Breast cancer screening outreach effectiveness: Mammogram-specific reminders vs. comprehensive preventive services birthday letters

Abstract

We compared the effectiveness of two outreach strategies on timely mammography adherence: a mammogram-specific reminder letter (sent just before a woman was due) to a birthday letter (addresses multiple preventive services and not timed around due dates). We evaluated screening mammography adherence following 79,848 mammogram-specific and 151,626 birthday letters mailed between 2002–2012 to women aged 40–74 years enrolled in Kaiser Permanente Washington. Screening mammogram adherence was specifically tied to due-date and was evaluated separately by age group and up-to-date or overdue status at the time of mailing. We used generalized estimating equations to account for correlation between repeated observations, to model the odds of screening mammography adherence by letter type. Among women up-to-date, adherence following birthday letters was 22–76% lower compared to the mammogram-specific reminders, with the greatest decreases in adherence in women aged 70–74. Birthday letters were more effective at activating screening uptake among some subgroups of overdue women aged 50–69 and most overdue women aged 70–74, but universally low adherence rates were observed in overdue women. Increasing number of recommended services for women aged 50–74 who were up-to-date resulted in 12–17% lower mammography adherence, but had no effect in women aged 40–49 or in overdue women. Birthday letters are less effective than mammogram-specific reminder letters at prompting women to undergo timely breast cancer screening, particularly among women up-to-date with screening. Birthday letters may be effective at increasing overall preventive care; however, supplemental outreach may be needed around the due date to increase timely preventive services receipt.

Behavioral interventions to improve population health outreach for hepatitis C screening: randomized clinical trial

“…However, screening rates in this group remain low and variable across practices,91011 possibly because many patients do not routinely see their primary care clinician, and there could be competing priorities at appointments. Screening might be increased by complementing efforts in clinic with direct outreach to patients’ homes, which has been incorporated into other population health initiatives 121314. Electronic patient portals that allow patients to send and receive messages securely have proliferated across health systems as a low cost alternative to mailed letters for outreach.…”

“…Screening might be increased by complementing efforts in clinic with direct outreach to patients' homes, which has been incorporated into other population health initiatives. [12][13][14] Electronic patient portals that allow patients to send and receive messages securely have proliferated across health systems as a low cost alternative to mailed letters for outreach.…”

Closing the Gap: A Comparison of Engagement Interventions to Achieve Equitable Breast Cancer Screening in Rural Illinois

“… 16 , 17 Reminders among those not yet scheduled but due or overdue for a mammogram have also been found useful in studies using modalities such as mailed letters, automated telephone calls, and manual phone calls, especially if individualized and relevant to the patient's specific needs. 18 , 19 …”

Improving the promise of embedded pragmatic trials: Surmountable barriers encountered in an evaluation of home-based HPV self-sampling to increase cervical cancer screening in overdue women

“…We wanted to mailing kits when women were reminded they were overdue. However, KPWA provides annual preventive services outreach around a woman's birthday noting all upcoming recommended preventive services and their due dates; this outreach is effective in activating overdue women [25,26]. To ensure we did not interfere with this overdue reminder, we negotiated to wait 5 months following the birthday letter before mailing kits.…”