Z Gastroenterol 2019; 57(09): 1051-1058
DOI: 10.1055/a-0958-2874
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

The effect of gender-specific invitation letters on utilization of colorectal cancer screening

Der Einfluss von geschlechtsspezifischen Einladungsschreiben auf die Inanspruchnahme von Darmkrebsvorsorgeuntersuchungen
Tianzuo Zhan
1   Department of Internal Medicine II, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
Thomas Hielscher
2   Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
,
Maximilian Eckardt
1   Department of Internal Medicine II, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
Thomas Giese
3   Department of Health Services Research, BARMER GEK Headquarters, Wuppertal, Germany
,
Christoph Schäfer
4   BARMER GEK Bavaria, Munich, Germany
,
Jürgen F. Riemann
5   Department of Medicine C, Klinikum Ludwigshafen, LebensBlicke Foundation, Ludwigshafen am Rhein, Germany
,
Matthias P. Ebert
1   Department of Internal Medicine II, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
Sebastian Belle
1   Department of Internal Medicine II, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
› Author Affiliations
Further Information

Publication History

27 February 2019

07 June 2019

Publication Date:
16 September 2019 (online)

Abstract

Background and aim Colorectal cancer (CRC) screening can effectively reduce cancer-associated mortality. In Germany, individuals over the age of 50 or 55 have access to CRC screening services. However, utilization rates are persistently low, particular in the male population. This observational study investigates the effect of standard versus gender-specific invitation letters on utilization of CRC screening services.

Methods We analyzed utilization rates of individuals who were insured by a large health insurance fund in Bavaria, Germany. Persons who became eligible for CRC screening received a standard (2013–2014) or a gender-specific invitation letter (2015–2016). We compared utilization rates within 6 months after receipt of the invitation letter using billing codes of the health insurance fund.

Results Invitation letters were sent to 49 535 individuals, of which 48.8 % were gender-specific. The overall utilization rate did not differ between recipients of the standard versus gender-specific invitation letter (11.6 % vs 11.1 %; RR: 0.97 [0.92–1.02], p = 0.19). However, uptake of screening colonoscopy was significantly higher among recipients of gender-specific invitations (2.9 % vs 3.5 %; RR: 1.21 [1.04–1.39], p = 0.01), whereas utilization of fecal occult blood tests declined (10.4 % vs 9.7 %; RR: 0.93 [0.88–0.99], p = 0.016).

Conclusions Gender-specific design of invitation letters can modify the patients’ preference for specific CRC screening services and increase the acceptance of screening colonoscopy.

Zusammenfassung

Hintergrund und Zielsetzung Darmkrebsvorsorgeuntersuchungen können die Krebs-assoziierte Mortalität wirksam reduzieren. In Deutschland haben Personen über 50 bzw. 55 Jahren Zugang zu spezifischen Vorsorgeuntersuchungen. Die Teilnahmerate am Darmkrebsvorsorgeprogramm ist jedoch persistierend niedrig, insbesondere in der männlichen Bevölkerung. Diese Beobachtungsstudie vergleicht den Einfluss von einfachen mit geschlechtsspezifischen Einladungsschreiben auf die Inanspruchnahme von Darmkrebsvorsorgeuntersuchungen.

Methodik Die Teilnahmerate am Darmkrebsvorsorgeprogramm wurde in einer Kohorte von Personen, die durch eine große, gesetzliche Krankenkasse in Bayern versichert sind, untersucht. Alle Personen, die während des Beobachtungszeitraums das 50. bzw. 55. Lebensjahr erreicht haben, erhielten entweder ein einfaches (2013–2014) oder geschlechtsspezifisches Einladungsschreiben (2015–2016). Die Inanspruchnahme von Vorsorgeuntersuchungen innerhalb von 6 Monaten nach Erhalt des Einladungsschreibens wurde verglichen.

Ergebnisse Es haben insgesamt 49 535 Personen ein Einladungsschreiben erhalten. Davon waren 48,8 % geschlechtsspezifische Einladungsschreiben. Die Teilnahmerate unterschied sich nicht zwischen Empfängern eines einfachen oder geschlechtsspezifischen Einladungsschreibens (11,6 % vs 11,1 %; RR 0,97 [0,92–1,02], p = 0,19). Die Inanspruchnahme von Vorsorgekoloskopien war jedoch signifikant höher bei Personen, die ein geschlechtsspezifisches Einladungsschreiben erhielten (2,9 % vs 3,5 %; RR 1,21 [1,04–1,39], p = 0,01). Hingegen war die Nutzung von Tests für okkultes Blut im Stuhl in der gleichen Gruppe geringer (10,4 % vs 9,7 %; RR 0,93 [0,88–0,99], p = 0,016).

Schlussfolgerung Geschlechtsspezifische Einladungsschreiben können die Präferenz von Patienten für spezifische Vorsorgeuntersuchungen verändern und die Inanspruchnahme von Vorsorgekoloskopien erhöhen.

 
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