title: The effect of patient and physician reminders on use of screening mammography in a health maintenance organization. Results of a randomized controlled trial.
abstract: BACKGROUND
  Despite its demonstrated efficacy in reducing breast carcinoma mortality, screening mammography remains underutilized and its promotion in the primary care setting provides an important opportunity for intervention.
  
  
  METHODS
  A randomized controlled trial was conducted in two sites of a health maintenance organization (HMO) serving an urban, minority population to evaluate the impact of patient and physician reminders on site visitation and mammography use. Eligible women (n = 2368) were randomly assigned to 1 of 4 intervention combinations (patient and physician reminders individually, together, or neither). The patient reminder letter invited mammography-due women to visit. The physician reminder was a notice placed in the medical record of mammography-due women. Logistic analysis and survival analysis were used to investigate the relationship of intervention status to visitation, time to a visit, and mammography use.
  
  
  RESULTS
  The patient reminder intervention had no effect upon rates of study year visitation or mammography at either site. However, among HMO Site 2 enrollees with entitlement insurance, the median time to the next visit was reduced from 12 to 9 weeks in association with assignment to patient reminder intervention. The physician reminder intervention was also effective in increasing the rate of completed mammography at Site 2 among all assignees (36% vs. 22% for those with vs. those without physician reminders) and among assignees who visited (59% vs. 43%).
  
  
  CONCLUSIONS
  Patient reminder letters had limited impact on visitation in this setting. Physician reminders are more effective but sites vary in their responsiveness. Further improvement in mammography utilization will require a better understanding of the determinants of patient and physician behavior.
authors.affiliation: Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Burack
authors.forename: P A
authors.initials: PA
authors.lastname: Gimotty
authors.forename: J
authors.initials: J
authors.lastname: George
authors.forename: M S
authors.initials: MS
authors.lastname: Simon
authors.forename: P
authors.initials: P
authors.lastname: Dews
authors.forename: A
authors.initials: A
authors.lastname: Moncrease
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006279:Health Maintenance Organizations; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007348:Insurance, Health; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010818:Practice Patterns, Physicians'; D017010:Reminder Systems