Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
Geisel School of Medicine, Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, USA.
Prev Med. 2017 Sep;102:49-58. doi: 10.1016/j.ypmed.2017.06.028. Epub 2017 Jun 24.
We compared the effectiveness of two outreach strategies on timely mammography adherence: a mammogram-specific reminder letter (sent just before a woman was due) to a birthday letter (addresses multiple preventive services and not timed around due dates). We evaluated screening mammography adherence following 79,848 mammogram-specific and 151,626 birthday letters mailed between 2002 and 2012 to women aged 40-74years enrolled in Kaiser Permanente Washington. Screening mammogram adherence was specifically tied to due date and was evaluated separately by age group and up-to-date or overdue status at the time of mailing. We used generalized estimating equations to account for correlation between repeated observations, to model the odds of screening mammography adherence by letter type. Among women up-to-date, adherence following birthday letters was 22-76% lower compared to the mammogram-specific reminders, with the greatest decreases in adherence in women aged 70-74. Birthday letters were more effective at activating screening uptake among some subgroups of overdue women aged 50-69 and most overdue women aged 70-74, but universally low adherence rates were observed in overdue women. Increasing number of recommended services for women aged 50-74 who were up-to-date resulted in 12-17% lower mammography adherence, but had no effect in women aged 40-49 or in overdue women. Birthday letters are less effective than mammogram-specific reminder letters at prompting women to undergo timely breast cancer screening, particularly among women up-to-date with screening. Birthday letters may be effective at increasing overall preventive care; however, supplemental outreach may be needed around the due date to increase timely preventive services receipt.
我们比较了两种外展策略对及时进行乳房 X 光检查的效果：一是专门针对乳房 X 光检查的提醒信（在女性即将进行检查之前发送），二是生日信（涵盖多种预防服务，且不围绕截止日期安排）。我们评估了 2002 年至 2012 年间向参加 Kaiser Permanente Washington 的 40-74 岁女性邮寄的 79848 封专门针对乳房 X 光检查的提醒信和 151626 封生日信后的筛查乳房 X 光检查依从性。筛查乳房 X 光检查的依从性与截止日期直接相关，并根据年龄组和邮寄时的最新或逾期状态分别进行评估。我们使用广义估计方程来考虑重复观察之间的相关性，根据信件类型来建立筛查乳房 X 光检查依从性的比值比模型。在最新的女性中，与专门针对乳房 X 光检查的提醒信相比，生日信后进行筛查乳房 X 光检查的依从性低 22%-76%，70-74 岁的女性依从性降幅最大。生日信在某些年龄在 50-69 岁且逾期的女性亚组和大多数年龄在 70-74 岁且逾期的女性中更能有效激活筛查参与度，但在逾期女性中普遍观察到依从率较低的情况。对于最新的年龄在 50-74 岁的女性，建议增加推荐服务的数量会导致乳房 X 光检查的依从性降低 12%-17%，但对年龄在 40-49 岁的女性或逾期女性没有影响。与专门针对乳房 X 光检查的提醒信相比，生日信在促使女性及时进行乳腺癌筛查方面的效果较差，特别是对于最新的筛查女性。生日信可能在增加整体预防保健方面有效；然而，可能需要在截止日期前后进行额外的外展活动，以增加及时接受预防服务的机会。
