Automated Phone Calls Research Articles

Impact of Multi-Component Outreach on Colorectal Cancer Screening and Genetic Testing Preferences

Background: Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide, with early detection through screening significantly reducing mortality rates. However, disparities in access to screening persist, particularly in disadvantaged communities. Fecal Immunochemical Testing (FIT) offers a cost-effective, non-invasive method that increases screening participation by eliminating the need for in-person visits. Multicomponent outreach strategies are crucial to improving participation rates, particularly in populations with limited healthcare access. Methods: This study employed a mixed-method, sequential explanatory design to assess the impact of a population-based, centralized outreach program on CRC screening rates. Quantitative data from Kaiser Permanente Northern California's (KPNC) screening program were analyzed alongside qualitative ethnographic data to explore the implementation of the FIT-based outreach system. A cohort of individuals aged 51 to 75 years was included, with screening completion rates and follow-up processes examined. Results: Among the community initially screened, 40% participated in CRC screening before intervention. The implementation of a centralized, computerized outreach system led to a significant increase in participation, with screening rates rising by 30 percentage points within eight weeks. A combination of automated phone calls, text messages, and reminders during clinic visits further increased coverage by 12 percentage points, resulting in a total screening participation rate of 80%. The study also found that mailed FIT kits significantly improved participation rates, with FIT mailers leading to a 28-percentage point increase in screening compared to opportunistic testing. Various forms of patient guidance resulted in a 17-percentage point rise in screening, while recall interventions led to a modest 3-percentage point increase. Conclusion: The study demonstrates the effectiveness of a multicomponent, centralized outreach approach in increasing CRC screening participation in a large and diverse population.

Feasibility of using an automated call service to collect quality of life and functional outcome data in trauma patients

ObjectivesFollowing up trauma patients after discharge, to evaluate their subsequent quality of life and functional outcomes, is notoriously difficult, time consuming, and expensive. Automated systems are a conceptually attractive solution....

The Reach of Calls and Text Messages for Mailed FIT Outreach in the PROMPT Stepped-Wedge Colorectal Cancer Screening Trial.

Mailed fecal immunochemical test (FIT) outreach can improve colorectal cancer screening participation. We assessed the reach and effectiveness of adding notifications to mailed FIT programs. We conducted secondary analyses of a stepped-wedge evaluation of an enhanced mailed FIT program (n = 15 clinics). Patients were stratified by prior FIT completion. Those with prior FIT were sent a text message (Group 1); those without were randomized 1:1 to receive a text message (Group 2) or live phone call (Group 3). All groups were sent automated phone call reminders. In stratified analysis, we measured reach and effectiveness (FIT completion within 6 months) and assessed patient-level associations using generalized estimating equations. Patients (n = 16,934; 83% Latino; 72% completed prior FIT) were reached most often by text messages (78%), followed by live phone calls (71%), then automated phone calls (56%). FIT completion was higher in patients with prior FIT completion versus without [44% (Group 1) vs. 19% (Group 2 + Group 3); P < 0.01]. For patients without prior FIT, effectiveness was higher in those allocated to a live phone call [20% (Group 3) vs. 18% (Group 2) for text message; P = 0.04] and in those who personally answered the live call (28% vs. 9% no call completed; P < 0.01). Text messages reached the most patients, yet effectiveness was highest in those who personally answered the live phone call. Despite the broad reach and low cost of text messages, personalized approaches may more successfully boost FIT completion.

Digital biomarker co‐design with people with preclinical or prodromal dementia

AbstractBackgroundLanguage markers can serve screening and early detection in Alzheimer’s disease (AD). Using artificial intelligence (AI) approaches enables automated assessment and analysis of speech biomarkes using chatbot technology. Reliable digital speech biomarkers require an easy‐to‐use chatbot which is adopted to the users’ needs. Currently, chatbots often are unsuitable for people with cognitive impairment and rather frustrating for their users. Here, we implemented a user centred design approach to iteratively evaluate usability of a chatbot system for automated speech assessments for people with prodromal or preclinical dementia.MethodWithin the study PROSPECT‐AD, participants (n = 53 by January 2023, 300 planned) are automatically called for six times every three months by our chatbot “Mili”. Each call takes about 15 minutes and consists of three cognitive tasks (Wordlist, Semantic Verbal Fluency, Story Telling). We applied a six stage usability check to improve Mili iteratively (see Figure 1). For deeper insights, we conduct semi‐structured interviews (n = 20). During the interviews, we focus on affinity for technology, usability, and participants’ attitude towards chatbots and artificial intelligence in medicine.ResultsTo date, Mili has completed 54 assessments (see Figure 2). Drop‐outs (11.3%) occcur around the first assessment. Reasons were e.g., lack of accessibility of participants, excessive demands through cognitive tasks or through Mili. Participants reported problems due to Mili’s high speaking pace and hangs of Mili. Additionally, Mili struggled in automatically retrieving appointments and missed calling. All problems were quickly resolved. The speaking pace was reduced and the time‐out time extented by 2 seconds. Results of the system usability scale revealed a high user‐friendliness of the calls (see Table 1). Participants (n = 6) evaluated the calls as quick to learn and easy to use. Two participants wished for more technical support for the calls. Two participants felt uncomfortable in using Mili.ConclusionOur results revealed a high usability and feasibility of the automated phone calls by Mili. Due to close colaboration, problems with Mili were solved qickly and further drop‐outs prevented. This underlines the benefit of close cooperation between participants, scientists, and IT specialists. Interviews are needed for further improvement of Mili and to understand uncertainty with Mili.

Patient and staff experiences of using technology-enabled and analogue models of remote home monitoring for COVID-19 in England: A mixed-method evaluation

ObjectiveTo evaluate patient and staff experiences of using technology-enabled (‘tech-enabled’) and analogue remote home monitoring models for COVID-19, implemented in England during the pandemic. MethodsTwenty-eight sites were selected for diversity in a range of criteria (e.g. pre-hospital or early discharge service, mode of patient data submission). Between February and May 2021, we conducted quantitative surveys with patients, carers and staff delivering the service, and interviewed patients, carers, and staff from 17 of the 28 services. Quantitative data were analysed using descriptive statistics and both univariate and multivariate analyses. Qualitative data were interpreted using thematic analysis. ResultsTwenty-one sites adopted mixed models whereby patients could submit their symptoms using either tech-enabled (app, weblink, or automated phone calls) or analogue (phone calls with a health professional) options; seven sites offered analogue-only data submission (phone calls or face-to-face visits with a health professional). Sixty-two patients and carers were interviewed, and 1069 survey responses were received (18 % response rate). Fifty-eight staff were interviewed, and 292 survey responses were received (39 % response rate). Patients who used tech-enabled modes tended to be younger (p = 0.005), have a higher level of education (p = 0.011), and more likely to identify as White British (p = 0.043). Most patients found relaying symptoms easy, regardless of modality, though many received assistance from family or friends. Staff considered the adoption of mixed delivery models beneficial, enabling them to manage large patient numbers and contact patients for further assessment as needed; however, they suggested improvements to the functionality of systems to better fit clinical and operational needs. Human contact was important in all remote home monitoring options. ConclusionsOrganisations implementing tech-enabled remote home monitoring at scale should consider adopting mixed models which can accommodate patients with different needs; focus on the usability and interoperability of tech-enabled platforms; and encourage digital inclusivity for patients.

Use of Information and Communication Technology Strategies to Increase Vaccination Coverage in Older Adults: A Systematic Review.

Coverage rates of routinely recommended vaccines in older adults still fall below the targets established by international and national advisory committees. As a result, related diseases still have a high incidence, morbidity, and mortality. Information and Communication Technologies (ICT) could provide useful tools to improve immunization rates by bringing information directly to the target user at a relatively low cost. The present research aims to systematically review recent literature on interventions applying ICT to improve the uptake of influenza, pneumococcal, COVID-19 and herpes zoster immunization rates among older adults. Studies published in English between 1 January 2000 and 10 November 2022 were identified by searching electronic medical databases (PubMed, Scopus) and were independently reviewed by two different authors. A total of 22 studies were included in this review. Interventions applied the following ICT tools: phone calls, text messages, messages sent via personal electronic medical records, automated phone calls, remote patient monitoring in a home telehealth program and emails. In terms of the vaccines promoted, 11 studies prompted the influenza vaccine, four prompted the influenza and pneumococcal vaccines, three the pneumococcal vaccine, two the herpes zoster vaccine, one the COVID-19 vaccine and one both the pneumococcal and herpes zoster vaccines. Overall, more than half of the studies (n = 12) found some level of effectiveness of these ICT strategies in increasing vaccination rates among older adults, while five studies were partially effective (for specific vaccines or population subgroups), and five reported no significant effect. Prevention programs using ICT tools could be effective in promoting immunizations among older adults.

Qualitative Exploration Of Tele-Exercise Program To Inform Adaptive Intervention Design For Adults With Multiple Sclerosis

<h3>Research Objectives</h3> To examine the experiences and perceptions of people with multiple sclerosis (MS) who completed a 3-month tele-exercise program regarding the program components and implementation procedures. To identify modifiable factors that could be used to develop an adaptive tele-exercise intervention. <h3>Design</h3> This qualitative study was nested within a pragmatic, cluster-randomized controlled effectiveness trial that compared a 3-month, home-based complementary and alternative medicine exercise intervention (yoga, Pilates, and neurorehabilitation activities) to the same intervention delivered in clinic by a therapist among 761 people with MS. The participants of this qualitative study were a convenience sample recruited from the tele-exercise arm of the main trial. <h3>Setting</h3> The interview was conducted via Zoom conference call. <h3>Participants</h3> Twenty-two people with MS were included in a semi-structured, single one-on-one interview. <h3>Interventions</h3> The 1-year main trial includes the 3-month (20 sessions) CAM intervention and a 9-month follow-up period. The intervention was delivered through a tablet with preloaded videos. The participants received weekly educational articles and automated phone calls that aligned with the key constructs of social cognitive theory (self-efficacy, outcome expectation, knowledge, self-regulatory strategies, facilitators/barriers). <h3>Main Outcome Measures</h3> Each interview was audio-recorded and then transcribed verbatim. Using interpretive thematic analysis, we identified desirable components and delivery mechanisms of the tele-exercise program. <h3>Results</h3> Our analysis indicated the importance of individualized, ongoing modification of exercise program content to accommodate changes in participants' functional abilities and health status. Participants reported an ideal time point of human support, preferably every 3 weeks, to capture the intervention modification needs (e.g., exercise position, intensity, and clarification of exercise instruction). We further identified desirable components for behavioral modifications, such as the inclusion of an exercise companion and self-monitoring tool and post-intervention resources for sustaining exercise participation during follow-up periods. <h3>Conclusions</h3> The findings of this study offer insights into tailoring future adaptive tele-exercise intervention designs aimed at promoting engaging and sustainable exercise participation in people with MS. <h3>Author(s) Disclosures</h3> The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

COVID-19 pandemic vaccination preparedness strategies for independent community pharmacies

ObjectiveThis study aimed to determine independent community pharmacist preparedness for coronavirus disease 2019 (COVID-19) vaccination and to identify strategies for COVID-19 pandemic vaccination implementation in Pennsylvania. MethodsThis study used a complementary mixed-methods approach to recruit independent community pharmacists to participate in an electronic survey and 2 virtually conducted focus groups before the availability of the first COVID-19 vaccine. Information was gathered and compiled into 5 topic areas: (1) workflow, (2) resources, (3) staff and patient safety, (4) communication, and (5) documentation and training. Data collection occurred between October and December 2020. Survey data were analyzed using descriptive statistics. Focus group discussions were audiorecorded and transcribed. A directed, content analysis was conducted to identify strategies for each topic area, and supporting quotes were selected. ResultsA total of 88 and 11 independent community pharmacists participated in the survey and focus groups, respectively. Because of the small size of most independent pharmacies, participants recommended working with community partners to support off-site mass vaccination clinics. Leveraging partnerships with community organizations and universities could be used to support staffing for vaccination efforts. Using an appointment-based immunization model was identified as one tool to optimize patient and staff safety during the pandemic. Pharmacists suggested using existing scheduling tools and text messaging and automated phone calls for second-dose reminders. Finally, independent pharmacists recommended further training and process improvements to support vaccine documentation and transmission to the Pennsylvania Statewide Immunization Information System. ConclusionRecommendations from this study were used to support planning and preparation for COVID-19 vaccinations across Pennsylvania. Incorporation of pharmacists’ ideas and recommendations on pandemic vaccination implementation is an important strategy to efficiently expand vaccination administration during pandemics.

Abstract B046: Incorporating Latino patient input in patient-facing materials for a mailed fecal test outreach program

Abstract Colorectal cancer screening rates are disproportionately low among Latinos. In 2015, only 63% of eligible adults, and 50% of Latinos, were up-to-date with colon cancer screening recommendations. One factor thought to contribute to the low screening rate is that patient-facing health information for Latinos is difficult to understand and patients face challenges in taking health action. As part of the Participatory Research to Advance Colon Cancer Prevention (PROMPT) study, we used boot camp translation (BCT), a community based participatory strategy, to elicit input from stakeholders and refine materials for a clinic-based mailed fecal immunochemical test (FIT) outreach program. Eligible patient participants were Latino, ages 50 to 75 years, able to speak English or Spanish, and willing to participate in an in-person meeting and follow-up phone calls. Separate sessions were held for English- and Spanish-speaking participants. The in-person session included presentations by a national expert on colon cancer prevention and screening messages, and interactive small group sessions to discuss optimal timing and modality for delivering reminders to a mailed FIT program. The phone calls consisted of iterative conversations to refine bilingual materials to encourage screening. BCT participants desired messages that increased awareness about colon cancer and prevention, stressed the importance of screening, emphasized the motivating influence of family, and used personalized statements such an “I” or “we” in letters or automated phone calls. These preferences were incorporated into outreach materials. (Samples will be provided.) 1-Patient Introductory Letter Included in the FIT Kit Mailing. Revisions recommended by BCT participants included 1) details about colon cancer and the need for prevention, 2) emphasis on a free test, 3) inclusion of a photograph of a multigenerational Latino family, 4) the addition of a colon diagram for visual appeal and education, and 5) messages about how screenings can save lives. The group also wanted emphasis on the test being “simple” and “something you can do at home.” 2-Educational Fact Sheet. We also developed a bilingual fact sheet using participant-preferred messages and simple infographics from the BCT expert presentation. The fact sheet presented statistics about colon cancer diagnoses and deaths, and answered the following questions: “What is colon cancer? When should I get tested? How do I get tested?” 3-FIT Kit Wordless Instructions. We found that patients generally preferred simple, wordless instructions, reporting they were less intimidating and helpful as they showed the small amount of fecal matter needed for the test. We developed FIT wordless instructions based on these findings and included the document with the mailing. Using BCT, we successfully incorporated feedback from English- and Spanish-speaking Latino patients to design and enhance culturally relevant materials to promote FIT testing among patients served by community clinics. Citation Format: Jamie Thompson, Melinda Davis, LeAnn Michaels, Jennifer Rivelli, Marta Castro, Brittany Younger, Melissa Castillo, Sacha Reich, Gloria Coronado. Incorporating Latino patient input in patient-facing materials for a mailed fecal test outreach program [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B046.

615-P: Engaging Family Supporters Improved Patient Activation among Adults with T2DM: An RCT

We evaluated the effectiveness of an intervention for patient-family dyads aimed at improving diabetes self-management and outcomes for adults with T2DM (AWD) at risk for complications. AWD were randomized with a family supporter to an intervention vs. usual care for 12 months. The intervention provided dyads: one health coaching session, biweekly automated phone calls to prompt action plans on new diabetes health concerns, coaching calls to prepare for medical visits, and medical visit summaries. 239 AWD-supporter dyads were enrolled at two Veterans Health Administration sites. AWD eligibility criteria included baseline HbA1c&amp;gt;8% or systolic blood pressure (SBP)&amp;gt;150mmHg. Intention-to-treat analyses of changes in outcomes were adjusted for baseline outcome levels, patient-supporter cohabitation, and patients’ baseline insulin use. 96% of dyads had complete 12-month outcome data. Enrolled patients were on average 60±9 years old and had HbA1c levels of 8.5±1.6% and SBP 140mmHg (IQR 128,150). 70% lived with their supporter. Over 12 months, Patient Activation Measure scores (pre-specified primary outcome) increased significantly more in the intervention group (intervention effect +2.6 points (95%CI 0.005, 5.149). There were no statistically significant differences by arm in diabetes-specific cardiac risk score, HbA1c, or SBP change. Patient self-reported adherence to healthy eating increased significantly more in the intervention group (intervention effect +0.7 days/week (95% CI 0.2, 1.2) but not for other self-management behaviors. 97% of patients and 94% of supporters in the intervention group agreed they would recommend the program to others. This family supporter-patient dyadic intervention successfully increased patient activation and one health behavior but not physiologic outcomes over a 12 month period. Improving sustained engagement of family supporters in care of diabetes for adults is feasible and could serve as an additional source of support for diabetes care. Disclosure A. Rosland: None. J. Piette: None. R.B. Trivedi: None. A.A. Lee: None. S.C. Stoll: None. M.K. Mor: None. D. Obrosky: None. E.A. Kerr: Advisory Panel; Self; Bind Insurance. M. Heisler: None. Funding Health Services Research and Development (IIR 14–074-1); Michigan Center for Diabetes Translational Research (5P60-DK09292); Michigan Claude D. Pepper Older Americans Independence Center (AG-024824); VA Ann Arbor Center for Clinical Management Research

Ensuring Equitable Access to School Meals

Ensuring Equitable Access to School Meals

The use of ICT to increase vaccination uptake: state of the evidence from experimental studies

Abstract Background Information and communication technology has a great potential to improve vaccine uptake by increasing the demand of vaccines and the supply of life-course immunization services. The EUVIS (EUrope Vaccines ICT Strategies) project aims at assessing the current use of ICT in European countries’ immunization programs to inform the planning and implementation of ICT-based intervention models to increase vaccine uptake. Here we present the output of Part I of the EUVIS Project, the state of the evidence from experimental studies at the global and regional level. Methods We conducted a systematic review following the PRISMA guidelines to analyze the available evidence from experimental studies on the impact of ICT-based interventions to improve: i) vaccine uptake (primary outcome), and other associated outcomes, including knowledge and attitudes towards immunization in infants, adolescents, adults, elder populations and at risk groups. Results We included 68 RCTs. Informative websites significantly increased vaccination uptake among adolescents. Among young adults, none of the assessed interventions was successful in increasing vaccination uptake. The tools targeting parents that increased uptake were SMS, automated phone calls or messages, websites and online decision aid platforms. For pregnant women, combinations of more types of ICT were more effective in increasing uptake. In the adult population, both SMS and videos proved to be successful, while in elder populations and at-risk groups, the use of more traditional methods as short phone calls proved to be more efficient than ICTs. Conclusions Technological innovations have made significant contributions to healthcare, but our results shows that the interventions must be tailored to target populations’ specific characteristics and needs. These data are of crucial importance to identify which ICT-based interventions are more effective in each target group, to plan and implement immunization programs. Key messages Information and Communication Technology-based interventions to increase vaccine uptake are more successful when planned tailoring target populations’ specific characteristics and needs. ICT can significantly improve healthcare delivery but its role to increase vaccine uptake is controversial. Results from this systematic review are fundamental to plan tailored ICT-based interventions.

A systematic review of email-based reminder interventions to increase vaccine uptake

Abstract Introduction Reminder and recall interventions have been proven to be effective in increasing vaccination coverage. Emails are a popular mean of communication, and their use as a reminder method has many potential benefits: low costs, timely delivery and no restriction of content. Nevertheless, there is limited evidence that compares the advantages of using emails for vaccination reminders to other methods, on which extensive literature is already present. Methods We conducted a systematic review following the PRISMA guidelines to analyze evidence from peer-reviewed studies on the application of email-based interventions to immunization programs. We included any measure of vaccine uptake or immunization coverage, in any target population and settings. Results We included 11 studies in the final analysis, of which 9 were RCTs, 1 was a controlled trial and 1 a before and after study. Most studies were conducted in the US. Six studies had data on the uptake of influenza vaccination, three on HPV series completion, 1 on PPSV23, and 1 on vaccines recommended for adolescents. In 4 studies email reminders proved to be more effective in increasing vaccination uptake than no reminders. Five studies didn’t show advantages of using email reminders when compared to traditional methods (phone call, mail, paper card) and digital reminders (SMS, automated phone calls). In 1 study a significantly higher increase in uptake was achieved when combining emails with Interactive Voice Response phone calls. Finally, 2 studies compared different email models. Conclusions In conclusion, this review outlined that not enough evidence is available regarding the use of email reminders to increase vaccination uptake. Our findings suggest that the choice of reminder method should depend on the population, and future studies should analyze its cost-effectiveness and convenience in respect to other methods, and aim at improving the content of emails to increase their efficacy as a reminder method. Key messages Based on our review of available studies, not enough evidence is available to prove the efficacy of email reminders to increase vaccine uptake. Additional evidence is needed to analyze cost-effectiveness of email reminders, convenience in respect to other methods, and to improve their content to increase their efficacy as a reminder method.

Improving HbA1c with Glucose Self-Monitoring in Diabetic Patients with EpxDiabetes, a Phone Call and Text Message-Based Telemedicine Platform: A Randomized Controlled Trial.

Background:We conducted a randomized controlled trial of EpxDiabetes, a novel digital health intervention as an adjunct therapy to reduce HbA1c and fasting blood glucose (FBG) among patients with type 2 diabetes mellitus (T2DM). In addition, we examined the effect of social determinants of health on our system.Methods:Sixty-five (n = 65) patients were randomized at a primary care clinic. Self-reported FBG data were collected by EpxDiabetes automated phone calls or text messages. Only intervention group responses were shared with providers, facilitating follow-up and bidirectional communication. ΔHbA1c and ΔFBG were analyzed after 6 months.Results:There was an absolute HbA1c reduction of 0.69% in the intervention group (95% confidence interval [CI], -1.41 to 0.02) and an absolute reduction of 0.03% in the control group (95% CI, -0.88 to 0.82). For those with baseline HbA1c >8%, HbA1c decreased significantly by 1.17% in the intervention group (95% CI, -1.90 to -0.44), and decreased by 0.02% in the control group (95% CI, -0.99 to 0.94). FBG decreased in the intervention group by 21.6 mg/dL (95% CI, -37.56 to -5.639), and increased 13.0 mg/dL in the control group (95% CI, -47.67 to 73.69). Engagement (proportion responding to ≥25% of texts or calls over 4 weeks) was 58% for the intervention group (95% CI, 0.373-0.627) and 48% for the control group (95% CI, 0.296-0.621). Smoking, number of comorbidities, and response rate were significant predictors of ΔHbA1c.Conclusions:EpxDiabetes helps to reduce HbA1c in patients with uncontrolled T2DM and fosters patient-provider communication; it has definite merit as an adjunct therapy in diabetes management. Future work will focus on improving the acceptability of the system and implementation on a larger scale trial.

SIPsmartER delivered through rural, local health districts: adoption and implementation outcomes

BackgroundSIPsmartER is a 6-month evidenced-based, multi-component behavioral intervention that targets sugar-sweetened beverages among adults. It consists of three in-person group classes, one teach-back call, and 11 automated phone calls. Given SIPsmartER’s previously demonstrated effectiveness, understanding its adoption, implementation, and potential for integration within a system that reaches health disparate communities is important to enhance its public health impact. During this pilot dissemination and implementation trial, SIPsmartER was delivered by trained staff from local health districts (delivery agents) in rural, Appalachian Virginia. SIPsmartER’s execution was supported by consultee-centered implementation strategies.MethodsIn this mixed-methods process evaluation, adoption and implementation indicators of the program and its implementation strategy (e.g., fidelity, feasibility, appropriateness, acceptability) were measured using tracking logs, delivery agent surveys and interviews, and fidelity checklists. Quantitative data were analyzed with descriptive statistics. Qualitative data were inductively coded.ResultsDelivery agents implemented SIPsmartER to the expected number of cohorts (n = 12), recruited 89% of cohorts, and taught 86% of expected small group classes with > 90% fidelity. The planned implementation strategies were also executed with high fidelity. Delivery agents completing the two-day training, pre-lesson meetings, fidelity checklists, and post-lesson meetings at rates of 86, 75, 100, and 100%, respectively. Additionally, delivery agents completed 5% (n = 3 of 66) and 10% (n = 6 of 59) of teach-back and missed class calls, respectively. On survey items using 6-point scales, delivery agents reported, on average, higher feasibility, appropriateness, and acceptability related to delivering the group classes (range 4.3 to 5.6) than executing missed class and teach-back calls (range 2.6 to 4.6). They also, on average, found the implementation strategy activities to be helpful (range 4.9 to 6.0). Delivery agents identified strengths and weakness related to recruitment, lesson delivery, call completion, and the implementation strategy.ConclusionsIn-person classes and the consultee-centered implementation strategies were viewed as acceptable, appropriate, and feasible and were executed with high fidelity. However, implementation outcomes for teach-back and missed class calls and recruitment were not as strong. Findings will inform the future full-scale dissemination and implementation of SIPsmartER, as well as other evidence-based interventions, into rural health districts as a means to improve population health.

An Interactive Voice Response and Text Message Intervention to Improve Blood Pressure Control Among Individuals With Hypertension Receiving Care at an Urban Indian Health Organization: Protocol and Baseline Characteristics of a Pragmatic Randomized Controlled Trial.

BackgroundEfficient and effective strategies for treating chronic health conditions such as hypertension are particularly needed for under-resourced clinics such as Urban Indian Health Organizations (UIHOs).ObjectiveThe objective of the Controlling Blood Pressure Trial is to assess the impact of an interactive voice response and text message (IVR-T) intervention compared with usual care among individuals with hypertension receiving care at a UIHO in Albuquerque, New Mexico. This manuscript presents the baseline characteristics of individuals enrolled in the trial and compares their characteristics with those in the hypertension registry who did not enroll in the trial.MethodsA hypertension registry developed from the clinic’s electronic health record was used for recruitment. Potentially eligible participants were contacted by letter and then by phone. Those who expressed interest completed an in-person baseline visit that included a baseline survey and blood pressure measurement using standardized procedures. Individuals randomized to the intervention group could opt to receive either automated text messages or automated phone calls in either English or Spanish. The messages include reminders of upcoming appointments at First Nations Community HealthSource, requests to reschedule recently missed appointments, monthly reminders to refill medications, and weekly motivational messages to encourage self-care, appointment keeping, and medication taking for hypertension. Individuals in the IVR-T arm could opt to nominate a care partner to also receive notices of upcoming and missed appointments. Individuals in the IVR-T arm were also offered a home blood pressure monitor. Follow-up visits will be conducted at 6 months and 12 months.ResultsOver a 9.5-month period from April 2017 to January 2018, 295 participants were enrolled from a recruitment list of 1497 individuals. The enrolled cohort had a mean age of 53 years, was 25.1% (74/295) American Indian or Alaska Native and 51.9% (153/295) Hispanic, and 39.0% (115/295) had a baseline blood pressure greater than or equal to 140/90 mmHg. Overall, the differences between those enrolled in the trial and patients with hypertension who were ineligible, those who could not be reached, or those who chose not to enroll were minimal. Enrolled individuals had a slightly lower blood pressure (129/77 mmHg vs 132/79 mmHg; P=.04 for systolic blood pressure and P=.01 for diastolic blood pressure), were more likely to self-pay for their care (26% vs 10%; P<.001), and had a more recent primary care visit (164 days vs 231 days; P<.001). The enrolled cohort reported a high prevalence of poor health, low socioeconomic status, and high levels of basic material needs.ConclusionsThe Controlling Blood Pressure Trial has successfully enrolled a representative sample of individuals receiving health care at a UIHO. Trial follow-up will conclude in February 2019.Trial RegistrationClinicalTrials.gov NCT03135405; http://clinicaltrials.gov/ct2/show/NCT03135405 (Archived by WebCite http://www.webcitation.org/76H2B4SO6)International Registered Report Identifier (IRRID)DERR1-10.2196/11794

04:21 PM Abstract No. 42 Utilization of an automated phone call reminder system for an ambulatory interventional radiology clinic: a quality improvement initiative

The purpose of this quality improvement project was to assess the use of an automated phone call reminder system on the number of patient “no shows” and cancellations in an ambulatory IR clinic. Our institution opened an ambulatory IR clinic on December 1, 2016. At the outset, patients received a letter in the mail approximately two weeks prior to their appointment. In order to improve the number of patients arriving for their appointments, we sent a series of automated phone calls to patients to remind them about their clinic appointments. To assess the efficacy of the automated phone calls, we performed a review of all clinic appointments that occurred both prior to and after the initiation of the automated phone call system. All appointments in the sampling period were categorized as either “arrived,” “early cancellation” (>48h notice), “late cancellation” (<48h notice), or “no shows.” The rates of arrivals, early cancellations, late cancellations, and no shows between the pre- and post-intervention periods was compared. There were a total of 1,489 individual clinic appointments during the sampling period. In the pre-intervention period, 51.1% of patients (n=495) arrived, 23.9% (n=232) cancelled late, 18.7% (n=181) cancelled early, and 6.3% (n=61) did not show up for their appointment. In the post-intervention period, 49.8% of patients (n=259) arrived, 19.4% (n=101) cancelled early, 17.1% (n=89) cancelled late, and 13.7% (n=71) did not show up for their appointment. There was no statistically significant difference in the rates of arrived patients (p=0.86) or patients who cancelled early (p=0.73) between the two groups. There was a statistically significant decrease in late cancellations (p=0.002). The implementation of automated reminder phone calls to patients prior to their scheduled appointment did result in a decrease in the number of late cancellations but no changes to the rates of arrived, early cancellations, or no-show appointments.

Engaging family supporters of adult patients with diabetes to improve clinical and patient-centered outcomes: study protocol for a randomized controlled trial

BackgroundMost adults with diabetes who are at high risk for complications have family or friends who are involved in their medical and self-care (“family supporters”). These family supporters are an important resource who could be leveraged to improve patients’ engagement in their care and patient health outcomes. However, healthcare teams lack structured and feasible approaches to effectively engage family supporters in patient self-management support. This trial tests a strategy to strengthen the capacity of family supporters to help adults with high-risk diabetes engage in healthcare, successfully enact care plans, and lower risk of diabetes complications.Methods/designWe will conduct a randomized trial evaluating the CO-IMPACT (Caring Others Increasing EnageMent in Patient Aligned Care Teams) intervention. Two hunded forty adults with diabetes who are at high risk for diabetes complications due to poor glycemic control or high blood pressure will be randomized, along with a family supporter (living either with the patient or remotely), to CO-IMPACT or enhanced usual primary care for 12 months. CO-IMPACT provides patient-supporter dyads: it provides one coaching session addressing supporter techniques for helping patients with behavior change motivation, action planning, and proactive communication with healthcare providers; biweekly automated phone calls to prompt dyad action on new patient health concerns; phone calls to prompt preparation for patients’ primary care visits; and primary care visit summaries sent to both patient and supporter. Primary outcomes are changes in patient activation, as measured by the Patient Activation Measure-13, and change in 5-year cardiac event risk, as measured by the United Kingdom Prospective Diabetes Study cardiac risk score for people with diabetes. Secondary outcomes include patients’ diabetes self-management behaviors, diabetes distress, and glycemic and blood pressure control. Measures among supporters will include use of effective support techniques, burden, and distress about patient’s diabetes care.DiscussionIf effective in improving patient activation and diabetes management, CO-IMPACT will provide healthcare teams with evidence-based tools and techniques to engage patients’ available family or friends in supporting patient self-management, even if they live remotely. The core skills addressed by CO-IMPACT can be used by patients and their supporters over time to respond to changing patient health needs and priorities.Trial registrationClinicalTrials.gov, NCT02328326. Registered on 31 December 2014.

Abstract C74: Developing and implementing an mHealth intervention for cervical cancer prevention in Santiago, Chile

Abstract Introduction: Cervical cancer is a serious public health problem. An estimated 270,000 women die every year from cervical cancer and more than 85% of these deaths take place in developing countries. Chile´s national cervical cancer program was created in 1987. Since then, and with the systematic implementation of cervical cancer screening through Papanicolau (Pap) smears, cervical cancer mortality rates have dropped significantly. Cancer screening rates, however, have stabilized in the last 10 years at approximately 59%. Additionally, most late-stage cervical cancers are diagnosed in low-socioeconomic-status (SES) Latinas. Mobile technologies may have use in improving health disparities due to their widespread availability. In Chile, more than 80% of low-SES people own a cell phone. Nevertheless, developing an effective mHealth intervention may require tailoring and adjusting of available technology in developing countries. The aim of this study was to describe key aspects of an mHealth intervention to be used in Latinas from an underserved area of Santiago, Chile. Methods: We held 9 focus groups at three health care centers with Latinas between 25-64 years old and midwives. Focus groups were recorded, and transcribed verbatim. We analyzed and coded the data grouping findings into relevant themes. With these findings, we developed a customized mHealth intervention that is now being tested using a randomized controlled trial (RCT) in a vulnerable area of Santiago, Chile. Results: Development: The results of our study revealed key aspects to consider for the final intervention: We asked about mode of delivery, content, frequency, and duration of the ideal intervention. Mode of delivery: Although younger women preferred texting and other “indirect” modes of communication, older women were not as savvy with reading texts--their preferred method of contact was a phone call. Content: Women agreed that messages needed to be clear and written in simple language. They would like the messages to have information about cervical cancer, as well as Pap smear availability at their health care centers. Frequency and duration of the intervention: Women mentioned the messages should be sent every week and no more than two times a week. They would like the messages to alternate being sent during weekends and weekday evenings to allow for sufficient time to read them. Previous studies had shown that a duration of 6 months would be effective to promote change in screening behavior. The final intervention was designed with the following characteristics: 1. Four months of text messages and two months of automated phone calls; 2. Twice a week on Wednesday and Sunday evenings; 3. Two types of messages: Information about cervical cancer and clinic hours, scheduling procedures, etc. Implementation: We planned to deliver the text and phone messages using a custom web platform connected to a generic SMS gateway provider. Lack of close relations between two such providers and Chilean mobile carriers generated profound disruptions in the reliability with which messages were sent during testing. After an iterative trial-and-error we settled for our current provider, which is delivering messages for our clinical trial without major issues. Conclusions: Developing and implementing an effective mHealth intervention requires tailoring according to cultural, socioeconomic, and educational characteristics of the population as well as knowledge of the technology available in every country. Transferring technologies proven easy to implement in developed countries is not as straightforward as it may seem. Our intervention is currently being tested through a RCT in a vulnerable population of Santiago, Chile. We hope to learn more about the implementation of such technologies in vulnerable populations, thus improving cancer screening rates across the country. Citation Format: Javiera Martinez Gutierrez, Daniel Capurro, Francis Ciampi, Mauricio Soto, Mackenzie C. Momany, Emilia Cea, Tania Mergudich, Klaus Puschel. Developing and implementing an mHealth intervention for cervical cancer prevention in Santiago, Chile [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C74.

Automated Telephone Follow-up for Smoking Cessation in Smokers With Coronary Heart Disease: A Randomized Controlled Trial.

Smokers with coronary heart disease (CHD) benefit from in-hospital cessation treatment, but relapse is common without ongoing support postdischarge. The purpose of this study was to determine if smoking abstinence would be higher after hospital discharge in smokers who received automated telephone follow-up (ATF) and nurse-counseling, compared with a standard care (SC) control group. A total of 440 smokers hospitalized with CHD were randomly assigned to the ATF group (n = 216) or to the SC group (n = 224). Participants in the ATF group received automated phone calls 3, 14, 30, 60, 90, 120, 150, and 180 days after hospital discharge. The ATF system posed questions concerning smoking status, confidence in staying smoke-free, and need for assistance. If flagged by the ATF system, a nurse-counselor provided additional counseling by phone. Self-reported continuous smoking abstinence was assessed 26 and 52 weeks postdischarge using intention-to-treat analysis. The main outcome measure was continuous abstinence for weeks 1-26 postdischarge. Participants in the ATF group achieved higher abstinence rates for weeks 1-26 than those in the SC group (odds ratio [OR] = 1.53, 95% confidence interval [CI] = 1.01 to 2.33). There was no significant difference between groups in abstinence rates for weeks 27-52 (OR = 1.37; 95% CI = 0.89 to 2.09). ATF-mediated follow-up helped smokers with CHD achieve abstinence during the intervention period. There was a trend toward clinically important improvements for weeks 27-52; but between-group differences for this time point did not achieve statistical significance. NCT00449852. Automated telephone follow-up exerts its effect by reinforcing participants' efforts to be smoke-free and by proactively linking people requiring assistance to individualized support (eg, telephone counseling). This study shows that automated telephone follow-up can assist smokers with CHD in remaining smoke-free; however, the success of automated telephone follow-up is limited to the treatment period and abstinence rates after the treatment period were not statistically different from among those receiving standard care. Extended treatment via automated telephone follow-up may provide a solution to extend cessation assistance beyond hospital discharge.