Web tool bolsters mammography screening rates

A new web-based system that automatically reminds women to schedule a mammogram could boost mammography screening rates, according to a study by Mayo Clinic researchers published in the Archives of Internal Medicine. The system may have implications for the design of improved care delivery systems.

The American Cancer Society's annual report Cancer Prevention and Early Detection Facts and Figures 2007, published in April, notes that mammography is not reaching as many women as it should. The new system devised by researchers in Rochester, MN, could turn the tide, according to senior investigator Dr. Robert Stroebel, chair of primary care internal medicine at Mayo.

"We were pleasantly surprised at how much we could increase mammography percentages through this new system. As we get more women screened, we are also going to find cancers earlier, when we are more likely to be able to treat them successfully," Stroebel said.

The Preventive Care Reminder System (PRECARES) uses a web-based mail and phone reminder software to help medical secretaries schedule and manage breast cancer screening appointments. The investigators enrolled 6665 women and randomized 3326 of them to get mailings and sometimes a phone call reminding them to schedule a mammogram using PRECARES. The other 3339 women were assigned to a control group that did not receive such reminders (Arch Intern Med 2007;167:606-611).

The investigators found that more than 64% of the PRECARES group had their yearly mammogram, compared with 55.3% in the control group (p<0.001). The program was expanded after the study period and has reached more than 72% annual screening compliance. About 86% of Mayo patients have had one mammogram in the last two years.

Typically, women have to remember it's time for their annual mammography exam, call their physician's secretary, get approval, then wait until to hear back from the physician's office to schedule the exam. That process is inefficient and expensive, and it tends to leave women without a test, said principal investigator Rajeev Chaudhry, MBBS.

Redesign of the primary care practice to enable appointment secretaries to schedule preventive services was key to PRECARES success, according to Chaudhry. The policy change and the new electronic tool allow secretaries to schedule mammography for over 10,000 women.

Patients are already approved by the time they get the reminder letter. They can thus schedule the test with the first phone call with no need to consult a doctor, Chaudhry said.

The ACS report states that the decline in cancer death rates could lose all momentum unless key interventions are made available to all segments of the population. Although existing guidelines say women age 40 and older should undergo annual mammography screening, only about 65% of women across the country have had one exam in the last two years, Chaudhry said.

"In this study, we showed we can increase that percentage through a team approach, and we are applying the findings to other chronic disease and preventive services, too," he said.

The U.S. population is living longer and having more chronic diseases. Primary care physicians may have to spend several hours daily just to manage preventive care services and diagnostic tests. Information technology and a team approach can free up physicians to focus on patients, Chaudhry said.

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