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Mammogram rates may improve with web-based reminder system
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An administrative database that helps appointment secretaries remind women to have mammograms increased the breast cancer screening rate at one large group practice, according to a report in the March 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

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The U.S. Preventive Services Task Force recommends that women age 40 and older have a screening mammogram every one to two years, according to background information in the article. However, a large number of women do not undergo this cancer-detecting test. “A recent study reported that only 47 percent of eligible Medicare patients underwent screening mammography in the preceding two years, and other studies have reported similar poor performance for this preventive service,” the authors write.

Rajeev Chaudhry, M.B.B.S., M.P.H, and colleagues at the Mayo Clinic, Rochester, Minn., implemented a Web-based system known as PREventive Care REminder System (PRECARES) to help appointment secretaries manage proactive breast cancer screening for their group practice. Using this system, the secretaries retrieve a list each month of patients due to undergo mammography in the next three months. Women who have not already made appointments are sent letters asking them to call and schedule mammograms. Those who do not call receive another letter one month later, and then a phone call after an additional month.

For the study, conducted between Oct. 1, 2003, and Oct. 31, 2004, 3,326 women were assigned to the intervention group (using the PRECARES program) and 3,339 received normal care, which did not involve any regular reminder system. A subgroup of 399 women employees of the Mayo Clinic were selected to receive the intervention group reminders via e-mail and were compared with 448 women employees who received reminders via U.S. mail.

The mammography rate was 64.3 percent among women assigned to the intervention group, compared with 55.3 percent in the control group. “For the employee subgroup, the screening rate was 57.5 percent for the control group, 68.1 percent for the U.S. mail group and 72.2 percent for the e-mail group,” although the difference between the mail and e-mail groups was not statistically significant, the authors write. Rates for other adult preventive screening services did not vary between the intervention and control groups.

“In 2005, after our study was completed, we implemented the proactive system of scheduling for mammography in our entire patient population, which includes 11,119 women between the ages of 40 and 75 years,” the authors write. “The current mammography rate for this population has increased further to 71 percent.”

Such a system could be effective for other screening procedures as well, they conclude. “Many preventive screening services can be delivered without involvement of physicians or physician visits, and office staff can manage the preventive service needs of patients, which should also decrease the costs incurred by practices, patients and insurers.”
(Arch Intern Med. 2007;167:606-611. Available to the media pre-embargo at

Editor's Note: This study was funded by the Mayo Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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