Role of educational materials in increasing cervical cancer screening adherence rates – Evidence from randomized controlled trial in NYS insured women

Objective: The compliance with recommended cervical cancer screening rates, as described in Healthy People 2010, is far below acceptable levels. The objective of this study is to evaluate the impact of member reminders and educational mailings as well as physician reminders on cervical cancer screening test rates in the non-compliant population. Methods: The study was designed as a randomized controlled trial. The non-compliant population was randomly assigned to three intervention groups and one control group. Group A1 included a physician intervention only – physicians received a list of their non-compliant patients. Group A2 included both a physician and a member intervention – the physicians received a list of their non-compliant patients and the members received a letter and an educational brochure. Group B1 included a member intervention only – a letter and an educational brochure. Group B2 was used as the control group. A two-phase randomization was used. First, physicians were randomized into 8 different groups. Then, patients within each physician's practice were randomized based on their characteristics. The study used Health Plan Employer Data and Information Set (HEDIS) specifications to define cervical cancer screening. Screening rates for a four-month period were used to compare the four groups. The intervention started on 11/15/2005 with a follow-up period through 03/31/2006. Population: The study included all women who did not have at least one cervical cancer screening test within the last three years enrolled in BCBS plan (commercial HMO and Medicaid) in the Central New York region. The sample size was 2,307 non-compliant women. Results: The findings from this study suggest that (1) sending educational materials to non-compliant members or (2) sending physicians a list of their non-compliant patients or (3) doing both do not lead to better results than doing nothing to improve cervical cancer screening rates. The difference among the four groups was less than 1.5% in compliance rate, which does not reach statistical significance. These results are true only for the non-compliant patient population. Implications: Since many Health Maintenance Organizations invest significant dollars and effort in educational interventions, it is important to understand the impact and significance of such interventions, especially in the non-compliant population. This study suggests that sending educational information and reminders to members as well as sending reminders to their physicians do not change member compliance rates. Different approaches need to be considered to make a significant impact on the compliance rates for cervical cancer screening tests.