Patient Reminders Research Articles

Determining the Content of a Melanoma Prevention and Care Mobile Application for Melanoma Patients: A Survey Study.

Skin cancer is one of the most common cancers and melanoma is the deadliest type of skin cancer. Since the Mobile based health interventions have significant effects in the management of diseases. This study aimed to determining the content of melanoma prevention and care application. This is a descriptive study that was conducted in three stages. at first, in order to identify the features of the application, search was conducted based on PubMed, Google Scholar ، Scopus databases. In the second step, in order to determine the content of information, articles and guidelines related to melanoma were searched. In the third stage, in order to ensure the validity of researcher-made questionnaire, a survey was conducted by 51 experts based on targeted sampling. The collected data were analyzed. demographic and clinical information and melanoma prevention training was common in 14 reviewed applications; The possibility of sending reminders for patients was less considered. Most of the articles have paid attention to the data elements: age, gender, history of sunburn, skin color and history of cancer, exposure to ultraviolet rays, how to care for the skin. The content of the melanoma prevention and care application consists of three general sections: 1- Demographic, clinical information and melanoma risk factors; 2- Educational needs; 3- Features and capabilities of the application for prevention and care were formed. The results of the expert survey showed that 81% of the section1, 80% of the section2, and 91% of the section3 were approved. Mobile applications has an effective role in disease management and accelerating the provision of health services and reducing the costs of providing services. Melanoma prevention and care application can be an aid in patient education and ultimately better disease management in the field of prevention and care during the current crisis.

Electronic health record and primary care physician self-reported quality of care: a multilevel study in China

ABSTRACT Background Health information technology is one of the building blocks of a high-performing health system. However, the evidence regarding the influence of an electronic health record (EHR) on the quality of care remains mixed, especially in low- and middle-income countries. Objective This study examines the association between greater EHR functionality and primary care physician self-reported quality of care. Methods A total of 224 primary care physicians from 38 community health centres (CHCs) in four large Chinese cities participated in a cross-sectional survey to assess CHC care quality. Each CHC director scored their CHC’s EHR functionality on the availability of ten typical features covering health information, data, results management, patient access, and clinical decision support. Data analysis utilised hierarchical linear modelling. Results The availability of five EHR features was positively associated with physician self-reported clinical quality: share records online with providers outside the practice (β = 0.276, p = 0.04), access records online by the patient (β = 0.325, p = 0.04), alert provider of potential prescription problems (β = 0.353, p = 0.04), send the patient reminders for care (β = 0.419, p = 0.003), and list patients by diagnosis or health risk (β = 0.282, p = 0.04). However, no association was found between specific features availability or total features score and physician self-reported preventive quality. Conclusions This study provides evidence that the availability of EHR systems, and specific features of these systems, was positively associated with physician self-reported quality of care in these 38 CHCs. Future longitudinal studies focused on standardised quality metrics, and designed to control known confounding variables, will further inform quality improvement efforts in primary care.

Motion Based Message Conveyer and Prescription Reminder for Paralytic Patients

Motion Based Message Conveyer and Prescription Reminder for Paralytic Patients

Strategies to Increase Cervical Cancer Screening With Mailed Human Papillomavirus Self-Sampling Kits

Optimal strategies for increasing cervical cancer screening may differ by patient screening history and health care setting. Mailing human papillomavirus (HPV) self-sampling kits to individuals who are overdue for screening increases adherence; however, offering self-sampling kits to screening-adherent individuals has not been evaluated in the US. To evaluate the effectiveness of direct-mail and opt-in approaches for offering HPV self-sampling kits to individuals by cervical cancer screening history (screening-adherent and currently due, overdue, or unknown). Randomized clinical trial conducted in Kaiser Permanente Washington, a US integrated health care delivery system. Individuals aged 30 to 64 years with female sex, a primary care clinician, and no hysterectomy were identified through electronic health records (EHRs) and enrolled between November 20, 2020, and January 28, 2022, with follow-up through July 29, 2022. Individuals stratified as due (eg, at the time of randomization, these individuals have been previously screened and are due for their next screening in ≤3 months) were randomized to receive usual care (patient reminders and clinician EHR alerts [n = 3671]), education (usual care plus educational materials about screening [n = 3960]), direct mail (usual care plus educational materials and a mailed self-sampling kit [n = 1482]), or to opt in (usual care plus educational materials and the option to request a kit [n = 3956]). Individuals who were overdue for screening were randomized to receive usual care (n = 5488), education (n = 1408), or direct mail (n = 1415). Individuals with unknown history for screening were randomized to receive usual care (n = 2983), education (n = 3486), or to opt in (n = 3506). The primary outcome was screening completion within 6 months. Primary analyses compared direct-mail or opt-in participants with individuals randomized to the education group. The intention-to-treat analyses included 31 355 randomized individuals (mean [SD] age, 45.9 [10.4] years). Among those who were due for screening, compared with receiving education alone (1885 [47.6%]), screening completion was 14.1% (95% CI, 11.2%-16.9%) higher in the direct-mail group (914 [61.7%]) and 3.5% (95% CI, 1.2%-5.7%) higher in the opt-in group (2020 [51.1%]). Among individuals who were overdue, screening completion was 16.9% (95% CI, 13.8%-20.0%) higher in the direct-mail group (505 [35.7%]) compared with education alone (264 [18.8%]). Among those with unknown history, screening was 2.2% (95% CI, 0.5%-3.9%) higher in the opt-in group (634 [18.1%]) compared with education alone (555 [15.9%]). Within a US health care system, direct-mail self-sampling increased cervical cancer screening by more than 14% in individuals who were due or overdue for cervical cancer screening. The opt-in approach minimally increased screening. To increase screening adherence, systems implementing HPV self-sampling should prioritize direct-mail outreach for individuals who are due or overdue for screening. For individuals with unknown screening history, testing alternative outreach approaches and additional efforts to document screening history are warranted. ClinicalTrials.gov Identifier: NCT04679675.

Effects of Academic Detailing, Panel Management and Mailed Multi-Target Stool-DNA Testing on Colorectal Cancer Screening.

Academic detailing, patient-panel management, and mailed, stool-based testing have each been utilized to increase colorectal cancer (CRC) screening in rural clinics. The effectiveness of combining these interventions to increase CRC screening during COVID-19 restrictions was unclear. We explored the effects of a multi-component intervention including academic detailing, active patient panel management, and mailed MT-sDNA testing on colorectal cancer screening in our rural family medicine clinic. Baseline interventions included EMR-based provider alerts and mailed patient reminders. Our intervention (March-May 2020) and follow-up periods (June-August 2020) coincided with the initial COVID-19 surge, giving us the opportunity to observe the effects of our intervention during COVID-19 restrictions. A total of 407 patients were eligible and overdue for colorectal cancer screening. Our clinic's CRC screening rate increased significantly after intervention (69.7%) as compared with before (64.3%) (P = <0.01; 95%CI = 5.39-5.4). Our clinic's CRC screening rates increased significantly during the initial 3 months of the COVID-19 surge (67.8%) compared with the same period the prior year. (62.3%) (P = .003; 95%CI = 3.4-7.6). Our CRC screening rates increased after intervention (69.7%) compared with our regional health system (67%) (P = <0.01; 95%CI = 2.6-2.77). Our weekly stool-based CRC screening increased (94% increase) compared with other health systems nationally (61 to 83% decrease). A multi-component intervention, including academic detailing, panel management, and mailed MT-sDNA testing, can lead to significant increases in CRC screening in a rural family medicine clinic, empowering providers to maintain an effective CRC screening outreach during COVID-19 related restrictions.

Characteristics of Anemic Pregnant Women Receiving SMS Intervention on Iron Supplement Consumption

The case of maternal deaths due to anemia is increasing. The high level of anemia is caused by a lack of compliance in taking iron supplements. SMS (Short Message Service) features on mobile phones can be used as reminders for patients to take iron supplements. This research aims to describe the characteristics of anemic pregnant women who receive SMS interventions regarding iron supplement consumption. This study uses a descriptive research design conducted in 7 community health centers in the city of Makassar. The sampling technique uses purposive sampling and a total of 68 pregnant women were included (33 received SMS intervention and 35 did not receive SMS intervention). The research involving 33 anemic pregnant women shows that 48.5% are between 17 and 25 years old, and 51.5% have completed high school. Most are unemployed (81.8%), with sufficient husband support (45.5%). Most of them are in the second trimester (57.6%), with the highest parity being multiparous (45.5%) with only one ANC visit (42.4%), and have moderate anemia (51.5%). This study concludes that the respondents are classified as having moderate anemia, multipara, and having only one ANC visit. Regarding socioeconomic status, most of them have completed high school, unemployed, and receive sufficient support from their husbands.&#x0D; Keywords: Anemia, Iron Supplement, SMS Intervention

Transplant Nephrologists' Preferences for Clinical Decision Support for APOL1 Genetic Testing of Living Kidney Donors: A Focus Group Study.

Key Points Opportunities exist for clinical decision support (CDS) to help transplant nephrologists counsel living donors receiving apolipoprotein L1 (APOL1) genetic test results.CDS for APOL1 genetic test results should provide access to patient education materials and reminders at follow-up appointments.Optimal APOL1 CDS would notify providers when results are available, provide information on follow-up appointments, and provide access to patient education materials. Podcast This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2023_12_01_KID0000000000000265.mp3

Automatic 1-year follow-up appointment creation and reminders can improve long-term follow-up after carotid revascularization

BackgroundLong-term follow-up (LTFU) following carotid revascularization is important for post-surgical care, stroke risk optimization and post-market surveillance of new technologies. MethodsWe instituted a quality improvement project to improve LTFU rates for carotid revascularizations (primary outcome) by scheduling perioperative and one-year follow-up appointments at time of surgery discharge. A temporal trends analysis (Q1 2019 through Q1 2022), multivariable regression, and interrupted time series (ITS) were performed to compare pre-post intervention LTFU rates. Results269 consecutive patients were included (151 pre-intervention, 118 post-intervention; mean 71 ​± ​12 years-old, 39% female, 77% White). The overall LTFU rate improved (64.9%–78.8%; P ​= ​0.013) after the intervention. After controlling for patient factors, procedures performed after the intervention were associated with increased odds of being seen for 1-year follow-up (OR: 2.2 95%CI: 1.2–4.0). Quarterly ITS analysis corroborated this relationship (P ​= ​0.01). ConclusionsTime-of-surgery appointment creation and automated patient reminders can improve LTFU rates following carotid revascularizations.

Factors Affecting Glaucoma Medication Adherence and Interventions to Improve Adherence: A Narrative Review.

Glaucoma is a leading cause of vision loss. First line therapy for primary open angle glaucoma (POAG) are topical ocular hypotensive drops. Patient adherence with topical therapy for glaucoma is a significant challenge with a reported adherence of 60%. The purpose of this review is to discuss factors associated with glaucoma adherence (including demographic factors, cost, patient education, health beliefs, treatment burden and regimen, and physical limitations) and to explore potential interventions to improve medication adherence. Articles included in this review were found by searching PubMed and Google Scholar using the key words "Glaucoma Treatment Adherence" and "Glaucoma Treatment Compliance." Data from this review demonstrates that higher medication cost, lower patient education/literacy levels, and being of African and Hispanic descent are associated with lower medication adherence rates. The data is inconclusive on whether medication regimen complexity lowers patient medication adherence rates. Interventions that have successfully improved medication adherence rates for minority patients have focused on building trust and addressing fears and false beliefs. For cost, explicit physician communication to patients regarding medication cost is important and can help the physician determine any patient concerns about cost. Outside the USA, adherence has been improved through adherence-contingent rebate systems and government subsidies. Most interventions that aim to increase adherence target patient education and literacy with the following interventions demonstrating efficacy: written instructions targeting glaucoma-specific health literacy, literacy level appropriate glaucoma education videos, and interactive and personalized educational programs. More clinic infrastructure and programs that utilize patient reminder tools and patient educators could help physicians and patients in support of these personalized action plans.

Exploring intelligent hospital management mode based on artificial intelligence.

To address the challenges posed by the COVID-19 pandemic, our hospital developed an intelligent hospital management mode specifically tailored to COVID-19 patients. This study included patients with confirmed diagnosis of COVID-19 admitted to our hospital between January 2020 to December 2022. We sought to explore intelligent hospital management mode based on artificial intelligence (AI) and new technologies such as 5G, Internet of Things (IoT), wearable devices, robots, and small programs. Intelligent hospital management mode can help improve the quality of life of patients, while also improving the management ability of the hospital, as it can automatically deliver timely patient reminders, maintain environmental cleanliness, and help in the transportation of medical equipment without any manual labor. This can help in conserving time and reducing the workload of medical staff. Moreover, itcan help intellectualize patient admission, patient discharge, and hospital management, thereby helping in providing efficient medical and patient humanistic care. The development of intelligent management mode can reduce the burden of medical personnel and the probability of developing infection and bring about timely and better patient care. Intelligent management can play a pivotal role in control of the epidemic, treating patients, allocation of resources, tracing the root cause of the virus, and monitoring.

Impact of a patient reminder letter from their general practitioners on influenza vaccination: A quasi-experimental study in Paris, France

BackgroundSeasonal influenza vaccination coverage levels remain too low in many countries.ObjectivesThis study aimed to evaluate the impact of a reminder letter from their general practitioner (GP) on patients’ influenza vaccination.MethodsEligible patients for this controlled non-randomised study were the vulnerable categories targeted by the 2019–2020 national health insurance fund (NHIF) vaccination campaign, on the lists of 14 GPs from three practices in Paris (France) and unvaccinated on January 2, 2020 (mid-campaign). The choice of practices and assigning five GPs to the intervention arm were made for convenience. At mid-campaign, GPs in the intervention arm sent a standardised letter reminding each eligible patient to be vaccinated. In the control arm, GPs worked as usual. The intervention effect, calculated from the NHIF databases, was estimated by the difference between the groups in their vaccination coverage at the end of the campaign, with a linear mixed model adjusted for age, sex, chronic disease (at the patient level) and medical practice (at the GP level).ResultsThe vaccination coverage at the end of the campaign was 14.7% in the intervention group (n = 317) and 1.7% in the control group (n = 493): a difference of 13.1% points (95% confidence interval [9.0–17.2], number needed to send 7.7). At the campaign’s end, vaccination coverage among patients from the lists of GPs in the intervention arm was 62.7%, and 46.2% among patients from the control-arm GP lists.ConclusionReminder letters could help increase influenza vaccination coverage.

Bridging the care gap: Harnessing telehealth for enhanced care access among adults with chronic health conditions in South-Eastern Nigeria

Introduction: Telehealth is a term that refers to the use of information communication technology to access both clinical and non-clinical health services. It bridges the long-distance barrier between the patient and the clinician. It allows for patient care, advice, reminders, education, intervention, monitoring, and remote admission. The objective of this study is to determine the use of telehealth for health care by adults with chronic health conditions among households in an urban community in South-Eastern Nigeria. Methods: This is a cross-sectional survey. Data was collated using an interviewer-administered questionnaire. Results were analyzed using SPSS version 25. Results: Their mean age was 39.9years with a range of 19 – 95years. Overall, 83.9% of the participants were aware of telehealth while 37.3% had a good knowledge of telehealth. 64% of the respondents had used telehealth before, and 38.7% of users used telehealth in emergencies only. 95.9% of the respondents owned either a phone or a laptop and speaking with a doctor or nurse on the phone about current health status was the commonest form of telehealth used by respondents [128(58.98%)]. Furthermore, the commonest facilitator to participants’ use of telehealth was level of computer literacy, while the commonest barrier noted was poor mobile network. There was statistically significant relationship between at least fair level of knowledge of telehealth and use of telehealth (P&lt;0.001). Discussion: To improve the awareness, level of knowledge and use of telehealth for healthcare, concerted efforts between individuals, health care professionals, telecommunication agencies, NGOs and the government is required.

A patient reminder to improve colorectal cancer screenings.

Colorectal cancer screenings detect the early, treatable, and often curable stages of the disease. Screenings are now recommended beginning at 45 years of age. Health care providers are expected to have patient's complete screenings, and reimbursement rates can be affected if results are not documented. An independent review of expected organizational core measures revealed inadequate colorectal cancer screenings completed and no formal patient outreach program for patients who had not completed ordered screenings. The lack of a formal reminder to patients resulted in a cumulative completion rate of 19%. A phone call intervention was designed to notify patients of the need to complete colorectal cancer screenings. A preimplementation and postimplementation design was used to compare completed colorectal cancer screenings. Patients with ordered colorectal cancer screenings received one reminder phone call to complete the screening. Preintervention and postintervention completion rates were evaluated using data from the electronic medical record. Results revealed a colorectal cancer screening rate of 19% preimplementation and 43% postimplementation and reflected a 61.9% increase in cumulative completion rates over a 12-week intervention period. The colorectal cancer patient reminder intervention showed clinical significance in improving completion rates of colorectal cancer screenings. The intervention was a successful method to improve patient compliance with the expected screening and helped improve provider core measure expectations.

Abstract 13: Barriers to Diagnostic Follow-Up for Women With a Suspicious Clinical Breast Examination at the Primary Health Center in Uttar Pradesh State in India: A Qualitative Study

Abstract Purpose: The purpose of this study was to understand key barriers to diagnostic follow-up for women with a suspicious clinical breast examination (CBE) at the primary care level in Uttar Pradesh (UP) state in India. We also explored acceptability of the use of mHealth strategies to address barriers to CBE follow up for women. Methods: We conducted 28 in-depth individual interviews with key stakeholders involved in the Breast Health Initiative in Lucknow district, UP. Primary health facilities in rural and urban settings were purposively selected based on the number of CBE screening exams conducted in the last year and the number of women with a suspicious CBE identified. We interviewed six women with a suspicious CBE at the primary health facility who did not have diagnostic follow-up, six community health workers (ASHAs), six healthcare providers from primary health facilities and four district or state-level health decisionmakers. Interviews were audio-recorded and transcribed verbatim. Coding and thematic analysis will proceed once translation of the full dataset of transcripts is complete. Results: Preliminary analyses of qualitative interviews found that cancer stigma and fear are significant barriers to both breast screening and follow-up of an abnormal CBE. Male providers and long waits at the district hospital are barriers to completing confirmatory diagnostic exams. Providers maintain that, despite community education and outreach efforts by ASHAs, lack of awareness of breast cancer and the importance of follow-up for abnormal CBE remains a barrier to early detection. Conclusion: Knowledge barriers, cultural barriers, and health system barriers challenge women’s ability to follow recommendations for diagnostic follow-up of an abnormal CBE in Uttar Pradesh, India. Multi-level strategies are needed to address these barriers. Our findings will help inform the content and approach of an mHealth patient navigation strategy that could include patient education, reminders, patient tracking, and care coordination. Citation Format: Erica Liebermann, Gulnoza Usmanova, Nadeem Akhtar, Shivani Agrawal, Vaibhav Patwardhan, Parag Bhamare, Somesh Kumar. Barriers to Diagnostic Follow-Up for Women With a Suspicious Clinical Breast Examination at the Primary Health Center in Uttar Pradesh State in India: A Qualitative Study [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 13.

Factors influencing the participation of groups identified as underserved in cervical cancer screening in Europe: a scoping review of the literature.

Cervical cancer is a preventable and inequitably distributed disease. Screening plays a vital role in prevention, but many women face barriers to participation. The aims of this scoping review, undertaken to inform the co-design of interventions to equitably increase screening uptake, were to: (1) identify barriers and facilitators to cervical cancer screening for underserved populations, and (2) identify and describe the effectiveness of interventions aimed at improving participation in cervical cancer screening among underserved groups in Europe. Qualitative, quantitative, and mixed methods studies focusing on barriers and facilitators to cervical screening participation and interventions to improve uptake undertaken in Europe and published after 2000 were included. Four electronic databases were searched to identify relevant papers. Titles and abstracts were screened, full text reviewed, and key findings extracted. Data were extracted and analyzed according to different health system strata: system-wide (macro), service specific (meso) and individual/community specific (micro). Within these categories, themes were identified, and the population groups impacted were recorded. All findings are presented in accordance with (PRISMA) guidelines. 33 studies on barriers and facilitators and eight intervention studies met the inclusion criteria. Collectively, the findings of these studies presented a wide array of screening uptake barriers, facilitators, and interventions, predominantly related to screening service and individual/community factors. However, although diverse, certain core themes around information provision, prompts for participation and the need for inclusive spaces were apparent. Implementation of screening programs should focus on: (1) reducing identifiable barriers, (2) increasing public awareness, and (3) providing patient reminders and measures to promote engagement by healthcare providers. There are many barriers to uptake of cervical cancer screening and this review, nested within a larger study, will inform work to devise a solution alongside groups identified in three European countries.

A provider survey of cystic fibrosis related diabetes screening and management practices at North American CF centers.

Cystic Fibrosis Foundation (CFF) Guidelines recommend annual screening for cystic fibrosis related diabetes (CFRD) with an oral glucose tolerance test (OGTT). However, screening rates remain consistently low. We conducted surveys of 1) US CF center directors and 2) Endocrinologists affiliated with the CFF-sponsored EnVision program to characterize CFRD screening practices, describe provider perceived barriers to screening, and identify strategies for improving screening. The surveys queried OGTT protocols, alternate screening strategies, and perceived barriers to screening. CF center characteristics and procedures for coordinating OGTTs were compared between centers achieving ≥50% versus <50% OGTT completion. Endocrinologists received additional questions regarding OGTT interpretation and management. The survey response rate was 18% (51/290) from CF Centers and 63% (25/40) from Endocrinologists. The majority (57%) of CF centers utilized 2 OGTT timepoints (0,120 min). The majority (72%) of Endocrinologists utilized 3 timepoints (0,60,120 min). Four percent of CF centers and 8% of Endocrinologists utilized other timepoints. Forty-nine percent of CF centers reported ≥50% OGTT completion in the past year. Completion of ≥50% OGTT was 5 times more likely when patient reminders were consistently provided (p = 0.017). Both CF Centers and Endocrinologists employed alternative screening strategies including HbA1c (64%, 92%), fasting plasma glucose (49%, 67%), continuous glucose monitoring (30%, 58%), and home fingerstick monitoring (55%, 50%). OGTT is the gold standard screening method for CFRD, but completion rates remain suboptimal, practice variation exists, and many providers utilize alternate screening strategies. Systematic reminders may improve completion rates. Studies to improve our approach to CFRD screening are urgently needed.

Colorectal cancer screening completion by patients due or overdue for screening after reminders: a retrospective study

BackgroundPatient and clinician reminders were implemented as part of an adherence improvement project at University of Florida (UF) Internal Medicine Clinics. We sought to assess colorectal cancer (CRC) screening completion rates among patients not up-to-date with screening following distribution of reminders and to identify characteristics correlated with screening outcomes.MethodsRetrospective chart review was performed for patients not up-to-date with CRC screening for whom at least one reminder (patient and/or clinician) was issued in June 2018. The primary endpoint, the completion of a CRC screening test, is characterized as the ratio of completed screening tests to the number of patients not up-to-date with screening. All analyses were performed using R 4.0 software.ResultsOf the 926 patients included, 403 (44%; 95% CI, 0.40–0.47) completed a CRC screening test within 24 months following a reminder. Family history of CRC (relative risk (RR) 1.33; P = 0.007), flu immunization within two years of the reminder (RR 1.23; P = 0.019), and receiving a patient reminder either alone (RR 1.62; P < 0.001) or in combination with a clinician reminder (RR 1.55; P = 0.006) were positively associated with CRC screening completion. Reporting being divorced, separated, or widowed was negatively associated with screening completion (RR 0.70; P = 0.004).ConclusionReminders, in particular patient reminders, seem to be an effective method to enhance screening among patients not up-to-date with CRC screening. This study suggests that reminder efforts should be focused at the level of the patients and provides insight on target populations for practical interventions to further increase CRC screening adherence.

Abstracts 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice”

Abstracts 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice”

Implementing Mailed Colorectal Cancer Fecal Screening Tests in Real-World Primary Care Settings: Promising Implementation Practices and Opportunities for Improvement

Colorectal cancer (CRC) screening reduces morbidity and mortality, but screening rates in the USA remain suboptimal. The Colorectal Cancer Control Program (CRCCP) was established in 2009 to increase screening among groups disproportionately affected. The CRCCP utilizes implementation science to support health system change as a strategy to reduce disparities in CRC screening by directing resources to primary care clinics to implement evidence-based interventions (EBIs) proven to increase CRC screening. As COVID-19 continues to impede in-person healthcare visits and compel the unpredictable redirection of clinic priorities, understanding clinics’ adoption and implementation of EBIs into routine care is crucial. Mailed fecal testing is an evidence-based screening approach that offers an alternative to in-person screening tests and represents a promising approach to reduce CRC screening disparities. However, little is known about how mailed fecal testing is implemented in real-world settings. In this retrospective, cross-sectional analysis, we assessed practices around mailed fecal testing implementation in 185 clinics across 62 US health systems. We sought to (1) determine whether clinics that do and do not implement mailed fecal testing differ with respect to characteristics (e.g., type, location, and proportion of uninsured patients) and (2) identify implementation practices among clinics that offer mailed fecal testing. Our findings revealed that over half (58%) of clinics implemented mailed fecal testing. These clinics were more likely to have a CRC screening policy than clinics that did not implement mailed fecal testing (p = 0.007) and to serve a larger patient population (p = 0.004), but less likely to have a large proportion of uninsured patients (p = 0.01). Clinics that implemented mailed fecal testing offered it in combination with EBIs, including patient reminders (92%), provider reminders (94%), and other activities to reduce structural barriers (95%). However, fewer clinics reported having the leadership support (58%) or funding stability (29%) to sustain mailed fecal testing. Mailed fecal testing was widely implemented alongside other EBIs in primary care clinics participating in the CRCCP, but multiple opportunities for enhancing its implementation exist. These include increasing the proportion of community health centers/federally qualified health centers offering mailed screening; increasing the proportion that provide pre-paid return mail supplies with the screening kit; increasing the proportion of clinics monitoring both screening kit distribution and return; ensuring patients with abnormal tests can obtain colonoscopy; and increasing sustainability planning and support.

Economic Evaluation of Mailed Home-Based Human Papillomavirus Self-sampling Kits for Cervical Cancer Screening

Human papillomavirus (HPV) self-sampling addresses barriers to cervical cancer screening, and mailed self-sampling kits have been reported to increase screening uptake. International research suggests mailed kits are cost-effective in certain settings. However, the cost-effectiveness of mailing HPV self-sampling kits for increasing screening uptake has not been evaluated in the US. To conduct an economic evaluation of a mailed HPV self-sampling intervention among underscreened women enrolled in an integrated US health care system. This economic evaluation involved a cost-effectiveness analysis of results from a randomized clinical trial of 19 851 women aged 30 to 64 years enrolled in a health plan from Kaiser Permanente Washington (KPWA), a US-based integrated health care system. Women were identified through electronic medical records, and eligible participants were enrolled in a health plan for at least 3 years and 5 months, had a primary care clinician, had not received a Papanicolaou test for at least 3 years and 5 months, and had not received a hysterectomy. Enrollment occurred from February 25, 2014, to August 29, 2016, with follow-up through February 25, 2018. The current economic evaluation was conducted between August 2, 2021, and July 30, 2022. Intervention delivery costs were calculated from both the KPWA and Medicare perspectives and were based on either wellness visit or Papanicolaou test-only visit costs. Participants in the control group received usual care, which comprised patient reminders and ad hoc outreach for screening. Participants in the intervention group received usual care plus a mailed HPV self-sampling kit. The primary economic outcome was the incremental cost-effectiveness ratio (ICER) for increased screening uptake, defined as the incremental difference in cost (intervention group minus control group) divided by the difference in the number of participants completing screening (intervention group minus control group) within 6 months of randomization. Among 19 851 women (mean [SD] age, 50.1 [9.5] years; 76.7% White), 9960 were randomized to the intervention group, and 9891 were randomized to the control group. Baseline ICERs ranged from $85.84 (95% CI, $85.68-$85.99) using KPWA wellness visits as the cost basis to $146.29 (95% CI, $146.20-$146.38) using Medicare Papanicolaou test-only visits as the cost source. Subgroups of participants aged 50 to 64 years and participants most recently overdue for screening achieved cost-effectiveness at lower levels of willingness to pay for an additional completed screening than other subgroups. In this economic evaluation, mailing HPV self-sampling kits to women overdue for cervical cancer screening was cost-effective for increased screening uptake relative to usual care. These results support mailing HPV kits as an efficient outreach strategy for increasing screening rates among eligible women in US health care systems.