The Role of Primary Care Physicians and Reminder Systems in Increasing Colorectal Screening Recommendation [Response to Letter]

Dear editor

Thank you for the recent read and comments on our article “Knowledge, Attitude and, Practice of Physicians Regarding Screening of Colorectal Cancer in Qatar: A Cross-Sectional Survey”; I hope the below response will clarify the queries raised by our colleagues from the UK.

In Qatar, healthcare is provided mainly through two organizations, the Primary Health care Corporation (PHCC) and Hamad Medical Corporation (HMC), alongside a small contribution from private health care providers. HMC is the main provider of secondary and tertiary healthcare, managing 12 hospital sites – nine specialist hospitals and three community hospitals – as well as the National Ambulance Service and home and residential care services. The health care system in Qatar is slightly different from the UK and Canadian systems. The Family Medicine Model (FMM) with each person having a named family practitioner is still being established as a part of the Primary Health Care Corporation Corporate Strategic Plan 2019–2023.¹ And many of the patients who are being followed under HMC, continue their medical care there and approaches primary health care for unforeseen situations only. The survey was conducted in three main general hospitals in HMC, which are Hamad General Hospital, Al Wakra Hospital, and Al Khor Hospital.

The cancer screening programs in Qatar are offered only in governmental institutes. Once the physician decides to refer an eligible patient for cancer screening from the above-mentioned hospitals, the patient will be directed to the only specialized cancer center in Qatar named the National Center for Cancer Care and Research (NCCCR), which is again part of HMC or one of the three major PHCCs chosen for cancer screening. Patients can also book direct appointments for cancer screening at the PHCCs, but the awareness of this pathway among the general population is low. It has been established that the knowledge and attitude of the Arab population towards colorectal cancer is poor compared to the western world.^2,3 Physician recommendation is one of the main factors that has been shown to improve compliance to cancer screening.

Since the launch of the National Cancer Strategy in 2011, the Qatari government has supported cancer screening and the population-based National Screening program was introduced in 2016. The electronic medical record system was modified to include pathways for referrals. Unfortunately, the trainees and senior physicians in the teritiary care centers were not instructed or made aware of it, making it mostly unused.

These were the rationale behind conducting the study among the internal medicine physicians and residents.

Regarding the comment about the general practitioner role in colorectal cancer screening in Qatar, unfortunately, we have not included them in the survey, but it provides an opportunity for further study. Lastly, I agree with the commenters that physician-targeted reminder incorporated into our current Electronic health records systems will be a cost effective method to increase uptake and recommendation of cancer screening. Periodic quality improvement audits could follow our survey to ensure the sustainability of physicians’ practices. We expect that this study will serve as a baseline to monitor changes over time.