Promoting mammography - Results of a randomized trial of telephone counseling and a medical practice intervention

Background: Despite widespread promotion of mammography screening, a distin ct minority of women have remained underusers of this effective preventive measure. We sought to measure the effects of barrier-specific telephone cou nseling (BSTC) and a physician-based educational intervention (MD-ED) on ma mmography utilization among underusers of mammography screening. Design: This was a randomized controlled trial. Women meeting criteria for mammography underuse at baseline (grouped by practice affiliation) were ran domized to a reminder control condition (RC group received annual mailed re minders), BSTC or MD-ED interventions and followed for 3 years. Underuse wa s defined by failure to get two annual or biannual mammograms over a 2- to 4-year period prior to a baseline survey. Participants and Settings: The study included 1655 female underusers of mam mography aged 50-80 years who were members of two health maintenance organi zations (HMO) in central Massachusetts. Interventions: BSTC consisted of periodic brief, scripted calls from traine d counselors to women who had not had a mammogram in the preceding 15 month s. Women could receive up to three annual calls during the study. MD-ED con sisted of physician and office staff trainings aimed at improving counselin g skills and office reminder systems. Main Outcome Measures: Self-report of mammography use during the study peri od was the main outcome measure. Regular use was defined as greater than or equal to 1 mammogram every 24 months. Results: Forty-four percent in each intervention group became regular users compared to 42% in the RC group. Among subjects who had prior but not rece nt mammograms at baseline, BSTC was effective (OR=1.48; 95% CI=1.04; 2.10), and MD-ED marginally effective (OR=1.28; 95% CI=0.88, 1.85). Most recent u sers at baseline and few never users became regular users (61% and 17%, res pectively) regardless of intervention status. Conclusions: Among mammography underusers BSTC modestly increases utilizati on for former users at a reasonable cost ($726 per additional regular user) . (C) 2000 American Journal of Preventive Medicine.