title: The effect of adding Pap smear information to a mammography reminder system in an HMO: results of randomized controlled trial.
abstract: BACKGROUND
  While reminders can promote cancer screening in primary care, little is known about the potential interaction between multiple reminders.
  
  
  METHODS
  We conducted a randomized controlled trial to compare the effect of combined Pap smear plus mammogram reminders and mammogram-only reminders among 2471 women 40 years of age or older enrolled in a health maintenance organization serving a predominantly Medicaid-eligible population. Reminders included both a mailed letter for the woman and a medical record prompt.
  
  
  RESULTS
  Intervention assignment was unassociated with differences in rates of visitation to family medicine or internal medicine or completion of mammography during the study year. Compared to women assigned to mammogram-only reminder treatment, those assigned to the combined Pap smear plus mammogram reminder intervention were more likely to visit a gynecologist (34% compared to 29%, adjusted odds ratio = 1.33, 95% confidence interval 1.08-1.63) and to complete a Pap smear (30% compared to 23%, adjusted odds ratio = 1.39, 95% confidence interval 1.07-1.89).
  
  
  CONCLUSIONS
  In the study setting, the addition of Pap smear to mammography reminders has a procedure-specific effect, increasing gynecology visits and Pap smear use while neither increasing nor decreasing other primary care visits or mammography. We find no evidence of reinforcement or competition between these reminders.
authors.affiliation: Department of Internal Medicine, University Health Center 5C, 4201 St. Antoine, Detroit, MI 48201, USA. rburack@intmed.wayne.edu
authors.forename: Robert C
authors.initials: RC
authors.lastname: Burack
authors.forename: Phyllis A
authors.initials: PA
authors.lastname: Gimotty
authors.forename: Michael
authors.initials: M
authors.lastname: Simon
authors.forename: Anita
authors.initials: A
authors.lastname: Moncrease
authors.forename: Peter
authors.initials: P
authors.lastname: Dews
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008327:Mammography / Q000706:statistics & numerical data*; D008484:Medicaid; D006278:Medicare; D008824:Michigan; D008875:Middle Aged; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D011203:Poverty / Q000208:ethnology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D017010:Reminder Systems; D014626:Vaginal Smears / Q000706:statistics & numerical data*