Mammograms for Poor Insured Rise With Stepwise Reminders

Sequential reminder letters plus personal counseling improve compliance
By Lindsey Marcellin
HealthDay Reporter

TUESDAY, June 29 (HealthDay News) -- A stepwise screening mammogram reminder program significantly increases the likelihood that an insured, very low-income woman will obtain a mammogram, according to research published online June 29 in Cancer Epidemiology, Biomarkers & Prevention.

Nasar U. Ahmed, Ph.D., of the Florida International University in Miami, and colleagues conducted a randomized controlled trial of 2,357 insured women (through a managed care organization [MCO]), with a median annual household income of $6,994, who were noncompliant with mammography recommendations. The women were randomized to one of three groups: a control group; a simple intervention group, which received one reminder letter from their MCO; or a stepwise intervention group, which received the same letter from their MCO and then a letter from their primary care physician if they were noncompliant, followed by personal counseling by lay health workers if still noncompliant with the mammogram recommendation.

The researchers found that the control group had a mammogram screening rate of 13.4 percent, while the group receiving only a single MCO letter had a mammography rate of 16.1 percent. The stepwise intervention group had the highest mammography rate, at 27.1 percent. The researchers note that, compared with the control group, the addition of the physician letter increased the likelihood of getting a mammogram by 80 percent, while the addition of counseling tripled the likelihood of getting a mammogram.

"Because low-income women are often faced with multiple competing priorities related to day-to-day survival that make preventive health care a low priority, efforts to promote compliance on cancer screening, when the issue is not of immediate concern to the patient, require extra effort and innovation, including perhaps a search for different approaches or different combinations of approaches," the authors write.

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