邮件和电子提醒可能会增加结肠癌筛查

根据2月23日出版的《癌症杂志》上的一篇报道，给病人邮寄提示似乎可以促进结肠癌筛查内科档案， 其中一个JAMA /档案期刊。此外，对医生的电子提醒似乎增加了更频繁的初级保健访问的患者中的筛查。

“结直肠癌是美国癌症死亡率[死亡]的继发性原因，”根据文章的背景信息。“筛选涉及粪便隐血血液检测的程序，柔软的血管镜检查和结肠镜检查通过去除癌前腺瘤来降低结直肠癌的发生率，在更可固化的早期阶段检测癌症并降低结肠直肠癌死亡率。”虽然国家指南表明，应筛查平均风险的成年人的成年人应筛查结直肠癌，只有60％的报告最新的测试。

Thomas D. Sequist, M.D., M.P.H., of Brigham and Women's Hospital, Harvard Vanguard Medical Associates and Harvard Medical School, Boston, and colleagues studied screening rates and colorectal adenoma (tumor) detection for 21,860 patients (age 50 to 80) of 110 physicians from April 2006 to June 2007. Fifty-five physicians were randomly assigned to receive electronic reminders during office visits with patients overdue for screening. Additionally, 10,930 patients were randomly assigned to receive mailings containing an educational pamphlet, a fecal occult blood test kit and instructions for direct scheduling of flexible sigmoidoscopy or colonoscopy. Screening rates and detection of colorectal adenomas (tumors) were noted 15 months after the start of the intervention.

收到邮件的患者的筛查率高于没有收到邮件的患者(44% vs. 38.1%)。这些邮件在老年患者中更有效——50 - 59岁患者的筛查率增加了3.7%，60 - 69岁患者的筛查率增加了7.3%，70 - 80岁患者的筛查率增加了10.1%。接受电子提醒的医生的患者筛查率与未接受提醒的医生的患者筛查率相似(41.9% vs. 40.2%)，而接受三次或以上初级保健就诊的患者中，电子提醒倾向于增加筛查率(59.5% vs. 52.7%)。

“腺瘤的检出倾向于随着病人邮件(5.7% vs. 5.2%)和医生提醒(6% vs. 4.9%)的增加而增加，”作者写道，但这些增加在统计学上并不显著。

更多信息：Arch Intern Med。2009; 169 [4]：364-371。

资料来源：Jama和Archives期刊

---

---