an appointment to talk about your next colon cancer screening test.

When physician-linked correspondence is expanded to the Ontario Breast Screening Program (OBSP) and the Ontario Cervical Screening Program (OCSP), the letters sent to your patients will include similar wording (i.e., the letter will be sent on your behalf). Communications about these expansions will be made available in advance.

View samples of the current generic OBSP and OCSP letters


You can sign up by completing the Physician-Linked Correspondence Consent Form and faxing it to 1-866-682-9534 or emailing it to screenforlife@cancercare.on.ca. You will be asked to provide your consent for all three cancer screening programs at once, which means that you will not need to re-enrol when physician-linked correspondence expands to the Ontario Breast Screening Program (OBSP) and Ontario Cervical Screening Program (OCSP). Communications about these expansions will be made available in advance.


Physicians must sign their own consent form; however, a delegate can complete the rest of the information on the form. Physicians are required to provide their signature to show that they understand and acknowledge what they are opting into and their responsibility.


Physicians must sign their own consent form; however, a delegate can complete the rest of the information on the form for any of the physicians in the group. Physicians are required to provide their signature because it shows that they understand and acknowledge what they are opting into and their responsibility.


By consenting to participate in all three cancer screening programs, you will not need to re-enrol when physician-linked correspondence expands to the OBSP and OCSP, which means that your patients will receive physician-linked letters for those programs in the future. You can opt out of one or more programs at any time. Please refer to question 8 for more information about opting out.


You can make a request to opt out of physician-linked correspondence for one or more of the screening programs at any time. You can call us at 1-866-662-9233 from Monday to Friday (8:30 a.m. to 5 p.m.) or email screenforlife@cancercare.on.ca.

The Physician-Linked Correspondence: Opt-Out Form is available here.

If you opt out, your eligible patients will continue to receive correspondence for the program(s) that you have opted out of; however, the letters will not be sent on your behalf (i.e., will not include your name).


ColonCancerCheck, Ontario Breast Screening Program, and Ontario Cervical Cancer Screening Program are population-based, organized cancer screening programs and are set up so that all eligible Ontarians receive program correspondence. At this time, we do not have a method in place allowing physicians to exclude patients from receiving correspondence or specify which correspondence they receive. This is something we will take into consideration in future planning.

Physicians participating in a pilot study were asked to validate lists of their eligible patients to ensure that it was clinically appropriate to send them a mailed invitation for colorectal cancer screening. The electronic lists were 93 per cent accurate for clinical information. In subsequent focus groups, validation of patient lists was explained and reviewed with participating physicians; as a part of this process, physicians were informed about the accuracy rate determined in the pilot. The pilot assessment confirmed that most participating physicians would opt not to validate their patient lists in future mailed invitation campaigns because they felt that the high accuracy rate was a sufficient trade-off for the considerable work involved in reviewing the lists.1

We send cancer screening letters in accordance with our policies; however, we do not always have access to the same data that you do. The physician-linked letters include wording to encourage your patients to contact you if they feel they have received a letter in error (see the bottom of the first page of the letters). If you feel that any of your patients are being inappropriately invited to participate in one or more of our programs, you can tell them how to withdraw from correspondence for those specific programs. To do this, your patient would need to make the request by downloading and completing the Cancer Screening Program: Participant Information Form from the Screening Letters page. Detailed instructions and contact information are provided on the form—for assistance, your patients can call 1-866-662-9233, Monday to Friday from 8:30 a.m. to 5 p.m.

1Tinmouth J, Ritvo P, McGregor E, Green J. September 2010. Perceptions of Patients and Physician Participants in Ontario’s ColonCancerCheck Primary Care Invitation Pilot: A Report Based on Findings from Family Physician Focus Groups Produced for Cancer Care Ontario and the ColonCancerCheck Program.


The benefits of participating in physician-linked correspondence include:

  • Supporting better care for your patients.
  • Maximizing your patients’ chances of early detection when cancer is easier to treat. For example, when colorectal cancer is detected early, the likelihood of curing someone is 90 per cent, but this decreases to 12 per cent if detected at later stages1.

  • Saving the cost and time of calling or sending letters to your patients.
  • Maximizing your preventive care bonuses (see question 25)

1National Cancer Institute [Internet]. SEER stat fact sheets: colon and rectum cancer; [cited 2015 Sept 14]. Available from: http://seer.cancer.gov/statfacts/html/colorect.html.


Research has shown that individuals who receive a personal recommendation from their family physician are more motivated to get screened for cancer than those who do not.

The ColonCancerCheck (CCC) program conducted a two-phase pilot to evaluate the feasibility and effectiveness of physician-linked correspondence. The first phase (n=102 volunteer physicians) compared the uptake of the guaiac-based fecal occult blood test (gFOBT) in screen-eligible patients who were mailed physician-linked invitation letters to a matched, contemporaneous (i.e., occurring in the same time period) control group that was not invited by mail. Screening participation with gFOBT was higher in the group that received physician-linked letters (22 per cent) compared to those not invited by mail (eight per cent).1 This means that for every seven physician-linked letters sent, one additional person was screened.

The next phase specifically evaluated the impact of physician linkage. It compared uptake of gFOBT after physician-linked invitations or recall letters were sent to patients of 1,000 volunteer physicians participating in the pilot (January to March 2012) to uptake after unlinked letters were sent to patients of the same group of physicians one year prior (January to March 2011)2. Patients who received physician-linked invitation letters were more likely to return a gFOBT when compared to patients who received unlinked letters (invitations: 16.9 per cent vs. 12.7 per cent; recalls: 54.8 per cent vs. 47.6 per cent, respectively); selection bias may be playing a role in these findings. Evaluation of patients of non-participating physicians who received unlinked letters during the same two time periods suggested a 0.9 per cent increase in gFOBT uptake, indicating that secular trends (i.e., long-term trends that are likely independent of the intervention) may have accounted for a small proportion of the improvement observed in this phase of the pilot.

Based on the results of the two-phase pilot, we recommended the implementation of physician-linked correspondence in the CCC program.

References

1 Tinmouth J, Baxter NN, Paszat L, Sutradhar R, Rabeneck L, Yun L. Physician-linked mailed invitation  to be screened improves uptake in an organized colorectal cancer screening program. BMJ Open.  2014 Mar 12;4(3):e004494. doi: 10.1136/bmjopen-2013-004494 available at http://bmjopen.bmj.com/content/4/3/e004494.full?rss=1.

2 Marrett L, Gao, J. Physician Linked Correspondence (PLC) Evaluation. Cancer Care Ontario. Internal Report. Dec 2012.


In 2012, we asked a group of investigators at Sunnybrook Research Institute (Sunnybrook Health Sciences Centre) and the Institute for Clinical Evaluative Sciences (ICES) to conduct a study to inform the development of new, more persuasive ColonCancerCheck (CCC) invitations. The research team included experts in public health communication, social and behavioral sciences, epidemiology and medicine. Over the course of 12 months, the study conducted a large number of focus groups with screen-eligible men and women from across Ontario (with a good representation of immigrants and people of lower socio-economic status) to identify, test and refine messages that would motivate individuals to get screened. Findings from the focus groups were then used to develop enhanced letters of invitation, which were subsequently tested in a randomized controlled trial with 80,000 Ontarians (this trial only tested letters that did not include a physician’s name). Based on the trial results, which indicated that the enhanced invitations improved colorectal cancer screening participation, the new CCC letters were implemented in 2014. Strong evidence from several other studies suggests that the addition of physician names to the letters developed by the Sunnybrook/ICES research team will further increase participation in colorectal cancer screening in Ontario.


Based on the success of the ColonCancerCheck (CCC) physician-linked correspondence pilot, all patient enrolment model (PEM) physicians are being invited to enrol in physician-linked correspondence, allowing CCC letters to be sent on their behalf to their eligible patients. We plan to implement physician-linked letters for the Ontario Breast Screening Program (OBSP) and Ontario Cervical Screening Program (OCSP), which is why we are asking you to enrol in physician-linked correspondence for all three screening programs. For more information on the pilot, please see question 11.


Physician-linked correspondence began in February 2016. If you have already completed and submitted a consent form, then your eligible patients will receive screening letters which include your name. If you were participating in the pilot project and did not re-consent, then your patients will receive the generic versions of the letters (not including your name). If you would like to enrol, please complete the Physician-Linked Correspondence Consent Form.


The letters are similar to the three pilot letters (invitation, recall, recall reminder), but some minor changes have been made to align them with the messaging in our generic letters (those not including your name). We have also introduced an invitation reminder (please see question 3 for more details).


Patients you see who are not enrolled to you will still receive ColonCancerCheck correspondence, but these letters will not include your name.


To remove a patient who should not be rostered to you, complete a Primary Care Request to Remove a Patient form #3624-84 available at http://health.gov.on.ca/en/public/forms/primary_fm.aspx. Mail the original completed form to: Ministry of Health and Long-Term Care, Enrolment Processing Unit, 49 Place d’Armes, PO Box 48, Kingston, ON K7L 5J3.


The introduction of physician-linked correspondence has no impact on the timing of the letters being sent. The timing of the letters is based on a person’s date of birth or date of last screen, and letters are mailed on the same schedule whether or not they are sent on your behalf.


Even if you do not sign up, your eligible patients will still receive correspondence; however, it will not be sent on your behalf (i.e., the letters will be generic).


We obtain address information from many data sources, including the Ministry of Health and Long-Term Care’s Registered Person Database, to determine the most appropriate address for correspondence. If any of your patients have not updated their address with ServiceOntario, please encourage them to do so. Information on how to do this is available at http://health.gov.on.ca/en/public/publications/ohip/address.aspx.


To stop receiving invitations to participate, you can call 1-866-662-9233 from Monday to Friday (8:30 a.m. to 5 p.m.) or email screenforlife@cancercare.on.ca. If you email us, please provide your full name and College of Physicians and Surgeons of Ontario number.


There is no deadline. You can enrol in physician-linked correspondence at any time.


For the purposes of physician-linked correspondence, we cannot change your address in our system or the way your name appears on patient correspondence. We suggest you contact both the Ministry of Health and Long-Term Care (MOHLTC) and the College of Physicians and Surgeons of Ontario (CPSO) to update your name and contact information. It is important that you update your contact information with MOHLTC and CPSO because we use this information to authenticate you when you call:

We receive regular updates from these sources and the changes will be incorporated in future mailings. The email, phone number or fax number you provide on your consent form will be used to contact you regarding all matters related to physician-linked correspondence. Please ensure this information is also kept up to date with CPSO and MOHLTC.


Once you have completed and submitted the consent form, you are considered enrolled in physician-linked correspondence. You can assume that your patients will be sent letters if they meet the requirements outlined in questions 1 and 2. You can also call 1-866-662-9233 from Monday to Friday (8:30 a.m. to 5 p.m.) to confirm your enrolment. To maintain your confidentiality, we have an authentication process to confirm your identity before any information is provided.


Participating in physician-linked correspondence will help you achieve your incentives and bonuses for colorectal cancer screening in a number of ways.

You can claim the Q150A Distribution and Counselling Fee ($7) when you provide a gFOBT kit directly to your enrolled or non-enrolled patients ages 50 and over who are at average risk of colorectal cancer. If a patient completes the kit and visits you to discuss results, and your minimum roster size is not met, then you can claim the Q152A fee code.

The preventive care bonus—comprising fee codes Q118A to Q123A—ranges from $220 to $4,000. To receive the bonus, a minimum of 15 per cent of your screen-eligible enrolled patients between 50 and 74 years of age must receive gFOBT screening within 30 months of fiscal year end. Payments increase as you reach higher screening thresholds to a maximum of $4,000 for reaching 70 per cent of your eligible patients.

For more information, please refer to the “Information and Procedures for Claiming the Cumulative Preventive Care Bonus” that you receive with your Target Population and Service Report (TPSR).


A PEM physician is determined by affiliation type B28 from the Corporate Provider Database (CPDB) indicating that he or she is a full-time member of their group. PEM physicians are typically members of Comprehensive Care Models (CCMs), Family Health Groups (FHGs), Family Health Networks (FHNs) and Family Health Organizations (FHOs).


Cancer Care Ontario is authorized to collect personal health information (PHI) without consent under Ontario’s Personal Health Information Protection Act, 2004 (PHIPA). Cancer Care Ontario is designated as a “prescribed registry” under clause 39(1)(c) of PHIPA with respect to its role in compiling and maintaining cancer screening information for colorectal, cervical and breast cancer in the Ontario Cancer Screening Registry. This designation grants Cancer Care Ontario the authority to collect, use and disclose PHI for the purposes of facilitating or improving the provision of healthcare with respect to colorectal, cervical and breast cancer.

Prescribed registry status requires CCO to undergo review of its information and privacy practices by the Information and Privacy Commissioner of Ontario every three years to maintain this special designation.


Cancer Care Ontario has administrative, technical and physical safeguards in place to protect personal health information.

  • Administrative safeguards: Cancer Care Ontario describes its privacy practices in its Privacy Policy, which staff must read, and privacy training sessions, which all staff must attend. Staff must also sign agreements verifying that they understand and will adhere to Cancer Care Ontario’s privacy practices.
  • Technical safeguards: Access to the Ontario Cancer Screening Registry is protected by authentication and authorization mechanisms, and CCO’s network security controls. Access to the Ontario Cancer Screening Registry is monitored by the CCO Logging Monitoring and Auditing System.
  • Physical safeguards: Access to the data centre, where the servers that support the Ontario Cancer Screening Registry are housed, is controlled by entry point access cards at doors and elevators, is safeguarded by security guards (24 hours a day, seven days a week), requires personnel security clearance/background checks and is monitored with video surveillance.

Last modified: Wed, Feb 15, 2017
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