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Recipe Name:	Patients who have never been screened or are overdue to screen for more than one screening program
Rationale:	This recipe supports identification of women who are non-screeners across multiple screening programs. Primary care providers are well positioned to provide women who may have complex reasons for non-participation in cancer screening with the support they need to engage with cancer screening. A high proportion (69%) of women who have screened participate in all the cancer screening programs they are eligible for. [1] This may mean that if the barriers to screening for non-screeners can be broken down in at least one program, it might improve participation in other screening programs as well, leading to more cancers detected through screening and reduced risk of death. Practices may wish to consider contacting patients who are overdue for more than one screening program by phone and inviting them to make an appointment to speak to a clinician about screening. _{1 Australian Institute of Health and Welfare 2018. Analysis of cancer outcomes and screening behaviour for national cancer screening programs in Australia. Cancer series no. 111. Cat. no. CAN 115. Canberra: AIHW}
Target:	Female patients aged 50 and older never screened or overdue for CST, mammogram and FOBT screening
Recipe Limitations:	This report excludes patients with a number of conditions under the 'ineligible’ category. Practices should be aware of the diagnosis codes that PEN uses to assign patients to ‘ineligible’. Practices should undertake periodic clinical review of patients in the ‘ineligible’ category to assess if any of these patients should return to screening. Your practice may have patients that you consider clinically ineligible for screening that are not captured by these diagnosis codes. These patients should be manually opted out of screening.
CAT Starting Point:	CAT Open - CAT4 view (all reports) loaded Population Extract Loaded and Extract Pane “Hidden” Filter Pane open OPTIONAL under the ‘General’ tab ‘Active Patients’ (3x <2 years) selected

CAT4 starting point

CAT Recipes > Patients who have never been screened or are overdue to screen for more than one screening program > NewUI_starting_point_blank.png

RECIPE Steps Filters:

In the “General” Tab, enter Start Age = 50 and End Age = 74. Practices should decide if they want to send screening reminders to active patients only. Population based screening programs target asymptomatic patients. You may have some patients who consider your practice their medical home who do not fit the criteria for being an ‘active’ patient. If required, select 'Active' to search for your active patients only.

CAT Recipes > Patients who have never been screened or are overdue to screen for more than one screening program > newUI_age50_to_74.png

You can select the Gender/Female but the report will automatically show female patients as well as patients with no gender entered. This is the preferred approach, as it will include all patients potentially at risk including those without gender information entered.

Practices should review those patients for whom no gender is entered to ensure they are only sent appropriate cancer screening reminders. Consideration should be given to keeping a register of transgender, gender diverse and intersex patients to support this process.

Click "Recalculate"

Click ‘Hide Filters’

Report Steps

Select the "Screening/Cervical Screening" tab

This reports shows the cervical screening results for the selected patients. Select the following categories from the graph:

HPV>5yrs / Pap>2yrs (no HPV) - No HPV test in more than 5 years/ no Pap test in more than 2 years
Not Recorded

CAT Recipes > Patients who have never been screened or are overdue to screen for more than one screening program > newUI_50_to_74_screening_cervical_2_options.png

Select the "Screening/Mammogram" tab

This report will show the selected patients and the proportion of patients with a mammogram recorded. To find patients with no Mammogram recorded or no Mammogram recorded in the last 28 months, select the following slices of the graph:

>2-3 years,
>3-4 years,
> 4 years,
No Mammogram recorded

CAT Recipes > Patients who have never been screened or are overdue to screen for more than one screening program > newUI_50_to_74_screening_cervical_and_mammogram_2_4_options.png

This report excludes patients with a number of conditions, including mastectomy. Full details can be found here:

https://help.pencs.com.au/display/CG/Diagnosis+Codes+Screening+Tests

Select the 'Screening/FOBT' tab. To find patients with no FOBT recorded or no FOBT recorded in the last 28 months, select the following slices of the graph:
- >2-3 years,
- >3-4 years,
- > 4 years,
- No FOBT Recorded

CAT Recipes > Patients who have never been screened or are overdue to screen for more than one screening program > newUI_50_to_74_screening_cervical_and_mammogram_FOBT_2_4_4_options.png

To find patients that are eligible for all screening tests you can do a cross-tabulation. Leave the relevant parts of each pie chart selected as shown above and you should see a dot next to each report:

CAT Recipes > Patients who have never been screened or are overdue to screen for more than one screening program > newUI_filter_view_screenings_all_3.png

Then click on the 'Report' icon on top of your screen:

CAT Recipes > Patients who have never been screened or are overdue to screen for more than one screening program > newui_report_button.png

This will show a list of all patient meeting the selected categories on all three reports:

CAT Recipes > Patients who have never been screened or are overdue to screen for more than one screening program > newUI_cross_tab_report_screening_all_3.png