Prostate Specific Antigen Ordering After Implementation of a Point-of-Care Reminder to Discuss Screening.

Abstract

In 2018, prostate cancer screening with prostate specific antigen (PSA) received a "C" recommendation from the US Preventive Services Task Force for men aged 55 to 69 years. In January 2023, our health system implemented a point-of-care electronic reminder for primary care clinicians to discuss PSA screening for men aged 55 to 69. We assessed the impact of reminder implementation on monthly rates of PSA ordering from January 1, 2022 to July 31, 2024 by performing interrupted time series analyses for men aged 55 to 69 years (for whom the reminder was implemented) and men aged 50 to 54, 70 to 74, and ≥75 years. Before reminder implementation, PSA was ordered in a median of 6.4% of visits for men aged 55 to 69 years versus a median of 10.2% of visits after reminder [adjusted incidence rate ratio (aIRR) 1.57 (95% CI: 1.43-1.73)]. The postreminder period was associated with smaller but significantly increased rates of PSA ordering in men aged 50 to 54 [aIRR 1.44 (1.25-1.65)], 70 to 74 [aIRR 1.26 (1.14-1.39)], and ≥75 years [aIRR 1.11 (1.02-1.11)]. Implementation of an electonic medical record (EMR) reminder to discuss PSA screening was associated with a large increase in PSA ordering among men in the targeted age-group, but also smaller increases in age groups for whom the balance of benefits and harms of PSA screening may be less favorable.