Alerts in electronic medical records in primary care to promote colorectal cancer screening

We agree with Gommans et al that the main evaluation of effectiveness should rely on intention-to-treat analysis.¹ Accordingly, the results in the discussion section of the article are those derived from this analysis. In our opinion, the lack of statistical significance may have been influenced by the fact that a non-negligible percentage of individuals did not visit their primary care centre during the study period, as well as the low response rate from professionals. In contrast with Gommans et al ’s statement, the present study was intentionally designed following a pragmatic approach. Indeed, if a centre agreed to participate in the study, all their primary care professionals were involved regardless of their particular intention, thus avoiding the inclusion of highly-motivated professionals only, and evaluating the intervention in daily practice conditions.

We do believe that electronic reminders can play a great role in promoting colorectal cancer screening, but we need to advance into qualitative and technological issues favouring its use by health professionals. For that reason, we were interested in emphasising the statistically significant results observed in the per-protocol analysis, that is, individuals attending in primary care, although we are aware of the weak effect found.

We are convinced that primary care is an ideal setting to develop preventive care measures and to enhance the uptake rates of population-based screening programmes. In such a scenario, synergies among all professionals involved — although complex — are critical to achieve these final goals.