Phillips Lindsay, Hendren Samantha, Humiston Sharon, Winters Paul, Fiscella Kevin
From the Department of Family Medicine, University of Rochester Medical Center, Rochester, NY (LP, PW, KF); the Department of Surgery, University of Michigan, Ann Arbor (S. Hendren); and the Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO (S. Humiston).
J Am Board Fam Med. 2015 Jan-Feb;28(1):46-54. doi: 10.3122/jabfm.2015.01.140174.
Low-cost interventions to improve cancer screening among primary care patients are needed. The comparative effectiveness of personalized letters, automated telephone calls, and both on breast cancer (BC) and colorectal cancer (CRC) screening is not known.
A pragmatic, randomized, controlled trial was conducted in 2011 to 2012. Eligible primary care patients were women ages 50 to 74 years who were past due for mammography and men or women who were past due for mammography or CRC screening of any kind (>12 months since last fecal occult blood test, >5 years since last sigmoidoscopy/double-contrast barium enema, or >10 years since last colonoscopy), respectively. Participants were randomized to 1 of 3 interventions: personalized mailed letters, automated telephone calls, or both. The primary outcome was medical record documentation of a completed mammogram or CRC screening within 36 weeks of randomization. We estimated the costs of each intervention and calculated the marginal cost-effectiveness per person screened.
The crude screening rates for BC were 19%, 22%, and 37% and for CRC were 17%, 14%, and 24% for the letter, automated call, and combined (letter/automated call) groups, respectively. The combined intervention group had a statistically higher screening rate (P < .05) compared with either of the single intervention groups (letter only or automated call) for both BC and CRC in both the crude and adjusted analyses. The combined intervention costs $5.11 per additional person screened for BC and $13.14 per additional person screened for CRC.
In a primary care practice, letters plus automated telephone calls are better than either alone in increasing cancer screening rates among patients who are overdue for screening. These findings suggest the promise of a relatively inexpensive intervention to improve cancer screening.
需要低成本干预措施来提高初级保健患者的癌症筛查率。个性化信件、自动电话呼叫以及两者结合对乳腺癌（BC）和结直肠癌（CRC）筛查的相对有效性尚不清楚。
2011年至2012年进行了一项实用的随机对照试验。符合条件的初级保健患者为50至74岁的女性，其乳房X线摄影检查逾期未做；以及男性或女性，其乳房X线摄影检查或任何类型的CRC筛查逾期未做（自上次粪便潜血试验超过12个月，自上次乙状结肠镜检查/双重对比钡灌肠超过5年，或自上次结肠镜检查超过10年）。参与者被随机分配到3种干预措施中的一种：个性化邮寄信件、自动电话呼叫或两者结合。主要结局是在随机分组后36周内完成乳房X线摄影检查或CRC筛查的病历记录。我们估计了每种干预措施的成本，并计算了每筛查一人的边际成本效益。
信件组、自动电话呼叫组和联合（信件/自动电话呼叫）组的BC粗筛查率分别为19%、22%和37%，CRC粗筛查率分别为17%、14%和24%。在粗分析和校正分析中，联合干预组在BC和CRC的筛查率上均显著高于单一干预组（仅信件组或自动电话呼叫组）（P < 0.05）。联合干预每多筛查一名BC患者的成本为5.11美元，每多筛查一名CRC患者的成本为13.14美元。
在初级保健实践中，信件加自动电话呼叫在提高筛查逾期患者的癌症筛查率方面比单独使用任何一种方法都更好。这些发现表明，一种相对便宜的干预措施有望改善癌症筛查。
