Screening rarely screened women: time-to-service and 24-month outcomes of tailored interventions

Background Managed care organizations and others reaching out to underscreened women seek strategies to encourage mammogram and Pap screening. Methods Female HMO members aged 50–69 years and overdue for a mammogram and a Pap test (n = 501) were followed for 24 months after interventions began. An Outreach intervention (tailored letters and motivational telephone interviews), an Inreach intervention (motivational interview delivered in clinics), and a Combined Inreach/Outreach intervention were compared to Usual Care at 24 months. Logistic regression and Cox hazard models examined predictors of obtaining screening services and time-to-service, respectively. Results Compared with Usual Care, the odds of Outreach women aged 50–64 obtaining a mammogram (OR = 2.06; 95% CI = 1.59–5.29), a Pap test (OR = 1.97; 95% CI = 1.12–3.53), or both (OR = 2.53; 95% CI = 1.40–4.63) remained significantly increased at 24 months. The average time-to-service for Outreach women was reduced by 4 months. Outreach effects persisted despite intensive, ongoing health plan efforts to improve screening of all women. Conclusions This brief, tailored outreach intervention was an effective strategy for encouraging cervical and breast cancer screening among women overdue for both screening services. It also shortened time-to-service, an important benefit for early detection and treatment. Alternative strategies are needed for women who remain unscreened.