From Awareness to Action: Supporting Equitable Preventative Care with a Few Yes/No Questions

A team of family doctors, researchers, and patients from across Canada have developed a screening tool to help easily identify a patient’s preventative care needs.

The tool, Screening.ca, is based on national preventative care guidelines for the promotion of health equity. Published in the Canadian Medical Association Journal, these guidelines outline 15 preventive care recommendations including lowering the screening age for colorectal cancer, blood testing for tuberculosis, patient self-testing for diseases like HIV and cervical cancer, and screening for depression and intimate partner violence.

“There is increasing awareness of the importance and impact of health inequities, but there is still a disconnect between recognition and action,” says Dr. Nav Persaud, study-co-lead and associate professor in the Department of Family and Community Medicine (DFCM) at the University of Toronto.

“While inequities are often rooted in systemic issues, there are things we can do in our day-to-day work as family physicians to support health for all, including prioritizing preventative screening for those who are at higher risk for certain conditions and might have difficulty accessing screening and other vital health services.”

Developed by a panel of busy family physicians and patients from across Canada, including Persaud and Dr. Aisha Lofters, associate professor in DFCM and family physician at Women’s College Hospital, the tool requires only your age and answers to a few yes-no questions to get a custom list of preventative care recommendations – including links to further information.

“Appropriate preventative care is hugely powerful but not always easily available to those who are Indigenous, racialized, 2SLGBTQ+, or those who live with disabilities and/or low incomes. We hope family doctors and other primary care providers will use this tool, perhaps even with the patient in the room, to prioritize preventative care,” explains Persaud, who is also a family physician at Unity Health Toronto and Canada Research Chair in Health Justice.

The tool is updated weekly to reflect the latest academic literature and respond to public health issues such as the recent surge in infectious and congenital syphilis. In response to this surge, the team was able to quickly add syphilis as a screening recommendation for anyone identified as sexually active, and provide supporting Public Health Agency of Canada resources for surveillance, testing, and care.

Since its launch in September 2023, Screening.ca has been used over 10,000 times, with many repeat visitors. Given the uptake, the team plans to expand to include other important conditions such as prostate and breast cancer screening.

“The goal with this tool is to improve the process of preventative care and encourage screening options that actually reduce the burden on family doctors, such as HPV self-testing and blood testing for tuberculosis instead of the traditional skin test that requires four patient visits,” says Lofters.

As the study authors highlight, many of those who experience systemic discrimination and health inequities do not have access to a health provider in the first place.

“Many changes are needed at a system level to support equitable care provision, but we must not forget that there are also actions we, as family doctors, can take today.”