Patients untapped resource for improving care

As the United States transitions to a new administration, and as the health care crisis mounts, the debate about how to buttress primary care delivery with information technology is getting louder. While much of the attention — and controversy — is focused on how to better equip physicians, little focus appears to be aimed at how to better equip patients to improve their health care.

A 15-month study looking at 21,860 patients and 110 primary care physicians from 11 Harvard Vanguard health centers found that patients who received mailed reminders that they were due for colorectal cancer screenings were more likely to schedule screenings than those who didn’t. Forty-four percent of patients who received a reminder in the mail got screened, versus 38 percent who did not — a 16 percent relative increase in screening rate. In an interesting twist to the findings, electronic reminders to physicians during office visits indicating that these same patients were due for screenings yielded no significant increase.

These findings are published in the Feb. 23 issue of Archives of Internal Medicine.

For this study, John Ayanian, Harvard Medical School professor of medicine and health care policy, and Thomas Sequist, assistant professor of medicine and of health care policy at Harvard Medical School and Brigham and Women’s Hospital, looked at a group of patients ages 50 to 80. Using data generated by an electronic health record, they were able to isolate a large group who were overdue for colorectal cancer screening.

One group of patients was randomly chosen to receive in the mail a personalized letter indicating their history of colon cancer screening exams, education literature on colon cancer, plus a fecal occult blood test kit and instructions for scheduling either a sigmoidoscopy or colonoscopy. The remaining patients received their usual care without this extra information. Not only did 44 percent of the first group get screened, but the effect increased with age; the older, the more compliant. In fact, for patients between 70 and 80 years old, screening rates increased from 37 percent to 47 percent among those who received mailed reminders to be screened — a 27 percent relative increase.

Some physicians were also chosen at random to receive electronic reminders during office visits indicating that their patients were overdue for screening. The fact that up to one-third of the patients did not visit their physician during this 15-month period may very well have contributed to the overall negligible results (42 percent versus 40 percent). Still, the effectiveness of such reminders increased with patients who visited their doctor three or more times during the study period. Among these patients with frequent visits, nearly 60 percent of those whose physicians received reminders were screened, compared with 52 percent of patients whose doctors did not receive reminders.