Open Access Study protocol

Can an alert in primary care electronic medical records increase participation in a population-based screening programme for colorectal cancer? COLO-ALERT, a randomised clinical trial

Carolina Guiriguet-Capdevila114*, Laura Muñoz-Ortiz2, Irene Rivero-Franco143, Carme Vela-Vallespín144, Mercedes Vilarrubí-Estrella144, Miquel Torres-Salinas5, Jaume Grau-Cano116, Andrea Burón-Pust1112137, Cristina Hernández-Rodríguez117, Antonio Fuentes-Peláez8, Dolores Reina-Rodríguez9, Rosa De León-Gallo4, Leonardo Mendez-Boo10 and Pere Torán-Monserrat2

Author Affiliations

1 Primary Healthcare Centre Santa Rosa, Catalan Health Institute, Carrer El Cano s/n, 08921 Santa Coloma de Gramenet, Spain

2 Primary Healthcare Research Support Unit Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària (IDIAP) Jordi Gol, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain

3 Primary Healthcare Centre Sanllehy, Catalan Health Institute, Av Mare de Deu de Montserrat 16-18, 08024 Barcelona, Spain

4 Primary Healthcare Centre Riu Nord-Riu Sud, Catalan Health Institute, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain

5 Department of Internal Medicine, Fundació Hospital de l’Esperit Sant, Avinguda Mossèn Pons i Rabadà s/n, 08923 Sta Coloma de Gramenet, Barcelona, Spain

6 Department of Preventive Medicine and Epidemiology, Hospital Clínic, Carrer del Rosselló 138, 08036 Barcelona, Spain

7 Department of Epidemiology and Evaluation, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain

8 Direcció d’Organització i Sistemes, Gerencia Territorial Metropolitana Nord, Catalan Health Institute, Canyet s/n, 08916 Badalona, Spain

9 Metodology, Quality and Care Evaluation, Metropolitana Nord Primary Care Service, Catalan Health Institute, Badalona, Spain

10 Primary Care Services Information System, Catalan Health Institute, Avinguda Gran Vía de les Corts Catalanes 587, 08007 Barcelona, Spain

11 Colorectal Screening Programme Research Group (PROCOLON), Barcelona, Spain

12 Health Services and Chronic Diseases Research Network (REDISSEC), Barcelona, Spain

13 Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain

14 Grupo emergente de investigación en cáncer (CANCER-AP), IDIAP JordiGol, Catalan Health Institute, Barcelona, Spain

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BMC Cancer 2014, 14:232  doi:10.1186/1471-2407-14-232

Published: 31 March 2014



Colorectal cancer is an important public health problem in Spain. Over the last decade, several regions have carried out screening programmes, but population participation rates remain below recommended European goals. Reminders on electronic medical records have been identified as a low-cost and high-reach strategy to increase participation. Further knowledge is needed about their effect in a population-based screening programme. The main aim of this study is to evaluate the effectiveness of an electronic reminder to promote the participation in a population-based colorectal cancer screening programme. Secondary aims are to learn population’s reasons for refusing to take part in the screening programme and to find out the health professionals’ opinion about the official programme implementation and on the new computerised tool.


This is a parallel randomised trial with a cross-sectional second stage. Participants: all the invited subjects to participate in the public colorectal cancer screening programme that includes men and women aged between 50–69, allocated to the eleven primary care centres of the study and all their health professionals. The randomisation unit will be the primary care physician. The intervention will consist of activating an electronic reminder, in the patient’s electronic medical record, in order to promote colorectal cancer screening, during a synchronous medical appointment, throughout the year that the intervention takes place. A comparison of the screening rates will then take place, using the faecal occult blood test of the patients from the control and the intervention groups. We will also take a questionnaire to know the opinions of the health professionals. The main outcome is the screening status at the end of the study. Data will be analysed with an intention-to-treat approach.


We expect that the introduction of specific reminders in electronic medical records, as a tool to facilitate and encourage direct referral by physicians and nurse practitioners to perform colorectal cancer screening will mean an increase in participation of the target population. The introduction of this new software tool will have good acceptance and increase compliance with recommendations from health professionals.

Trial registration

Clinical identifier NCT01877018