Promoting mammography: results of a randomized trial of telephone counseling and a medical practice intervention

Mary E. Costanza, University of Massachusetts Medical School
Anne M. Stoddard
Roger Luckmann, University of Massachusetts Medical School
Mary Jo White, University of Massachusetts Medical School
Jill S. Avrunin
Lynn Clemow

Abstract

BACKGROUND: Despite widespread promotion of mammography screening, a distinct minority of women have remained underusers of this effective preventive measure. We sought to measure the effects of barrier-specific telephone counseling (BSTC) and a physician-based educational intervention (MD-ED) on mammography utilization among underusers of mammography screening.

DESIGN: This was a randomized controlled trial. Women meeting criteria for mammography underuse at baseline (grouped by practice affiliation) were randomized to a reminder control condition (RC group received annual mailed reminders), BSTC or MD-ED interventions and followed for 3 years. Underuse was defined by failure to get two annual or biannual mammograms over a 2- to 4-year period prior to a baseline survey.

PARTICIPANTS AND SETTING: The study included 1655 female underusers of mammography aged 50-80 years who were members of two health maintenance organizations (HMO) in central Massachusetts.

INTERVENTIONS: BSTC consisted of periodic brief, scripted calls from trained counselors to women who had not had a mammogram in the preceding 15 months. Women could receive up to three annual calls during the study. MD-ED consisted of physician and office staff trainings aimed at improving counseling skills and office reminder systems.

MAIN OUTCOME MEASURE: Self-report of mammography use during the study period was the main outcome measure. Regular use was defined as > or =1 mammogram every 24 months.

RESULTS: Forty-four percent in each intervention group became regular users compared to 42% in the RC group. Among subjects who had prior but not recent mammograms at baseline, BSTC was effective (OR=1.48; 95% CI=1.04; 2. 10), and MD-ED marginally effective (OR=1.28; 95% CI=0.88, 1.85). Most recent users at baseline and few never users became regular users (61% and 17%, respectively) regardless of intervention status.

CONCLUSIONS: Among mammography underusers BSTC modestly increases utilization for former users at a reasonable cost ($726 per additional regular user).