Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: May 23, 2018
Open Peer Review Period: May 25, 2018 - Aug 7, 2018
Date Accepted: Oct 26, 2018
(closed for review but you can still tweet)
Repeated automated mobile text reminders for follow-up of positive fecal occult blood tests: A Randomized Controlled Trial
ABSTRACT
Background:
Fecal occult blood tests are recommended by the US Preventive Services Task Force as a screening method for colorectal cancer, 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:
To examine the effectiveness of a short message service (SMS) in increasing adherence to colonoscopy follow-up after a positive FOBT.
Methods:
This randomized controlled trial was conducted with patients who had positive colorectal cancer screening results. Randomization was stratified by residential district and socioeconomic status. 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 three 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 EMR (electronic medical records). Physicians of the study patients completed an attitude survey regarding FOBT as a screening test for colorectal cancer. The intervention and control groups were compared using chi-squared for discrete variables. Logistic regression was used to calculate odds ratios and 95% confidence intervals for performing colonoscopy within 120 days for the intervention group compared with the control group, and adjusting for potential confounders of age, gender, socioeconomic status, district, ethnicity, and physician's attitude.
Results:
Of 232 patients in the intervention group, 163 had a colonoscopy within 120 days from the positive FOBT, and 112 of 238 patients in the control group had a colonoscopy within 120 days from the positive FOBT (70% vs. 47%, P<.0001). This association remained significant after adjusting for all potential confounders (P=.001).
Conclusions:
A 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. Clinical Trial: This study was approved by the Meuhedet Institutional Review Board on March 23, 2016 (IRB; trial reference number: 01-023-03-016). ClinicalTrials.gov Identifier: NCT03642652. https://clinicaltrials.gov/ct2/show/NCT03642652.
Citation
Per the author's request the PDF is not available.
Copyright
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