Enhancing the use of mammography: effectiveness and cost.

The Group Health Cooperative trial9 showed that telephone interventions were more effective than reminder cards in encouraging mammography among women older than 50 years of age. About 50% of women who received calls had mammography compared with about 35% of those who received the reminder card. As shown in Table 1, these results are consistent with those of other randomized trials involving telephone counseling. Like other studies,7, 8 the trial found the greatest benefit among lapsed users as opposed to never-users. With the increasing use of mammography, overcoming lapses among women who have had previous mammograms is likely to be the most common challenge. The Group Health trial is particularly noteworthy for investigating telephone strategies with and without a motivational component.9 Although research has shown brief telephone counseling to be effective, it is important to know whether the mechanism is the reminder function or some motivational aspect of the call, such as its potential to overcome a woman’s barriers.4 Since the difference between the two telephone strategies was not statistically significant, the reminder function appears to be primarily responsible for the overall phone effect. Research that examines the constituent parts of an intervention is essential and should be done more often. The fact that the reminder call required less than half the time of the motivational call and used less costly personnel obviously has important cost implications.