Randomized, Controlled Trial of a Multimodal Intervention to Improve Cancer Screening Rates in a Safety-Net Primary Care Practice

Hendren, Samantha; Winters, Paul; Humiston, Sharon G.; Idris, Amna; Li, Shirley X. L.; Ford, Patricia; Specht, Raymond; Marcus, Stuart G.; Mendoza, Michael; Fiscella, Kevin

doi:10.1007/s11606-013-2506-1

Cited by 60 publications

(58 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our previous research showed that interventions caused smaller absolute increases in screening among uninsured pa-tients. 20,21 The conditions indicating a higher risk of cancer based on chart data abstraction included prior cancer, premalignant conditions (eg, ulcerative colitis, familial polyposis), inadequately evaluated breast masses, positive FOBT/FIT result at last testing, or a first-degree relative with a previous diagnosis of BC or CRC. Higher-risk patients and those without insurance who were past due were not randomized but were given the most intensive intervention, that is, both a letter and an automated phone call, and were not analyzed.…”

Section: Participantsmentioning

confidence: 99%

See 1 more Smart Citation

Improving Breast and Colon Cancer Screening Rates: A Comparison of Letters, Automated Phone Calls, or Both

Phillips

Hendren

Humiston

et al. 2015

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

Purpose: Low-cost interventions to improve cancer screening among primary care patients are needed. The comparative effectiveness of personalized letters, automated telephone calls, and both on breast cancer (BC) and colorectal cancer (CRC) screening is not known.Methods: A pragmatic, randomized, controlled trial was conducted in 2011 to 2012. Eligible primary care patients were women ages 50 to 74 years who were past due for mammography and men or women who were past due for mammography or CRC screening of any kind (>12 months since last fecal occult blood test, >5 years since last sigmoidoscopy/double-contrast barium enema, or >10 years since last colonoscopy), respectively. Participants were randomized to 1 of 3 interventions: personalized mailed letters, automated telephone calls, or both. The primary outcome was medical record documentation of a completed mammogram or CRC screening within 36 weeks of randomization. We estimated the costs of each intervention and calculated the marginal cost-effectiveness per person screened.Results: The crude screening rates for BC were 19%, 22%, and 37% and for CRC were 17%, 14%, and 24% for the letter, automated call, and combined (letter/automated call) groups, respectively. The combined intervention group had a statistically higher screening rate (P < .05) compared with either of the single intervention groups (letter only or automated call) for both BC and CRC in both the crude and adjusted analyses. The combined intervention costs $5.11 per additional person screened for BC and $13.14 per additional person screened for CRC.Conclusion: In a primary care practice, letters plus automated telephone calls are better than either alone in increasing cancer screening rates among patients who are overdue for screening. These findings suggest the promise of a relatively inexpensive intervention to improve cancer screening. Rates of screening for breast cancer (BC) and colorectal cancer (CRC) remain suboptimal, particularly among poor and minority patients.1-3 BC screening, based on self-report of a mammogram within 2 years, was 72% in 2010, whereas selfreported rates of CRC screening were only 64%.

show abstract

Section: Participantsmentioning

confidence: 99%

“…18 A systematic review confirmed the benefit of mailed reminders for BC and CRC screening. 19 Our own research suggests that multimodal interventions are effective, 20,21 but which component(s) of the interventions really prompted increases in screening rates is unclear from prior studies.…”

mentioning

confidence: 99%

Improving Breast and Colon Cancer Screening Rates: A Comparison of Letters, Automated Phone Calls, or Both

Phillips

Hendren

Humiston

et al. 2015

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

show abstract

“…We previously conducted a trial of a multimodal intervention to increase cancer screening in a similar safety-net practice and found a significant increase in screening rates, 7 raising the question which component(s) of the intervention were most important. This project was designed to assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety-net practice.…”

Section: Introductionmentioning

confidence: 99%

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

et al. 2013

Self Cite

View full text Add to dashboard Cite

BACKGROUND:Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments. OBJECTIVE: To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice. DESIGN: Pragmatic randomized trial. PARTICIPANTS: Men and women aged 50-74 years past due for CRC screen and women aged 40-74 years past due for BC screening. INTERVENTIONS: We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call). MAIN MEASURES: Documentation of mammography or colorectal cancer screening at 52 weeks following randomization. KEY RESULTS: Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2-4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1-3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1-3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0-3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates. CONCLUSIONS:The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.KEY WORDS: cancer screening; colorectal cancer; breast cancer; outreach; inreach.

show abstract

“…Reminder phone calls and postcards are effective in increasing rates of CRC screening [11]. In this study population, since all patients received an automated phone call reminder during the study period, it is unknown how this practice affected overall results.…”

mentioning

confidence: 99%

Adherence to Screening Colonoscopy: Can We Get Our Recommendations to Stick?

Rogers

Keswani

2015

Dig Dis Sci

View full text Add to dashboard Cite

Although colorectal cancer (CRC) remains the second leading cause of cancer-related mortality in the USA, its incidence and mortality have decreased in men and women since 1997, a reduction attributed, in part, to the increased use of CRC screening modalities [1]. Colonoscopy, regarded by most expert advisory groups as the mainstay of CRC screening, is the only modality that both detects and removes neoplastic polyps from the entire colon. Despite its efficacy, only 20-38 % of the population is adherent to CRC screening guidelines [2,3]. Colonoscopy at present is estimated to decrease CRC-related mortality by 53 %, with further decrements expected if a greater proportion of individuals received age-appropriate screening [4]. Given limited healthcare resources, information that enables practitioners to focus interventions on populations most likely to be non-adherent to screening colonoscopy is valuable.Multiple patient factors influence adherence to CRC screening [5,6]. Demographic factors associated with lower rates of screening include female gender, younger age, low income or educational attainment, recent immigrant status, lack of health insurance, and persons of African-American or Hispanic descent [5]. Health factors associated with non-adherence include multiple medical comorbidities and decreased primary care utilization [6]. Nevertheless, little is known about how adherence differs among patients who are undergoing surveillance colonoscopy indicated for a history of colorectal polyps or are undergoing screening colonoscopy.In this issue of Digestive Diseases and Sciences, Greenspan et al. [7] report the results of a prospective study comparing rates of adherence to screening and surveillance colonoscopy in a population of 617 patients seeking care at an urban, tertiary medical center. Of multiple demographic factors studied in patients scheduled to undergo colonoscopy, patients scheduled for screening colonoscopy were significantly less likely to undergo their procedures than those scheduled for surveillance of adenomatous polyps (RR 5.42,). This intuitive finding represents a new, easily identifiable factor toward which patient adherence efforts can be directed.While univariate analysis indicated that female gender and the presence of medical comorbidities (represented by clopidogrel use and a history of congestive heart failure) were associated with an increased risk of non-adherence, these were not significant according to multivariable logistic regression analysis, consistent with prior studies [8]. The single factor associated with non-adherence and repeated procedure cancellations according to multivariable analysis, was indication for colonoscopy [7]. Although patients with a prior history of adenomatous polyps are at high risk of the development of adenomas or carcinoma (20-50 %) at subsequent surveillance colonoscopy, the risk of adenoma or carcinoma in asymptomatic patients undergoing screening colonoscopy can also be as high as 50 % [9]. Thus, it is appropriate to direct efforts toward ensuri...

show abstract

Randomized, Controlled Trial of a Multimodal Intervention to Improve Cancer Screening Rates in a Safety-Net Primary Care Practice

Cited by 60 publications

References 30 publications

Improving Breast and Colon Cancer Screening Rates: A Comparison of Letters, Automated Phone Calls, or Both

Improving Breast and Colon Cancer Screening Rates: A Comparison of Letters, Automated Phone Calls, or Both

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

Adherence to Screening Colonoscopy: Can We Get Our Recommendations to Stick?

Contact Info

Product

Resources

About