Promoting mammography: results of a randomized trial of telephone counseling and a medical practice intervention.
BACKGROUND
Despite widespread promotion of mammography screening, a distinct minority of women have remained underusers of this effective preventive measure. We sought to measure the effects of barrier-specific telephone counseling (BSTC) and a physician-based educational intervention (MD-ED) on mammography utilization among underusers of mammography screening.


METHODS
This was a randomized controlled trial. Women meeting criteria for mammography underuse at baseline (grouped by practice affiliation) were randomized to a reminder control condition (RC group received annual mailed reminders), BSTC or MD-ED interventions and followed for 3 years. Underuse was defined by failure to get two annual or biannual mammograms over a 2- to 4-year period prior to a baseline survey.


METHODS
The study included 1655 female underusers of mammography aged 50-80 years who were members of two health maintenance organizations (HMO) in central Massachusetts.


METHODS
BSTC consisted of periodic brief, scripted calls from trained counselors to women who had not had a mammogram in the preceding 15 months. Women could receive up to three annual calls during the study. MD-ED consisted of physician and office staff trainings aimed at improving counseling skills and office reminder systems.


METHODS
Self-report of mammography use during the study period was the main outcome measure. Regular use was defined as > or =1 mammogram every 24 months.


RESULTS
Forty-four percent in each intervention group became regular users compared to 42% in the RC group. Among subjects who had prior but not recent mammograms at baseline, BSTC was effective (OR=1.48; 95% CI=1.04; 2. 10), and MD-ED marginally effective (OR=1.28; 95% CI=0.88, 1.85). Most recent users at baseline and few never users became regular users (61% and 17%, respectively) regardless of intervention status.


CONCLUSIONS
Among mammography underusers BSTC modestly increases utilization for former users at a reasonable cost ($726 per additional regular user).
Costanza
M E
ME
University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA. Mary.Costanza@umassmed.edu
Stoddard
A M
AM
Luckmann
R
R
White
M J
MJ
Spitz Avrunin
J
J
Clemow
L
L
D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003376:Counseling; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data*; D008404:Massachusetts; D008875:Middle Aged; D013689:Telephone