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Carol P. Somkin, PhD; Robert A. Hiatt, MD, PhD; Leo B. Hurley, MPH; Elisabeth Gruskin, MPH; Lynn Ackerson, PhD; Pamela Larson, MPH

Arch Intern Med. 1997;157(15):1658-1664.

Abstract
Background
We evaluated the effectiveness of 2 reminder interventions to increase the use of screening mammograms and Papanicolaou (Pap) smears among female members of a large health maintenance organization.

Methods
Seven thousand seventy-seven female health maintenance organization members (aged 50-74 years with no prior mammogram in the previous 30 months or aged 20-64 years with no prior Pap smear in the previous 36 months) were randomized to receive one of the following: a letter inviting them to make an appointment for a mammogram or a Pap smear; in addition to the letter, a reminder manually placed in the patient's medical chart alerting providers of that member's need for screening; or their usual care.

Results
Compared with women who did not receive the reminder letter, women who did receive the letter were more likely to obtain mammograms (16.0% vs 25.5%, respectively; P<.001) or Pap smears (9.1% vs 19.5%, respectively;^P<.001) in the 6 months following their entry into the study. Compared with women who received only the reminder letter, women who received a reminder letter and had a reminder placed in their medical chart were more likely to obtain mammograms (26.5% vs 30.9%, respectively;^P=.02) and marginally more likely to receive Pap smears (19.5% vs 22.8%, respectively; P=.04).

Conclusions
We recommend the use of patient reminder letters as a first step in a mammography or Pap smear screening outreach program. Further research is needed to evaluate a cost-effective provider reminder system and additional outreach strategies directed to women who do not use health care services.

Arch Intern Med. 1997;157:1658-1664

Author Affiliations
From the Division of Research (Drs Somkin, Hiatt, and Ackerson, Mr Hurley, and Ms Gruskin) and the Regional Department of Health Education (Ms Larson), Kaiser Permanente Medical Care Program, Northern California Region, Oakland.

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