THE EFFECT OF PATIENT AND PROVIDER REMINDERS ON MAMMOGRAPHY AND PAPANICOLAOU SMEAR SCREENING IN A LARGE HEALTH MAINTENANCE ORGANIZATION

Background: We evaluated the effectiveness of 2 reminder interventions to increase the use of screening mammograms and Papanicolaou (Pap) sm ears among female members of a large health maintenance organization. Methods: Seven thousand seventy-seven female health maintenance organi zation members (aged 50-74 years with no Frier mammogram in the previo us 30 months or aged 20-64) ears with no prior Pap smear in the previo us 36 months) were randomized to receive one of the following: a lette r inciting them to make an appointment for a mammogram or a Pap smear; in addition to the letter, a reminder manually placed in the patient' s medical chart alerting providers of that member's need for screening ; or their usual care. Results: Compared with women who did not receiv e the reminder letter, women who did receive the letter were more like ly to obtain mammograms (16.0% vs 25.5%, re spectively: P<.001) or Pap smears (9.1% vs 19.5%, respectively: P<.001) in the 6 months followin g their entry into the study. Compared with women who received only th e reminder letter, women who received a reminder letter and had a remi nder placed in their medical chart were more likely to obtain mammogra ms (26.5% vs 30.9%, respectively; P=.02) and marginally more likely to receive Pap smears (19.5% vs 22.8%, respectively; P=.04). Conclusions : We recommend the use of patient reminder letters as a first step in a mammography or Pap smear screening outreach program. Further researc h is needed to evaluate a cost-effective provider reminder system and additional outreach strategies directed to women who do not use health care services.