"We now know that HMOs not only can successfully sponsor preventive health outreach, but also can design and conduct such education efforts without enlisting busy physicians to participate," said lead author Barbara Gerbert, Ph.D., chair of the Division of Behavioral Sciences in the UCSF School of Dentistry.
Studies about how best to encourage patients to adopt preventive health behaviors are increasingly important because the United States is rapidly embracing a model of health care delivery managed less by individual physicians and more by capitated plans, such as HMOs, Gerbert said.
In an effort to increase patient satisfaction and health outcomes as well as to reduce the number of physician visits, HMOs are becoming more and more concerned about educating patients about prevention, according to Gerbert.
"The organization, in a sense, is taking on the role that physicians once played as the provider of messages regarding health care and prevention," Gerbert said.
For the study, UCSF researchers mailed a questionnaire to a random sample of 981 patients to assess their concern about and risk for skin cancer. The patients belonged to a large medical group that contracts with several San Francisco Bay Area HMOs to provide care.
Accompanying the questionnaire was a letter inviting patients to call a toll-free number. The patients received the letter either from their physician, their HMO, or a fictitious direct mail organization.
The letter emphasized one of three messages about the effects of ultraviolet rays on the skin. One-third of the patients received a letter emphasizing skin cancer, one-third a letter stressing aging and wrinkling, and one-third a letter emphasizing aging and wrinkling along with a book that also focused on preventing the aging and wrinkling effects of the sun. All three of the messages were based on factual medical information.
A total of 66 patients responded to the mailing by calling the toll-free number and completing a brief interview. Of these, 34 had received the physician letter; 23, the HMO letter; and 9, the direct mail letter. Findings showed that messages that appealed to patient concern about skin cancer were just as effective in activating patient response as messages that appealed to concern about the wrinkling and aging of skin.
"Patients responded to health preventive messages from their health care provider, whether an individual physician or HMO, more than to health preventive messages in general," Gerbert said. "This is good news, because HMOs are better equipped administratively to conduct mass mailings than individual physicians, therefore making preventive efforts logistically, and possibly financially, feasible."
Skin cancer accounts for more than 35 percent of all new cancers detected in the United States annually, and the incidence is increasing at an alarming rate. The U.S. Department of Health and Human Services estimates that 90 percent of skin cancers are due to exposure to sunlight. Other studies have estimated that 90 percent of the visible age-related changes that occur in the skin of Caucasians are due to exposure to UV light.
UCSF co-authors are: Mimi Wolff, MSW, Division of Behavioral Sciences; Jeanne M. Tschann, Ph.D., Division of Behavioral and Developmental Pediatrics; Stephen J. McPhee, M.D., Division of General Internal Medicine; Nona M. Caspers, MFA, Division of Behavioral Sciences; Michael J. Martin, M.D., Department of Epidemiology and Biostatistics; Thomas Bleecker, Ph.D., Division of Behavioral Sciences; and Anne Saulovich, Division of Behavioral Sciences.
CONTACT: University of California, San Francisco | Rebecca Higbee, 415/476-2557
[Copyright 1997, Business Wire]