title: Barriers to adherence to preventive services reminder letters: the patient's perspective.
abstract: BACKGROUND
  Despite an emerging consensus as to which preventive services are appropriate, a minority of patients receive them. Although adherence to recommendations for some interventions has increased, research studies have shown that adherence rates can be further improved through a better understanding of patient attitudes and motivations regarding preventive services.
  
  
  METHODS
  Using components of the Patient Path Model, this study examined the response to patient reminder letters for cholesterol screening sent to 1077 adult patients between August and October 1990. The research strategy incorporated both quantitative and qualitative methods, including a telephone survey and focus group interviews of nonresponders to the reminder letter.
  
  
  RESULTS
  Three hundred seven patients were surveyed by telephone to ascertain their reasons for nonresponse. One hundred fifty-four (50.2%) did not recall receiving the reminder letter, 84 (27.4%) recalled receiving the letter but did not recall its content, and 69 (22.5%) recalled both receiving the letter and its content. No consistent reason for nonadherence emerged among the 69 nonresponders who recalled the reminder. Twenty-seven of the nonresponders who did not recall receiving the cholesterol reminder participated in the focus groups. The participants stressed the importance of distinguishing the reminder letter from a bill, conveying a personally relevant message, and addressing logistical barriers to preventive services.
  
  
  CONCLUSIONS
  Careful attention to the format and content of patient reminder letters is necessary to improve adherence to preventive services recommendations.
authors.affiliation: Department of Family Medicine, Medical University of South Carolina, Charleston 29425.
authors.forename: S M
authors.initials: SM
authors.lastname: Ornstein
authors.forename: C
authors.initials: C
authors.lastname: Musham
authors.forename: A
authors.initials: A
authors.lastname: Reid
authors.forename: R G
authors.initials: RG
authors.lastname: Jenkins
authors.forename: L D
authors.initials: LD
authors.lastname: Zemp
authors.forename: D R
authors.initials: DR
authors.lastname: Garr
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D015709:Correspondence as Topic; D003625:Data Collection; D005194:Family Practice; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010361:Patients / Q000523:psychology; D011177:Postal Service; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D017010:Reminder Systems / Q000592:standards*; D013022:South Carolina; D013689:Telephone