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C-A3-01: The Effect of an Automated Reminder Call Intervention on Completion of Fecal Occult Blood Testing (FOBT).

ABSTRACT: Background: Colorectal cancer (CRC) is the third most common cancer in the United States and is associated with significant morbidity and mortality. Although CRC has a good prognosis if diagnosed early, screening rates remain low. Innovative, low cost intervention, such as the use of automated reminder calls, may increase CRC screening rates. The objective of this prospective study was to determine the effect of an automated telephone reminder message on completion of a fecal occult blood test (FOBT), an evidence-based screening method for populations with average risk for CRC.Methods: A prospective randomized clinical trial of 5,993 patients (intervention group = 2,993, usual care group = 3,000), between ages 51?80, due for CRC screening with average risk for CRC. The patient population received care in a not for profit HMO in the Pacific Northwest. The intervention group received a 1-minute automated telephone call, which provided a general description and health benefits of FOBT. Patients could request that an FOBT kit be mailed to their home on the call. Up to three calls were attempted for non respondents over a five month period. Multiple logistic regressions was used to examine the independent effect of automated reminder calls on completion of an FOBT test, after adjusting for age, gender and prior CRC screening.Results: Compared to usual care, those in the intervention group were significantly more likely to complete an FOBT (OR = 1.60, 95% CI = 1.39?1.84), five months post randomization. Two characteristics were also associated with completion of FOBT:Conclusions: Automated telephone calls increased completion of screening FOBT compared to usual care. Broad implementation may cost effectively increase community CRC screening rates. Further research is needed to better understand how the stage at CRC diagnosis and CRC related mortality are impacted and to evaluate cost effectiveness.

SUBMITTER: Mosen DM

PROVIDER: S-EPMC2842388 | biostudies-other | 2010 Mar

REPOSITORIES: biostudies-other

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Project description:BACKGROUND:Fecal occult blood tests (FOBTs) are recommended by the US Preventive Services Task Force as a screening method for colorectal cancer (CRC), but they are only effective if positive results are followed by colonoscopy. Surprisingly, a large proportion of patients with a positive result do not follow this recommendation. OBJECTIVE:The objective of this study was to examine the effectiveness of text messaging (short message service, SMS) in increasing adherence to colonoscopy follow-up after a positive FOBT result. METHODS:This randomized controlled trial was conducted with patients who had positive CRC screening results. Randomization was stratified by residential district and socioeconomic status (SES). Subjects in the control group (n=238) received routine care that included an alert to the physician regarding the positive FOBT result. The intervention group (n=232) received routine care and 3 text messaging SMS reminders to visit their primary care physician. Adherence to colonoscopy was measured 120 days from the positive result. All patient information, including test results and colonoscopy completion, were obtained from their electronic medical records. Physicians of study patients completed an attitude survey regarding FOBT as a screening test for CRC. Intervention and control group variables (dependent and independent) were compared using chi-square test. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs for performing colonoscopy within 120 days for the intervention group compared with the control group while adjusting for potential confounders including age, gender, SES, district, ethnicity, and physicians' attitude. RESULTS:Overall, 163 of the 232 patients in the intervention group and 112 of the 238 patients in the control group underwent colonoscopy within 120 days of the positive FOBT results (70.3% vs 47.1%; OR 2.17, 95% CI 1.49-3.17; P<.001); this association remained significant after adjusting for potential confounders (P=.001). CONCLUSIONS:A text message (SMS) reminder is an effective, simple, and inexpensive method for improving adherence among patients with positive colorectal screening results. This type of intervention could also be evaluated for other types of screening tests. TRIAL REGISTRATION:ClinicalTrials.gov NCT03642652; https://clinicaltrials.gov/ct2/show/NCT03642652 (Archived by WebCite at http://www.webcitation.org/74TlICijl).

Project description:BackgroundAs the rates of vaccination decline in children with logistical barriers to vaccination, new strategies to increase vaccination are needed. The goal of this study was to develop and evaluate the effectiveness of the Vaccines For Babies (VFB) intervention, an automated reminder system with online resources to address logistical barriers to vaccination in caregivers of children enrolled in an integrated healthcare system. Effectiveness was evaluated in a randomized controlled trial.MethodsQualitative interviews were conducted with parents of children less than two years old to identify logistical barriers to vaccination that were used to develop the VFB intervention. VFB included automated reminders to schedule the 6- and 12-month vaccine visit linking caregivers to resources to address logistic barriers, sent to the preferred mode of outreach (text, email, and/or phone). Parents of children between 3 and 10 months of age with indicators of logistical barriers to vaccination were randomized to receive VFB or usual well child care (UC). The primary outcome was percentage of days undervaccinated at 2 years of life. A difference in differences analysis was conducted.ResultsQualitative interviews with 6 parents of children less than 2 years of age identified transportation, scheduling challenges, and knowledge of vaccine timing as logistical barriers to vaccination. We enrolled 250 participants in the trial, 45% were loss to follow-up. There were no significant differences in vaccination uptake between those enrolled in UC or the VFB intervention (0.51%, p = 0.86). In Medicaid enrolled participants, there was a modest decrease in percentage of days undervaccinated in the VFB intervention compared to UC (6.3%, p = 0.07).ConclusionAutomated Reminders and with links to heath system resources was not shown to increase infant vaccination uptake demonstrating additional resources are needed to address the needs of caregivers experiencing logistical barriers to vaccination.

Project description:BackgroundNo head-to-head randomized controlled trials have demonstrated the superiority of one colorectal screening modality over another in reducing colorectal cancer mortality. We conducted a pilot randomized controlled trial of fecal occult blood testing (FOBT), optical colonoscopy (OC), and virtual colonoscopy (VC), to inform the planning of a larger evaluative trial.MethodsEligible patients (aged 50 to 70) were recruited from five primary care practices in Hamilton, ON, Canada, between March 23, 2010 and August 11, 2010, and randomized 1:1:1 in a parallel design using an automated, centralized telephone service to either FOBT, OC, or VC. To reflect conventional practice, patients received no additional reminders to complete their allocated screening test beyond those received in usual practice. The primary outcome was completion of the assigned screening procedure. Results of the index test and any follow-up investigations were ascertained at 6 months. Participants, caregivers, and outcome assessors were not blinded to group assignment. The trial was stopped early due to lack of ongoing funding.ResultsA total of 198 participants were enrolled, of whom 67 were allocated to FOBT, 66 to OC, and 65 to VC. The allocated screening procedure was completed by 43 (64%) subjects allocated to FOBT (95% confidence interval [CI], 52-75%), 53 (80%) subjects allocated to OC (95% CI, 69-88%), and 50 (77%) subjects allocated to VC (95% CI, 65-85%); because the trial stopped early, we had insufficient statistical power to detect clinically relevant differences in completion rates. During 6 months follow-up, colorectal adenomas were detected in 0 (0%) subjects allocated to FOBT, 12 (18%) subjects allocated to OC, and 2 (3%) subjects allocated to VC. One subject in the OC arm had histological evidence of high-grade dysplasia. No subjects were diagnosed with colorectal cancer.ConclusionsIn this pilot randomized controlled trial of colorectal cancer screening in a primary care setting, 64-80% of subjects completed their allocated screening test. These findings may be of value to investigators planning clinical trials to evaluate the effectiveness of colorectal cancer screening.Trial registrationClinicalTrials.gov NCT00865527. https://clinicaltrials.gov/ct2/show/NCT00865527.

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C-A3-01: The Effect of an Automated Reminder Call Intervention on Completion of Fecal Occult Blood Testing (FOBT).

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