Patient Engagement with Interactive Text Message System Improves Successful Colonoscopy Rates in an Outpatient Endoscopy Center

Abstract

Introduction: Text message-based interventions reduce colonoscopy no-show rates and improve bowel preparation scores. In this non-randomized study, we assessed whether an interactive text messaging system could improve colonoscopy outcomes. Methods: Colonoscopy pre-procedural instructions were programmed into a dedicated software platform created for this study. In the intervention arm, text messages were sent to veterans during a 4-week study period. Validated pre-procedural satisfaction questionnaires were completed by patients during standard protocol and intervention periods. Demographics and colonoscopy outcomes data were compared between the standard protocol and intervention arms, including procedure completion rate on scheduled date, Boston bowel preparation score (BPPS), adenoma detection rate, and satisfaction. Results: Of 241 patients, 128 were in the standard protocol arm and 113 in the intervention arm. Higher proportions of patients receiving text messages underwent colonoscopy on their scheduled date (69.9%) compared to the ones in the standard protocol (50.8%, p = 0.015). Patients with ≥3 interactions with the system had 80.6% likelihood of completing colonoscopy on the scheduled date compared to 56.9% with <3 interactions and 50.8% with standard protocol (p < 0.001). Frequency of interaction with the system was similar between older (>65 years) and younger patients (p = 1.0). Among older patients, colonoscopy was completed successfully in 84.2% when alert-based human interactions occurred compared to 65.6% in those without and 47.9% with standard protocol (p = 0.018). More than 90% indicated they would recommend the system to patients undergoing future colonoscopy. Conclusion: An interactive text messaging system improves successful colonoscopy rates in a VA setting, with greatest impact in older patients.

Effect of Text Messaging on Bowel Preparation and Appointment Attendance for Outpatient Colonoscopy

“…Additionally, it is more difficult to demonstrate the benefit of an intervention on appointment adherence in settings in which the baseline colonoscopy nonattendance rate is relatively low. This may be the case with the present study, in which the control arm nonattendance or cancellation rate was 19.0%, compared with the study by Rogers et al study, in which the control nonattendance rate was 49.2%. These diverse considerations must be evaluated on a case-by-case basis, and it is likely that a 1-size-fits-all intervention to improve adherence and attendance for colonoscopy appointments may not currently exist.…”

“…For example, in a German multicenter randomized clinical trial, Walter et al found that a text message reminder system significantly improved colonoscopy bowel preparation compared with usual care controls. Similarly, a 2020 study in 3 clinics in Hong Kong, China, by Lam et al found that text message reminders in the 7 to 10 days prior to outpatient colonoscopy reduced nonadherence rates, and a 2020 study by Rogers et al demonstrated improved appointment attendance rates with an interactive text messaging program among patients receiving care at Veterans Health Administration centers. By contrast, a 2018 prospective randomized clinical trial by Patel et al found no benefit in terms of bowel preparation quality associated with a text message intervention compared with usual care.…”

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“…While there is a literature on digital patient information, the main focus is on retention of information or outcomes rather than environmental consequences, but a number of examples exist 63. Interactive text message-based systems used in scheduling appointments improve non-attendance rates,64 65 while patient-facing digital technology can be used in scheduling communications and in pre-assessment 66…”

The unmet needs for identifying the ideal bowel preparation

“…This article will analyze and discuss the various aspects of BP in clinical practice. Currently available BP formulations will be described, and unmet needs will be discussed in order to identify the ideal preparation as envisaged in the literature 22–26 …”

“…Currently available BP formulations will be described, and unmet needs will be discussed in order to identify the ideal preparation as envisaged in the literature. 22 , 23 , 24 , 25 , 26 …”