Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Transl Behav Med. 2019 Mar 1;9(2):328-335. doi: 10.1093/tbm/iby031.
As population health has become a focus of health care payers and providers, interest has grown in mail, phone, and other forms of outreach for improving population rates of cancer screening. Translational research is needed to compare the effectiveness and cost of low- and high-intensity behavioral outreach interventions for promoting cancer screening. The purpose of the article is to compare the effectiveness in promoting biannual mammograms of three interventions delivered over 4 years to a primary care population with a high baseline mammography adherence of 83.3%. We randomized women aged 40-84 to reminder letter only (LO arm), letter + reminder call (RC arm), and two letters + counseling call (CC arm) involving tailored education and motivational interviewing. Mammography adherence (≥1 mammogram in the previous 24 months) at four time points was determined from insurance claims records. Over 4 years, 30,162 women were randomized. At the end of 4 years, adherence was highest in the RC arm (83.0%) compared with CC (80.8%) and LO (80.8%) arms (p = .03). Only 23.5% of women in the CC arm were reached and accepted full counseling. The incremental cost per additional mammogram for RC arm women was $30.45 over the LO arm cost. A simple reminder call can increase screening mammogram adherence even when baseline adherence is high. Some more complex behavioral interventions delivered by mail and phone as in this study may be less effective, due to limited participation of patients, a focus on ambivalence, lack of follow-up, and other factors.
随着人口健康已成为医疗保健支付者和提供者关注的焦点，人们对通过邮件、电话和其他形式的外展来提高人口癌症筛查率的兴趣日益浓厚。需要开展转化研究来比较低强度和高强度行为外展干预措施在促进癌症筛查方面的效果和成本。本文的目的是比较三种干预措施在促进 83.3%基线乳房 X 光筛检依从率较高的初级保健人群中每两年进行一次乳房 X 光检查的效果，这三种干预措施在 4 年内完成。我们将年龄在 40-84 岁的女性随机分配到仅接受提醒信（LO 臂）、信件+提醒电话（RC 臂）和两封信件+咨询电话（CC 臂）组，这些干预措施包括量身定制的教育和动机访谈。通过保险索赔记录确定四个时间点的乳房 X 光筛检依从性（过去 24 个月内至少进行一次乳房 X 光检查）。在 4 年内，有 30162 名女性被随机分配。在 4 年结束时，RC 臂的依从率最高（83.0%），高于 CC 臂（80.8%）和 LO 臂（80.8%）（p =.03）。只有 23.5%的 CC 臂女性接受了全面咨询。与 LO 臂相比，RC 臂女性每增加一次乳房 X 光检查的增量成本为 30.45 美元。即使基线依从率较高，简单的提醒电话也可以提高乳房 X 光筛检的依从率。本研究中通过邮件和电话提供的一些更复杂的行为干预措施可能效果较差，原因是患者参与度有限、关注犹豫不决、缺乏后续行动以及其他因素。
