RT Journal Article
SR Electronic
T1 Improving Breast and Colon Cancer Screening Rates: A Comparison of Letters, Automated Phone Calls, or Both
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 46
OP 54
DO 10.3122/jabfm.2015.01.140174
VO 28
IS 1
A1 Lindsay Phillips
A1 Samantha Hendren
A1 Sharon Humiston
A1 Paul Winters
A1 Kevin Fiscella
YR 2015
UL http://www.jabfm.org/content/28/1/46.abstract
AB Purpose: Low-cost interventions to improve cancer screening among primary care patients are needed. The comparative effectiveness of personalized letters, automated telephone calls, and both on breast cancer (BC) and colorectal cancer (CRC) screening is not known.Methods: A pragmatic, randomized, controlled trial was conducted in 2011 to 2012. Eligible primary care patients were women ages 50 to 74 years who were past due for mammography and men or women who were past due for mammography or CRC screening of any kind (>12 months since last fecal occult blood test, >5 years since last sigmoidoscopy/double-contrast barium enema, or >10 years since last colonoscopy), respectively. Participants were randomized to 1 of 3 interventions: personalized mailed letters, automated telephone calls, or both. The primary outcome was medical record documentation of a completed mammogram or CRC screening within 36 weeks of randomization. We estimated the costs of each intervention and calculated the marginal cost-effectiveness per person screened.Results: The crude screening rates for BC were 19%, 22%, and 37% and for CRC were 17%, 14%, and 24% for the letter, automated call, and combined (letter/automated call) groups, respectively. The combined intervention group had a statistically higher screening rate (P < .05) compared with either of the single intervention groups (letter only or automated call) for both BC and CRC in both the crude and adjusted analyses. The combined intervention costs $5.11 per additional person screened for BC and $13.14 per additional person screened for CRC.Conclusion: In a primary care practice, letters plus automated telephone calls are better than either alone in increasing cancer screening rates among patients who are overdue for screening. These findings suggest the promise of a relatively inexpensive intervention to improve cancer screening.