Regular testing is important for early detection of new disease and for identification of changes in existing disease status. Yet many people fail to get tested at recommended frequency for treatable conditions such as diabetes, heart disease and cancer. Two recent studies demonstrate that systems of phone and mail reminders can significantly increase the proportion of patients getting recommended tests.

A multicenter study of 5640 diabetic patients in 13 different health plans showed that a telephone call to remind them to schedule tests improved participation significantly. The patients had all been non-adherent, meaning that they had not had recommended testing, such as A1c or LDL-cholesterol, during the past year. The Americian Diabetes Association recommends that A1c, a reflection of glucose control, be done at least twice a year and as many as four times per year depending on the patient’s history of glucose control. They also recommend regular cholesterol testing, since diabetics are at increased risk for cardiovascular complications.

The diabetic patients were divided into groups, to be either contacted with a reminder call about testing or not. All diabetic patients in the study continued to be sent regular mailings about diabetes care. The researchers found a 30% improvement in A1c testing and an 11% improvement in cholesterol testing in those patients who received telephone reminders.

Another group of investigators - at Mayo Clinic - developed an automated system called PRECARES (PREventive CAre REminder System) to provide reminders to women before an annual mammogram was due. Mammography is an effective method for early detection of breast cancer. It is credited with as much as a 32% decrease in mortality from a disease that claims the lives of over 40,000 women annually. Yet the screening rates for mammography are suboptimal, with as few as half of eligible women getting this important test.

The reminder system, which is managed by the existing appointment scheduling staff, represents a practice redesign to proactively manage breast cancer screening.

These studies are excellent examples of ways that medical practice can play a role in encouraging people to complete routine screening and monitoring tests to assure early detection and treatment (See Screening articles by age in the pull-down menu above).

A patient-initiated reminder system is available from the College of American Pathologists (CAP), an organization of laboratory physicians. The CAP system provides a free email reminder service for the following screening tests: cholesterol, colon cancer screening, fasting glucose (for diabetes), mammogram (for breast cancer), and Pap smear (for cervical cancer). If you are interested in having regular email reminders for these tests, visit http://www.myhealthtestreminder.com/ for more information.

Sources

S1
Coberley, C. et al. Impact of Telephonic Interventions on Glycosylated Hemoglobin and Low-density Lipoprotein Cholesterol Testing. Am J Manag Care. 2007;13:188-192.

S2
Chaudhry, R. et al. Web-Based Proactive System to Improve Breast Cancer Screening: A Randomized Controlled Trial. Arch Intern Med. 2007;167:606-611.

S3
American Diabetes Association Position Paper. Diabetes Care. 28:S4-S36, 2005.