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Showing content from https://pubmed.ncbi.nlm.nih.gov/26820221/ below:

Comparative effectiveness of two outreach strategies for cervical cancer screening

doi: 10.1016/j.ypmed.2016.01.016. Epub 2016 Jan 25. Comparative effectiveness of two outreach strategies for cervical cancer screening

Affiliations

¹ Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA. Electronic address: Bowles.e@ghc.org.
² Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
³ Department of Clinical Improvement and Prevention, Group Health Cooperative, 201 16th Ave E, Seattle, WA 98112, USA.

PMID: 26820221
PMCID: PMC4902104
DOI: 10.1016/j.ypmed.2016.01.016

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Comparative effectiveness of two outreach strategies for cervical cancer screening

Erin J Aiello Bowles et al. Prev Med. 2016 May.

doi: 10.1016/j.ypmed.2016.01.016. Epub 2016 Jan 25. Affiliations

¹ Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA. Electronic address: Bowles.e@ghc.org.
² Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
³ Department of Clinical Improvement and Prevention, Group Health Cooperative, 201 16th Ave E, Seattle, WA 98112, USA.

PMID: 26820221
PMCID: PMC4902104
DOI: 10.1016/j.ypmed.2016.01.016

Item in Clipboard

Abstract

Objective: Test-specific reminder letters can improve cancer screening adherence. Little is known about the effectiveness of a reminder system that targets the whole person by including multiple screening recommendations per letter.

Methods: We compared the effectiveness of a Pap-specific reminder letter sent 27months after a woman's last Pap, to a reminder letter that included up to seven preventive service recommendations sent before a woman's birthday ("birthday letter") on Pap smear adherence from a natural experiment occurring in routine clinical care. Participants included 82,016 women from Washington State who received 72,615 Pap-specific letters between 2003 and 2007 and 100,218 birthday letters between 2009 and 2012. We defined adherence as having a Pap test within a six month window around the Pap test due date. Using logistic regression, we calculated adjusted odds ratios (OR) for adherence with 95% confidence intervals (CI) following the birthday letter with 1-2 recommendations, 3-5 recommendations, and 6-7 recommendations compared to the Pap-specific letter. All analyses were stratified by whether a woman was up-to-date or overdue for screening at the time she received a letter.

Results: Adjusted ORs showed reduced adherence following the birthday letter compared with the Pap-specific letter for up-to-date women whether the letter had 1-2 recommendations (OR=0.37, 95%CI=0.36-0.39), 3-5 recommendations (OR=0.44, 95%CI=0.42-0.45), or 6-7 recommendations (OR=0.36, 95%CI=0.32-0.40). We noted no difference in Pap-test adherence between letter types for overdue women.

Conclusions: In conclusion, for women regularly adherent to screening, an annual birthday letter containing reminders for multiple preventive services was less effective at promoting cervical cancer screening compared with a Pap-specific letter.

Keywords: Adherence; Cervical cancer; Outreach; Preventive care; Reminder letters; Screening programs.

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Conflict of interest statement

The authors declare that there are no conflicts of interest

Figures
Figure 1. CONSORT diagram of women (and…

Figure 1. CONSORT diagram of women (and letters) included in the study after each exclusion…
Figure 1. CONSORT diagram of women (and letters) included in the study after each exclusion criterion was applied

Figure 1 is a CONSORT-like diagram showing the number of women (and letters in parenthesis) in the initial sample and remaining after each exclusion criterion was applied. At the bottom of the figure are the final sample sizes of women (and letters) included by letter type and whether women were up-to-date or overdue for screening.

Figure 2. Adherence definitions for screening based…

Figure 2. Adherence definitions for screening based on timing of reminder letter and whether women…
Figure 2. Adherence definitions for screening based on timing of reminder letter and whether women were overdue for a Pap test

Figure 2 depicts the definitions we used for cervical cancer screening adherence by the timing of the reminder letter and by whether women were up-to-date with screening or overdue for a Pap test from 2003–2012 in Washington State. Each inset figure (a-c) shows that each group had a 6-month window around the test due date to be adherent.

Figure 3. Percent of women who received…

Figure 3. Percent of women who received a Pap test within 36 months after receiving…
Figure 3. Percent of women who received a Pap test within 36 months after receiving their birthday letter, according to their due dates

Figure 3 applies to birthday letters only. It depicts the percent of women who received a Pap test within 3 years after receiving their birthday letter over time from 2009–2012 in Washington State. Each line represents a different group depending on when women were due. The first blue line represents women who were due now (within 1 month of receiving the letter) and shows the percent of women who received a subsequent Pap test peaked a 1 month and trailed off thereafter. The numbers in parentheses in the legend show that 21.1% of women who were “due now” did not have a Pap test within 36 months of receiving their letter. The red line represents women who were due between 1–6 months after receiving their letter, and the percent of women who came in after receiving their letter peaked at 2 months. Percents declined thereafter but women due 1–6 months after receiving their letter had Pap tests throughout the 36 months depicted in the figure. The green line shows that women due within 7–12 months after receiving their letter peaked at 13 months – but many came in for a Pap test before and after that time. The pink line represents the percent of women overdue for a Pap test at the time they received their letter. The percent of overdue women who received a Pap test peaked at 1 month following the letter and sharply declined thereafter with 53.7% of these women not receiving a Pap test within 36 months.