Improving Pap screening rates in Eastern Zone

At the Senator’s Health Centre in Nova Scotia’s Eastern Zone, improving patient care started with a simple but important question: How can we make it easier for patients to stay up to date on preventive care?

That work took shape through the Quality Improvement Collaborative, a province-wide initiative that brought together primary care teams to strengthen how they deliver care. Over several months, teams participated in shared learning, testing small changes in their clinics to build skills to support long-term improvement.

For the Senator’s team, the focus quickly became clear. Pap screening.

“We started to notice that many of our missed appointments were for Pap tests,” said Lisa Harte, a family practice nurse. “We wanted to understand why patients weren’t coming in and what barriers they might be facing.”

Early data showed that only about half of eligible patients were up to date on their Pap screenings. For a test that plays a key role in detecting cervical cancer early, the team knew this was an important gap to address.

“It’s so important because it can be preventative. Early detection is key, particularly for cervical cancer,” said Harte. “We live in an area with a lot of barriers, and sometimes fear or past experiences can prevent people from coming in."

For this project, the Senator’s Health Centre leaned on the support of a Nova Scotia Health practice facilitator who is trained to work alongside primary healthcare teams to help improve how care is delivered and how teams efficiently work together.

“We built a shared system that allows us to quickly see who is overdue or coming due,” said Brittany Gwynn, the project’s practice facilitator. “(The system) automatically updates, flags patients within a few months of their due date, and includes notes that help guide follow up. It is much easier for staff to access and helps with planning and outreach.”

The system also improved clinic flow. Administrative staff used the overdue list to proactively call patients and book appointments directly with Harte. At the same time, Harte made use of any available gaps in her schedule to complete Pap screenings without disrupting other essential appointments, such as infant visits.

The team also began using the preventive care section in their electronic medical record more consistently. This meant that even during routine visits, providers could quickly see if a patient was overdue for a Pap test.

“Even if someone comes in for something simple, like an injection or blood pressure check, we can now see right away if they are due for a Pap,” said Harte.  

Administrative staff supported the work by reaching out directly to patients, while dedicated appointment time was set aside for nurse-led Pap tests.

Over time, these small system changes have added significant improvements to patient access. The clinic has seen a 34 per cent increase in eligible patients who are up to date on their Pap screening, with rates continuing to improve as the team builds consistency in their approach and supports ongoing patient outreach.

"I am very passionate about women's health and the critical role of cervical cancer screening,” said Harte. “This quality improvement initiative has given us the opportunity to identify key barriers and misconceptions surrounding Pap screening and develop effective strategies to address them."

Patients have responded positively, especially those who fell behind during the COVID-19 pandemic. “Sometimes people don’t realize how overdue they are,” said Harte. “When we reach out, they’re often grateful for the reminder.”

With a strong system now in place, the team is looking ahead to expanding this work and continuing to improve preventive care for their patients.

Across Nova Scotia, primary healthcare teams are working together in new ways to improve access to care and better support patients through the Health Home Quality Improvement Collaborative. This six-month program, led by Nova Scotia Health’s Primary Health Care and Chronic Disease Management Network, brought together nine clinic teams from across the province to test practical changes in their own settings. Supported by structured learning and practice facilitators, teams strengthened how they work together, made better use of their full care team, and adopted a more intentional, team-based approach, with quality improvement becoming part of their daily work. 

Photo of (L-R) Lisa Harte, family practice nurse, at the Senator’s Clinic and Brittany Gwynn, practice facilitator.