THE EFFECT OF PATIENT AND PHYSICIAN REMINDERS ON USE OF SCREENING MAMMOGRAPHY IN A HEALTH MAINTENANCE ORGANIZATION - RESULTS OF A RANDOMIZED CONTROLLED TRIAL

BACKGROUND. Despite its demonstrated efficacy in reducing breast carci noma mortality, screening mammography remains underutilized and its pr omotion in the primary care setting provides an important opportunity for intervention. METHODS. A randomized controlled trial was conducted in two sites of a health maintenance organization (HMO) serving an ur ban, minority population to evaluate the impact of patient and physici an reminders on site visitation and mammography use. Eligible women (n = 2368) were randomly assigned to 1 of 4 intervention combinations (p atient and physician reminders individually, together, or neither). Th e patient reminder letter invited mammography-due women to visit. The physician reminder was a notice placed in the medical record of mammog raphy-due women. Logistic analysis and survival analysis were used to investigate the relation ship of intervention status to visitation, ti me to a visit, and mammography use. RESULTS. The patient reminder inte rvention had no effect upon rates of study year visitation or mammogra phy at either site. However, among HMO Site 2 enrollees with entitleme nt insurance, the median time to the next visit was reduced from 12 to 9 weeks in association with assignment to patient reminder interventi on. The physician reminder intervention was also effective in increasi ng the rate of completed mammography at Site 2 among all assignees (36 % vs. 22% for those with vs. those without physician reminders) and am ong assignees who visited (59% vs. 43%). CONCLUSIONS. Patient reminder letters had limited impact on visitation in this setting. Physician r eminders are more effective but sites vary in their responsiveness. Fu rther improvement in mammography utilization will require a better und erstanding of the determinants of patient and physician behavior. (C) 1996 American Cancer Society.