Reducing financial barriers enhances the return rate of stool hemoccult packets

Patient compliance in returning fecal-hemoccult card packets has been studied in recent years but no specific interventions have been shown consistently to improve the return rate. It was wondered whether removing a small financial barrier for indigent patients would positively affect compliance. Therefore, the effect of prepaid postage on the rate of return was studied. Pre-prepared packets containing hemoccult cards with return envelopes were distributed in a randomized fashion to indigent and private insurance patients in outpatient clinics. On half of the return envelopes return postage was applied. The main outcome measure was the rate of return of stamped and unstamped packets stratified between indigent and private insurance patients. The overall rates of return were 117 of 159 (74%) for the stamped packets and 102 of 166 (61%) for unstamped packets (p < 0.02). After stratification, in the indigent patients (n = 177), 73 of 95 (77%) stamped packets were returned compared to 46 of 82 (56%) unstamped packets (p < 0.006). In the private insurance patients (N = 148), 44 of 64 stamped packets (69%) and 52 of 84 unstamped packets (62%) were returned (p > 0.10). Removing even small financial barriers (eg, providing a postage stamp) can enhance compliance for indigent patients.