title: Effectiveness of four outreach modalities to patients overdue for cervical cancer screening in the primary care setting: a randomized trial.
abstract: Papanicolaou (Pap) testing has dramatically decreased cervical cancer incidence in the USA, but only 83 % of women screen according to guidelines. Our study aimed to examine the real-world effectiveness of various outreach methods in engaging patients who are overdue for cervical cancer screening.
  
  
  
  In total, 1,100 patients at an urban federally qualified health center overdue for Pap testing were randomized to receive usual care (control), letter outreach, email outreach, telephone outreach, or multimodal (letter/email/telephone) outreach over a period of 3 months. Eighteen months after randomization, medical records were used to determine whether and when each patient had obtained a Pap.
  
  
  
  Compared to patients receiving usual care, patients in the multimodal (36 vs. 21 %, AOR 2.3, 95 % CI 1.4, 3.6) and telephone (29 vs. 21 %, AOR 1.7, 95 % CI 1.1, 2.8) outreach groups were significantly more likely to receive cervical cancer screening during the follow-up period. Intervention effects were similar among older and younger patients. Telephone, multimodal, and letter outreach resulted in significantly lower median time to screening among patients who did screen (119, 122, and 157 days, respectively) in those groups as compared to the usual care group (270 days).
  
  
  
  This is the first study to perform a direct, randomized comparison of four distinct cervical cancer outreach intervention modalities with a control usual care group, ensuring comparability across intervention methods. In an urban primary care setting, a multimodal outreach strategy was most effective at increasing the proportion of overdue patients who undergo cervical screening and decreasing time to screening.
  
  
  
  ClinicalTrials.gov ;
  
  
  
  NCT02427399; https://clinicaltrials.gov/ct2/show/NCT02427399 .
authors.affiliation: The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215-4302, USA.|Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Peitzmeier
authors.affiliation: The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215-4302, USA.|University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.
authors.forename: K
authors.initials: K
authors.lastname: Khullar
authors.affiliation: The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215-4302, USA. jpotter@bidmc.harvard.edu.|Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA. jpotter@bidmc.harvard.edu.|Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. jpotter@bidmc.harvard.edu.
authors.forename: J
authors.initials: J
authors.lastname: Potter
mesh_terms: D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011320:Primary Health Care; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*
keywords: Cervical cancer; Intervention study; Patient outreach; Primary care