The effect of patient reminders on the use of screening mammography in an urban health department primary care setting

Mammography screening continues to be under-utilized, especially among wome n from lower socioeconomic groups. In order to determine whether having dir ect access to health care services has an effect on mammography use among l ow income women, we conducted a randomized trial of two alternative letter reminders among 1,717 women who were enrolled at two locations of a multi-s ite inner city health department in Detroit. All participants were 391/2 ye ars of age and older and were due for a screening mammogram at randomizatio n. A physician-directed reminder form was placed in each of the participant 's medical records at the beginning of the study. In addition participants were randomized to receive either a letter directing them to visit their pr imary care physician, a letter directing them to contact the clinic directl y to schedule a mammogram, or no letter. Study participants were predominan tly African-American, two-thirds of whom were over age 50, and who had mini mal health insurance coverage. During the intervention year, mammograms wer e completed by 179 out of 967 study women at site one (18.5%), and 90 out o f 750 study women at site two (12%). A multivariate model controlling for t he simultaneous effect of age, insurance type, visit history and past mammo graphy use, showed no significant independent effect of either type of lett er reminder on mammography completion during the study year. In conclusion, letters targeted at women due for screening mammograms did not have a bene ficial effect on mammography utilization above and beyond that of a physici an medical record reminder.