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Z Gastroenterol 2017; 55(12): 1307-1312
DOI: 10.1055/s-0043-121347
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Invitation letters increase participation in colorectal cancer screening – results from an observational study

Einladungsbriefe erhöhen die Teilnahmerate am Darmkrebsvorsorgeprogramm – Ergebnisse einer Beobachtungsstudie
Tianzuo Zhan
1   Division of Signaling and Functional Genomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
2   Department of Internal Medicine II, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
Thomas Hielscher
3   Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
,
Asmé Bilge
2   Department of Internal Medicine II, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
Thomas Giese
4   Department of Health Services Research, BARMER GEK Headquarters, Wuppertal, Germany
,
Christoph Schäfer
5   BARMER GEK Bavaria, Munich, Germany
,
Jürgen F Riemann
6   Department of Medicine C, Klinikum Ludwigshafen, LebensBlicke Foundation, Ludwigshafen am Rhein, Germany
,
Matthias P Ebert
2   Department of Internal Medicine II, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
Sebastian Belle
2   Department of Internal Medicine II, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
› Author Affiliations
Further Information

Publication History

05 June 2017

08 October 2017

Publication Date:
06 December 2017 (online)

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Abstract

Background and Aim Participation rates in the German colorectal cancer screening program are low. Starting in 2013, a large health insurance plan in Bavaria, Germany, is sending an additional invitation letter to insured individuals when they turn 50 or 55 years and become eligible for participation in the program. The letter provides detailed information on colorectal cancer screening. We assessed the impact of the invitation letter on utilization rates.

Methods Insurance claims data of a total of 48 343 individuals who had turned 50 or 55 years between 2012 to 2014 were reviewed for utilization rates of screening colonoscopy and fecal blood tests. Utilization rates 1 year prior (2012) and 2 years after introduction of the invitation letter (2013 and 2014) were compared. Furthermore, providers of colorectal cancer screening were determined.

Results Within 6 months after turning 50 or 55 years, 8.8 – 10.2 % of all insured individuals participated in colorectal cancer screening, with the majority being females. After the introduction of the invitation letter, a moderate increase in participation rates could be observed (increase to 109 % [RR 101.7 – 117.3 %, p = 0.02] in 2014). The uptake rate of screening colonoscopy was significantly higher in recipients of the letter (increase to 138.4 % [RR 110.4 – 173.8 %, p = 0.0043] in 2013 and to 149 % [RR 119.5 – 186.3 %, p = 0.0003] in 2014). Furthermore, a significantly higher proportion of general practitioners and gastroenterologists provided colorectal cancer screening in individuals receiving the invitation letter.

Conclusions Introduction of an invitation letter can improve participation rates for colorectal cancer screening.

Zusammenfassung

Hintergrund und Zielsetzung Die Teilnahmerate am Darmkrebsvorsorgeprogramm ist in Deutschland niedrig. Seit 2013 versendet die BARMER Krankenkasse in Bayern zusätzlich einen Einladungsbrief an Versicherte, die 50 oder 55 Jahre alt werden und somit für eine Teilnahme am Vorsorgeprogramm berechtigt sind. Der Brief enthält detaillierte Information zum Darmkrebsvorsorgeprogramm. Wir haben die Wirkung dieser zusätzlichen Maßnahme auf die Teilnahmerate untersucht.

Methodik Die Versicherungsdaten von insgesamt 48 343 Versicherten, die zwischen 2012 und 2014 50 und 55 Jahre geworden sind, wurden ausgewertet. Es wurden die Inanspruchnahmen von Vorsorgekoloskopien und Okkultbluttests im Stuhl erfasst. Die Nutzungsraten im Jahr vor (2012) und zwei Jahre nach der Einführung des Einladungsbriefes (2013 und 2014) wurden miteinander verglichen. Zusätzlich wurden die ärztlichen Anbieter der Vorsorgeuntersuchungen ermittelt.

Ergebnisse Innerhalb von sechs Monaten nach Eintritt ins 50 und 55. Lebensjahr haben 8,8 % bis 10,2 % aller Versicherten an einer Darmkrebsvorsorgeuntersuchung teilgenommen, von denen die meisten weiblich waren. Nach Einführung des Informationsbriefes war 2014 ein leichter Anstieg der Teilnehmerrate zu beobachten (Anstieg auf 109 % [RR 101,7 – 117,3 %, p = 0,02] im Vergleich zu 2012). Die Inanspruchnahme von Vorsorgekoloskopien bei Empfängern des Einladungsbriefes ist signifikant gestiegen (Anstieg auf 138,4 % [RR 110,4 – 173,8 %, p = 0,0043] im Jahr 2013 und auf 149 % [RR 119,5 – 186,3 %, p = 0,0003] im Jahr 2014). Zudem haben nach Einführung des Briefes signifikant mehr Allgemeinmediziner und Gastroenterologen Vorsorgeuntersuchungen durchgeführt.

Schlussfolgerung Die Einführung eines Einladungsbriefes kann die Teilnahmerate am Darmkrebsvorsorgeprogramm erhöhen.

Schlüsselwörter

kolorektales Adenom - kolorektales Karzinom - Vorsorgeuntersuchung - Koloskopie

Key words

colorectal adenoma - colorectal cancer - screening - colonoscopy
 

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