Patient Barriers to Mammography Identified During a Reminder Program.

Area of Science:

• Public Health
• Preventive Medicine
• Health Services Research

Background:

• Mammogram reminders are proven effective for increasing screening rates.
• However, patient-specific barriers continue to impede mammogram completion.
• Understanding these barriers is crucial for optimizing screening interventions.

Purpose of the Study:

• To evaluate patient characteristics and reported barriers associated with mammogram completion following a reminder intervention.
• To identify demographic and socioeconomic factors influencing mammogram adherence.
• To explore the role of specific barriers, such as pain and perceived busyness, in mammogram completion.

Main Methods:

• Retrospective cohort study utilizing electronic health records and subgroup survey data.
• Inclusion of female Kaiser Permanente Northwest health maintenance organization (HMO) members aged 50-69, 20 months post-mammogram.
• Intervention involved a postcard reminder, automated calls, and live calls; outcome was mammogram completion within 10 months.

Main Results:

• Lower mammogram completion rates were associated with younger age (<60), shorter health plan membership (<5 years), lower family income (<$40,000/year), and obesity.
• Obese women reported higher rates of "too much pain" during mammograms.
• Younger women were more likely to report being "too busy" and expressed greater worries about mammogram accuracy.

Conclusions:

• Significant barriers to mammogram completion persist despite effective reminder systems in insured populations.
• Pain associated with mammography appears to mediate the relationship between obesity and lower completion rates.
• Tailored interventions addressing specific patient barriers are essential to improve mammogram screening adherence.