Effectiveness of Multi-modal Reminders for a Direct-mail Fecal Testing Program

Authors:

Morgan Fuoco (Presenter)
Kaiser Permanente Northwest

Gloria Coronado, Kaiser Permanente Northwest
Jennifer Rivelli, Kaiser Permanente Northwest
Amanda Petrik, Kaiser Permanente Northwest
Erin Keast, Kaiser Permanente Northwest
William Vollmer, Kaiser Permanente Northwest

Public Health Statement: A direct-mail program plus reminders may address the disparate rates of colorectal cancer screening among Hispanics, compared to non-Hispanic whites.

Purpose: Colorectal cancer (CRC) screening has been shown to reduce CRC incidence and mortality, yet screening is underused, especially in underserved populations. Direct-mail fecal testing programs have been shown to improve rates screening. Automated and live telephone reminders are increasingly also being used to promote the use of preventive care services in clinical settings. However, little is known about the efficacy of such reminders. As part of the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) study, we sought to compare the efficacy of single- and multi-modal reminders for a direct-mail fecal testing program in a community health center.

Methods/Approach: This pilot study included adults ages 50–75 in four clinics, who had a primary care visit in the previous year and were not up-to-date with colorectal cancer screening recommendations. After receiving an informational letter and fecal immunochemical test (FIT) kit by mail, patients who did not return their FIT kits within 3 weeks were randomized to receive either a reminder letter, a series of three automated phone calls, text messages, live phone call, a text message and a live call, a reminder letter and a live call, or an automated and live call. All reminders were delivered in English, Spanish or Russian according to the language preference.

Results: Of 2,478 adults, 10% of FITs were returned before any reminders were delivered. An additional boost in FIT returns was observed once reminders were delivered. Overall, return rates differed significantly across the treatment arms (p=.0014), with patients who received a live call reminder having the highest return rate (32%). Return rates differed significantly by preferred language. Patients whose preferred language was Spanish had a higher return rate than English speakers (34% vs. 22%, P<0.001). Among Spanish-speakers, multi-modal reminders were found to have the highest FIT return rates.

Conclusions/Implications: Our comparison of the efficacy of reminders to a direct-mail FIT program showed the highest return rates among patients who received the live telephone call. Spanish-speakers had a higher FIT return rate than English-speaking, and the combination of an automated (call or text) and live phone call was particularly efficacious among Spanish-speakers.