title: The effect of patient and provider reminders on mammography and Papanicolaou smear screening in a large health maintenance organization.
abstract: BACKGROUND
  We evaluated the effectiveness of 2 reminder interventions to increase the use of screening mammograms and Papanicolaou (Pap) smears among female members of a large health maintenance organization.
  
  
  METHODS
  Seven thousand seventy-seven female health maintenance organization members (aged 50-74 years with no prior mammogram in the previous 30 months or aged 20-64 years with no prior Pap smear in the previous 36 months) were randomized to receive one of the following: a letter inviting 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 receive the reminder letter, women who did receive the letter were more likely to obtain mammograms (16.0% vs 25.5%, respectively; P < .001) or Pap smears (9.1% vs 19.5%, respectively; P < .001) in the 6 months following their entry into the study. Compared with women who received only the reminder letter, women who received a reminder letter and had a reminder placed in their medical chart were more likely to obtain mammograms (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 research is needed to evaluate a cost-effective provider reminder system and additional outreach strategies directed to women who do not use health care services.
authors.affiliation: Division of Research, Kaiser Permanente Medical Care Program, Northern California Region, Oakland, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Somkin
authors.forename: R A
authors.initials: RA
authors.lastname: Hiatt
authors.forename: L B
authors.initials: LB
authors.lastname: Hurley
authors.forename: E
authors.initials: E
authors.lastname: Gruskin
authors.forename: L
authors.initials: L
authors.lastname: Ackerson
authors.forename: P
authors.initials: P
authors.lastname: Larson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015709:Correspondence as Topic; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D065006:Papanicolaou Test; D011159:Population Surveillance; D014626:Vaginal Smears / Q000706:statistics & numerical data*