The effect of adding Pap smear information to a mammography reminder system in an HMO: results of randomized controlled trial
The effect of adding Pap smear information to a mammography reminder system in an HMO: results of randomized controlled trial
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DOI：
10.1016/s0091-7435(02)00062-2
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发表时间：
2003-05-01
影响因子：
5.1
通讯作者：
Dews, P
中科院分区：
文献类型：
--
作者：
Burack, RC;Gimotty, PA;Dews, P
背景虽然提醒可以促进初级保健中的癌症筛查，但对多个提醒者之间的潜在相互作用知之甚少。我们进行了一项随机对照试验，在2471名40岁或以上的妇女中比较巴氏涂片加乳房X光检查提醒和仅乳房X光检查提醒的效果，这些妇女参加了一个健康维护组织，为主要符合医疗补助条件的人群提供服务。提醒包括一封寄给这位妇女的信和一份医疗记录。干预分配与研究年期间家庭医学或内科就诊率或乳房X光检查完成率的差异无关。与只接受乳房X光检查提醒治疗的妇女相比，接受巴氏涂片检查加乳房X光检查提醒干预的妇女更有可能去看妇科医生（34%对29%，调整后的比值比= 1.33，95%置信区间1.08-1.63）和完成巴氏涂片检查（30%对23%，调整后比值比1.39，95%可信区间1.07-1.89）。在研究环境中，将巴氏涂片添加到乳房X光检查提醒中具有程序特异性效果，增加妇科就诊和巴氏涂片使用，而不会增加或减少其他初级保健就诊或乳房X光检查。我们没有发现这些提醒之间的强化或竞争的证据。(C)2003年美国健康基金会和爱思唯尔科学（美国）。All rights reserved.
Background. While reminders can promote cancer screening in primary care, little is known about the potential interaction between multiple reminders.Methods. We conducted a randomized controlled trial to compare the effect of combined Pap smear plus mammogram reminders and mammogram-only reminders among 2471 women 40 years of age or older enrolled in a health maintenance organization serving a predominately Medicaid-eligible population. Reminders included both a mailed letter for the woman and a medical record prompt.Results. Intervention assignment was unassociated with differences in rates of visitation to family medicine or internal medicine or completion of mammography during the study year. Compared to women assigned to mammogram-only reminder treatment, those assigned to the combined Pap smear plus mammogram reminder intervention were more likely to visit a gynecologist (34% compared to 29%, adjusted odds ratio = 1.33, 95% confidence interval 1.08-1.63) and to complete a Pap smear (30% compared to 23%, adjusted odds ratio 1.39, 95% confidence interval 1.07-1.89).Conclusions. In the study setting, the addition of Pap smear to mammography reminders has a procedure-specific effect, increasing gynecology visits and Pap smear use while neither increasing nor decreasing other primary care visits or mammography. We find no evidence of reinforcement or competition between these reminders. (C) 2003 American Health Foundation and Elsevier Science (USA). All rights reserved.