REDUCING LOSS-TO-FOLLOW-UP AMONG WOMEN WITH ABNORMAL PAP SMEARS - RESULTS FROM A RANDOMIZED TRIAL TESTING AN INTENSIVE FOLLOW-UP PROTOCOL AND ECONOMIC INCENTIVES

OBJECTIVES. This study evaluates the efficacy of two interventions des igned to reduce loss-to-follow-up among women with abnormal Pap smears . METHODS. The two interventions were evaluated in two large public ho spitals using a randomized 2 x 2 factorial design. One intervention in volved an intensive follow-up protocol that relied on multiple attempt s (mail and telephone) to contact the patient. The second intervention provided patients with economic vouchers to offset out-of-pocket expe nses associated with the follow-up visits. Loss-to-followup was addres sed by medical chart reviews and telephone interviews. RESULTS. The st udy population (n = 1453) was primarily Hispanic, married or otherwise living with a significant other, relatively young in age, and with no source of payment for health care. Overall, 30% of the total sample w as loss-to-follow-up tie, no return visits). Among patients assigned t o the control condition, loss-to-follow-up was 36.1% compared with 27. 8% for the intensive follow-up condition, 28.8% for the voucher condit ion, and 29.0% for the intensive follow-up plus voucher condition. Bot h intervention conditions significantly improved follow-up rates. The odds ratio for intensive follow-up was 1.56 compared with 1.50 for the voucher intervention. The combined intervention condition (intensive follow-up x voucher program) did not have a significant effect after t aking into account the main effects of the two interventions. Correlat es of loss-to-follow-up included age (younger women had lower return r ates), race/ethnicity (African American women had lower return rates), live-in relationship (women who were not married or living as married had lower return rates), and severity of the abnormal Pap smear (less severe abnormalities were associated with lower return rates). CONCLU SIONS. Both interventions were associated with moderate reductions in loss-to-follow-up in this underserved population. The implications of these findings are discussed relative to implementing cervical cancer control programs within state and local health departments.