Improving Abdominal Aortic Aneurysm (AAA) Screening Uptake through Patient Engagement-Analysis and Outcomes of Strategies to Improve Uptake at a Regional Program Level

Abstract

Background: To identify areas of health inequality that adversely affect patient engagement at a regional level within the National Abdominal Aortic Aneurysm Screening Program (NAAASP). Patient-reported improvements to services were implemented and analysis of subsequent uptake undertaken.

Methods: A prospective study of 390 men who failed to attend their AAA screening invitation. Nonattendees were contacted by post and telephone. Patients were analyzed as per ethnicity, working status, and Index of Multiple Deprivation quintile. Patient-suggested improvements to the service were recorded, analyzed, and implemented. Uptake data were then collected for the subsequent two years.

Results: The Screening Management and Referral Tracking system used by NAAASP is 97% accurate in holding patient contact details, and nonattenders are four times more likely to respond to telephone contact. Reasons for failing to attend screening invitations include factors that can be addressed at a regional level such as: inconvenient timings/locations of screening clinics and a lack of awareness or understanding of what AAA screening means as well as language/literacy barriers. The incidence of AAAs in the nonattendee group was almost 3 times that of our general (attending) population. Afro-Caribbean men were disproportionately less likely to attend for screening. After implementing patient-suggested improvements to the service, screening uptake increased from 75.2% (2015-16 screening year) to 81.3% (2017-2018).

Conclusions: To date, no other studies have gone on to assess the effectiveness of interventions targeted at reducing inequalities in NAAASP attendance, but we show an increase in local screening uptake of 6% in a 2-year period after implementing improvement strategies. This article adds to existing literature by confirming external factors such as social deprivation adversely influence screening uptake and that AAAs are more prevalent in socially deprived groups. It reinforces the importance of regional attempts to contact and engage nonattenders as they may be most at risk of developing AAAs.