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JMIR mHealth and uHealth
02 05, 2019;7 (2): e11114.

Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial.

Revital Azulay, Liora Valinsky, Fabienne Hershkowitz, Racheli Magnezi
Author Information
  1. Revital Azulay: Master of Health Administration Program, Department of Management, Bar Ilan University, Ramat Gan, Israel. ORCID
  2. Liora Valinsky: Quality Department, Meuhedet Health Care, Tel Aviv, Israel. ORCID
  3. Fabienne Hershkowitz: Quality Department, Meuhedet Health Care, Tel Aviv, Israel. ORCID
  4. Racheli Magnezi: Master of Health Administration Program, Department of Management, Bar Ilan University, Ramat Gan, Israel. ORCID
PMID: 30720439 DOI: 10.2196/11114

Abstract

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).

Keywords

SMS adherence cancer screening colonoscopy fetal occult blood test patient-physician relationship positive colorectal cancer screening text reminder

Associated Data

ClinicalTrials.gov | NCT03642652

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MeSH Term

Aftercare
Aged
Colorectal Neoplasms
Female
Humans
Male
Mass Screening
Middle Aged
Mobile Applications
Occult Blood
Reminder Systems
Text Messaging
Treatment Adherence and Compliance
Journal Article

Word Cloud

Created with Highcharts 10.0.0positivescreeningcolonoscopygrouppatientsresultsresulttextSMSFOBTcontrolinterventiontestcolorectalcancerCRCadherencecare120daysFecaloccultbloodtestsmethodeffectivestudymessagingmessagedistrictSESreceivedroutinephysicianregardingincludingattitudecompared95%withinadjustingpotentialconfounders17001reminderBACKGROUND:FOBTsrecommendedUSPreventiveServicesTaskForcefollowedSurprisinglylargeproportionfollowrecommendationOBJECTIVE:objectiveexamineeffectivenessshortserviceincreasingfollow-upMETHODS:randomizedcontrolledtrialconductedRandomizationstratifiedresidentialsocioeconomicstatusSubjectsn=238includedalertn=2323remindersvisitprimaryAdherencemeasuredpatientinformationcompletionobtainedelectronicmedicalrecordsPhysicianscompletedsurveyInterventionvariablesdependentindependentusingchi-squareLogisticregressionusedcalculateoddsratiosORsCIsperformingagegenderethnicityphysicians'RESULTS:Overall163232112238underwent703%vs471%OR2CI149-3P<associationremainedsignificantP=CONCLUSIONS:simpleinexpensiveimprovingamongtypealsoevaluatedtypesTRIALREGISTRATION:ClinicalTrialsgovNCT03642652https://clinicaltrialsgov/ct2/show/NCT03642652ArchivedWebCitehttp://wwwwebcitationorg/74TlICijlRepeatedAutomatedMobileTextMessagingRemindersFollow-UpPositiveOccultBloodTests:RandomizedControlledTrialfetalpatient-physicianrelationship

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