Abstract
OBJECTIVE: To perform a meta-analysis on existing randomized controlled trials to investigate the efficacy of patient letter reminders on increasing cervical cancer screening using Pap smears.
METHODS: A search was conducted for all relevant published and unpublished studies between the years 1966 and 2000. Eligibility criteria included randomized controlled studies that examined populations due for Pap smear screening. The intervention studied was in the form of a reminder letter. The Mantel-Haenszel method was used to measure the summary effect of the intervention. A test for homogeneity using the Mantel-Haenszel method was performed.
RESULTS: Ten articles fulfilled the inclusion criteria, including one unpublished study. The test for homogeneity showed evidence of heterogeneity (x2=31, 9 df, P<.001). An analysis for causes of heterogeneity was pursued. Division into subpopulations based on socioeconomic status resolved the heterogeneity (x2=5.2, 8 df, P=.75). The studies evaluating those in lower socioeconomic groups had a smaller response (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.99 to 1.35) than those studies using mixed populations (OR, 2.02; 95% CI, 1.79 to 2.28). The pooled odds ratio showed that patients who received the intervention were significantly more likely to return for screening than those who did not (OR, 1.64; 95% CI, 1.49 to 1.80).
CONCLUSIONS: Patient reminders in the form of mailed letters increase the rate of cervical cancer screening. Patient letter reminders have less efficacy in lower socioeconomic groups.
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References
U.S. Preventive Services Task Force. Guide to Clinical Preventive Services: Report of the US Preventive Services Task Force. Baltimore, Md: Williams and Wilkins; 1996.
Trends in cancer screening—United States, 1987 and 1992. Morb Mortal Wkly Rep. 1995;45:57–61.
Anderson L, May D. Has the use of cervical, breast and colorectal cancer screening increased in the United States? Am J Public Health. 1995;85:840–2.
Pirkis JE, Jolley D, Dunt DR. Recruitment of women by GPs for Pap tests: a meta-analysis. Br J Gen Pract. 1998;48:1603–7.
Wagner TH. The effectiveness of mailed patient reminders on mammography screening: a meta-analysis. Am J Prev Med. 1998;14:64–70.
Shea S, DuMouchel W, Bahamonde L. A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. JAMIA. 1996;3:399–409.
Garr D, Ornstein S, Jenkins R, Zenk L. The effect of routine use of computer-generated preventive reminders in a clinical practice. Am J Prev Med. 1993;9:55–61.
Becker D, Gomez E, Kaiser D, Yoshihasi A, Hodge R. Improving preventive care at a medical clinic: how can the patient help? Am J Prev Med. 1989;5:353–9.
Lantz P, Stencil D, Lippert M, Beversdorf S, Jaros L, Remington P. Breast and cervical cancer screening in a low-income managed care sample: the efficacy of physician letters and phone calls. Am J Public Health. 1995;85:834–6.
Clementz G, Aldag J, Gladfelter T, Barclay A, Brooks H. A randomized study of cancer screening in a family practice setting using a recall model. J Fam Pract. 1990;30:537–41.
Ornstein S, Garr D, Jenkins R, Rust P, Arnon A. Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services. J Fam Pract. 1991;32:82–90.
Torres-Mejía G, Salmerón-Castro J, Téllez-Rojo MM, et al. Call and recall for cervical cancer screening in a developing country: a randomized controlled field trial. Int J Cancer. 2000;87:869–73.
Buehler S, Parsons W. Effectiveness of a call/recall system in improving compliance with cervical cancer screening: a randomized controlled trial. Can Med Assoc J. 1997;157:521–6.
Bowman J, Sanson-Fisher R, Boyle C, Pope S, Redman S. A randomized controlled trial of strategies to prompt attendance for a Pap smear. J Med Screening. 1995;2:211–8.
Hogg W, Bass M, Calonge N, Crouch H, Satenstein G. Randomized controlled study of customized preventive medicine reminder letters in a community practice. Can Fam Physician. 1998;44:81–8.
Somkin C, Hiatt R, Hurley L, Gruskin E, Ackerson L, Larson P. The effect of patient and provider reminders on mammography and Papanicolaou smear screening in a large health maintenance organization. Arch Intern Med. 1997;157:1658–64.
Pritchard D, Straton J, Hyndman J. Cervical screening in general practice. Aust J Public Health. 1995;19:167–72.
McDowell I, Newell C, Rosser W. Computerized reminders to encourage cervical screening in family practice. J Fam Pract. 1989;28:420–4.
Pierce M, Lundy S, Palanisamy A, Winning S, King J. Prospective randomized controlled trial of methods of call and recall for cervical cytology screening. BMJ. 1989;299:160–2.
Burack R, Gimotty P, George J, et al. How reminders given to patients and physicians affected Pap smear use in a health maintenance organization. Results of a randomized controlled trial. Cancer. 1998;82:2391–400.
Petitti D. Meta-analysis, Decision Analysis and Cost-effectiveness Analysis. Methods for Quantitative Synthesis in Medicine. Monographs in Epidemiology and Biostatistics. New York, NY: Oxford University Press; 1994.
Lacey L. Cancer prevention and early detection strategies for reaching underserved urban, low-income black women. Cancer. 1993;72:1078–83.
Renneker M. An inner city cancer prevention clinic. Design, methods and early results. Cancer. 1991;67:1802–7.
Ansell D, Lacey L, Whitman S, Chen E, Phillips C. A nursedelivered intervention to reduce barriers to breast and cervical cancer screening in Chicago inner city clinics. Public Health Rep. 1994;109:104–11.
Margolis K, Lurie N, McGovern PG, Tyrrell M, Slater JS. Increasing breast and cervical cancer screening in low-income women. J Gen Intern Med. 1998;13:515–21.
Preisser J, Cohen S, Wofford J, et al. Physician and patient predictors of health maintenance visits. Arch Fam Med. 1998;7:346–51.
Binstock M, Geiger A, Hackett J, Yao J. Pap smear outreach: a randomized controlled trial in an HMO. Am J Rev Med. 1997;13:425–6.
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Tseng, D.S., Cox, E., Plane, M.B. et al. Efficacy of patient letter reminders on cervical cancer screening. J GEN INTERN MED 16, 563–568 (2001). https://doi.org/10.1046/j.1525-1497.2001.016008567.x
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DOI: https://doi.org/10.1046/j.1525-1497.2001.016008567.x