Murayama Hiroshi, Shimada Seitaro, Takahashi Yuta
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology.
City of Yokohama.
Nihon Koshu Eisei Zasshi. 2023 Jun 24;70(6):381-389. doi: 10.11236/jph.22-107. Epub 2023 Mar 10.
Objectives Medical insurers have applied a reminder (i.e., recall) system to improve the implementation rate of specific health guidance. However, the effectiveness of the system has not been verified. This study aims to examine the effectiveness of two methods of specific health guidance reminders (i.e., letter and telephone) using a randomized controlled trial.Methods Subscribers of National Health Insurance in Yokohama City, Kanagawa Prefecture, who were eligible for specific health guidance in 2020, were recruited. A specific health examination questionnaire was used to identify participants intending to use health guidance. The intervention period was from September to November 2020, with 252 people being randomly assigned to one of the three groups: a "no-reminder group," "a letter-reminder group," or "a telephone-reminder group" (84 people each). Those in the letter-reminder group received a reminder by mail and those in the telephone-reminder group received a reminder by phone from a public health nurse two weeks after the specific health guidance coupon was sent to the participants by mail. The outcome showed the utilization rate of specific health guidance. Chi-square tests were performed to compare the three groups and conduct multiple comparisons (post-hoc test).Results The participants had a mean age of 61.4±11.0 years and 70.6% were male. There was no difference among the three groups in terms of demographic characteristics and the results of specific health examinations. The utilization rates of specific health guidance were 20.2% in the no-reminder group, 22.6% in the letter-reminder group, and 20.2% in the telephone-reminder group; thus, the three groups did not significantly differ (χ=0.191, P=0.909). Multiple comparisons also showed no difference between any two groups. However, in the telephonereminder group, 56.0% of the participants themselves or their family members could be reached by a public health nurse, and their utilization rate was higher than those participants whom a public health nurse could not reach.Conclusion Neither letter nor telephone reminders changed the participants' utilization rates of specific health guidance compared to those with no reminder. Although the effectiveness of a telephone reminder might be underestimated, this study suggests setting a lower priority in reminding those who intend to use health guidance.
目的 医疗保险公司已应用提醒（即召回）系统来提高特定健康指导的实施率。然而，该系统的有效性尚未得到验证。本研究旨在通过随机对照试验检验两种特定健康指导提醒方法（即信件和电话）的有效性。
方法 招募了神奈川县横滨市2020年有资格接受特定健康指导的国民健康保险参保者。使用特定健康检查问卷来确定打算使用健康指导的参与者。干预期为2020年9月至11月，252人被随机分配到三组之一：“无提醒组”、“信件提醒组”或“电话提醒组”（每组84人）。信件提醒组在通过邮件向参与者发送特定健康指导优惠券两周后收到邮件提醒，电话提醒组在两周后由公共卫生护士通过电话提醒。结果指标为特定健康指导的利用率。进行卡方检验以比较三组并进行多重比较（事后检验）。
结果 参与者的平均年龄为61.4±11.0岁，70.6%为男性。三组在人口统计学特征和特定健康检查结果方面没有差异。无提醒组的特定健康指导利用率为20.2%，信件提醒组为22.6%，电话提醒组为20.2%；因此，三组之间无显著差异（χ=0.191，P=0.909）。多重比较也显示任意两组之间无差异。然而，在电话提醒组中，56.0%的参与者本人或其家庭成员能够被公共卫生护士联系到，他们的利用率高于公共卫生护士无法联系到的参与者。
结论 与无提醒相比，信件和电话提醒均未改变参与者对特定健康指导的利用率。尽管电话提醒的有效性可能被低估，但本研究表明，对于那些打算使用健康指导的人，提醒的优先级可以降低。
