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 attention seems to be aimed at equipping patients to improve their 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 did not. 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, electronic reminders to physicians during office visits indicating that these same patients were due for screenings yielded no significant increase.
“We had a large group of people who needed to be screened for a very important condition. If we provided them with basic information about colon cancer and their need for screening, this approach was more effective than simply leaving it all up to the doctor,” said John Ayanian, HMS professor of health care policy and HMS professor of medicine at Brigham and Women’s Hospital. The findings appear in the Feb. 23 Archives of Internal Medicine.
For the study, Ayanian, who is also a professor in the Department of Health Policy and Management at HSPH, and Thomas Sequist, an HMS assistant professor of health care policy and an HMS assistant professor of medicine at Brigham and Women’s Hospital, looked at a group of patients aged 50 to 80. Using data generated by an electronic health record, the researchers were able to isolate a large group of patients who were overdue for colorectal cancer screening.
One group of patients was randomly chosen to receive in the mail a personalized letter and 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. Not only did 44 percent of the first group get screened, but the effect increased with age: the older, the more compliant. In fact, among 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.
“Getting something in the mail might seem low tech, but it was only possible because in these health centers electronic medical records already existed,” said Sequist. “People speak of primary care being in crisis and that there’s too much for physicians to get done in a regular workday. But here we see that patients can take a more active role in their health care.”
Students may contact either John Ayanian at ayanian@hcp.med.harvard.edu or Thomas Sequist at tsequist@partners.org for more information.
Conflict Disclosure: The authors report no conflicts of interest.
Funding Sources: The National Cancer Institute
