Patient Reminders Research Articles

An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees

BackgroundScreening supports early detection and treatment of colorectal cancer (CRC). Provision of fecal immunochemical tests/fecal occult blood tests (FIT/FOBT) in primary care can increase CRC screening, particularly in populations experiencing health disparities. This study was conducted to describe clinical workflows for FIT/FOBT in Oregon primary care practices and to identify specific workflow processes that might be associated (alone or in combination) with higher (versus lower) CRC screening rates.MethodsPrimary care practices were rank ordered by CRC screening rates in Oregon Medicaid enrollees who turned age 50 years from January 2013 to June 2014 (i.e., newly age-eligible). Practices were recruited via purposive sampling based on organizational characteristics and CRC screening rates. Data collected were from surveys, observation visits, and informal interviews, and used to create practice-level CRC screening workflow reports. Data were analyzed using descriptive statistics, qualitative data analysis using an immersion-crystallization process, and a matrix analysis approach.ResultsAll participating primary care practices (N=9) used visit-based workflows, and four higher performing and two lower performing used population outreach workflows to deliver FIT/FOBTs. However, higher performing practices (n=5) had more established workflows and staff to support activities. Visit-based strategies in higher performing practices included having dedicated staff identify patients due for CRC screening and training medical assistants to review FIT/FOBT instructions with patients. Population outreach strategies included having clinic staff generate lists and check them for accuracy prior to direct mailing of kits to patients. For both workflow types, higher performing clinics routinely utilized systems for patient reminders and follow-up after FIT/FOBT distribution.ConclusionsPrimary care practices with higher CRC screening rates among newly age-eligible Medicaid enrollees had more established visit-based and population outreach workflows to support identifying patients due for screening, FIT/FOBT distribution, reminders, and follow up. Key to practices with higher CRC screening was having medical assistants discuss and review FIT/FOBT screening and instructions with patients. Findings present important workflow processes for primary care practices and may facilitate the implementation of evidence-based interventions into real-world, clinical settings.

Strategi Pemasaran Klinik Mata KMU Gresik Seabagai Pelayanan Kesehatan Mata


 
 KMU Gresik Main Eye Clinic is a medical eye health service with modern technology that specifically deals with eye problems such as cataracts, glaucoma, cornea, retina and refraction. The trend of eye clinics is increasing, so marketing activities are a management tool in today's business world. With the development of existing eye clinics, the eye clinic marketing strategy has become competitive. The dynamics of competition in seizing market opportunities are becoming tighter and increasingly felt. Each eye clinic has a different promotion strategy, namely in conveying information about products related to the services available. The formulation of this research problem consists of: 1. What are the marketing strategies being carried out by the KMU Gresik eye clinic in 2020 – 2023? 2. What innovative ideas can researchers provide to increase the target offering of KMU Gresik eye clinic services in 2023? This study aims to find out the marketing strategy carried out by the KMU Gresik eye clinic in 2020 – 2023. As well as provide ideas for innovation in the KMU Gresik eye clinic so that it is easy to achieve the target of eye health services. The research method used in this study is a qualitative research method with a descriptive approach. The research instruments used to collect data are observation, interviews, and documentation. The marketing strategy carried out by the KMU Gresik Eye Clinic is the first before sales (stakeholder visits, Education, Screening, Home visit, KMU Goest to school). The second is sales (health services at clinics, diagnostic examinations, doctor's examinations, medical procedures or outpatient care). The third is after sales (control reminders for post cataract surgery patients one day, one week, and one month.
 
 
 
 
 
 

Abstract PO-025: Implementing evidence-based interventions (EBI) to increase uptake of fecal immunochemical test (FIT) colorectal cancer (CRC) screening in Vulnerable Populations

Abstract Purpose: We partnered with a local Federally Qualified Health Center (FQHC) to test implementation of evidence-based interventions (EBI) promoting Fecal Immunochemical Test (FIT) CRC screening in an environment in which colonoscopy has been the prevailing screening strategy. We report on implementation adaptations and preliminary results. Background: Sociocultural and medical concerns are barriers to colonoscopy uptake in some populations. An additional barrier to CRC screening is system level capacity for colonoscopy that results in a back log of cases and long wait times. With Covid-19, the additional backlog in overdue CRC screening has underscored the need to expand FIT testing capacity to address screening needs and to pre-empt further racial/ethnic and SES disparities in CRC outcomes. This trial tests the unique and additive value of multiple EBIs for increasing CRC screening (primarily through FIT testing, but also colonoscopy when indicated) while evaluating the success of implementing these approaches. EBIs include the use of medical reminders, addressing the structural barriers (social determinants of health [SDOH]), and assistance from community health workers. Methods: Participants (3500), ages 45-75, were identified from a large FQHC in New Haven, CT and determined to be overdue for CRC screening. Participants were randomly assigned to one of the four arms of the study: 1) Provider reminder (overdue for CRC screening) only; 2) Provider Reminder + SDOH short message and one-size-fits all link to resources; 3) Provider Reminder + SDOH short message and offer for individualized navigation (trained navigators from local community) to address SDOH and other barriers; 4) Provider Reminder + offer to participate in a CRC educational program as phase 2 of the NCI's Screen to Save program (not an EBI). Preliminary data on uptake of CRC screening will be presented. Results: With input from stakeholders, we have: 1) lowered age eligibility from 50 to 45 to align with new guidelines; 2) expanded the target population to 2 additional satellite clinics, more than doubling the proposed study enrollment; 3) incorporated design changes in the patient reminders. The collaboration between research team and clinician stakeholders has been critical in minimizing disruptions to clinical workflow while assuring fidelity to the evidence-based interventions. Preliminary outcomes (within one month of intervention) on uptake of intervention across the 4 arms of the study, i.e., referral for CRC screening and test completion will be presented. Conclusion: The unique challenges of this urban community of primarily African American/Black, Hispanic/Latinx and/or low socioeconomic status individuals stem from the disproportionate burden of SDOH barriers. Findings will inform primary care setting implementation of EBIs to address the anticipated increase in disparities in CRC screening, exacerbated by COVID-19 changes in health care access and utilization, as well as the increased demand associated with the change in guidelines. Citation Format: Beth A. Jones, Sakinah C. Suttiratana, Sally A. DeGiovanni, Levita Y. Robinson, Michael J. Couturie, Denise Stevens, Monique K. Stefanou, Jose DeJesus, Eduardo Reyes, Jonathan Colon, Maryanne Cosgrove, Steven J. Parra. Implementing evidence-based interventions (EBI) to increase uptake of fecal immunochemical test (FIT) colorectal cancer (CRC) screening in Vulnerable Populations [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-025.

Abstract PO-067: Developing provider education to address barriers and reduce disparities in lung cancer screening and smoking cessation treatment among underserved patients

Abstract Introduction: Lung cancer is a major public health problem in the US and disparities exist in lung cancer burden and lung cancer screening (LCS) utilization. African Americans (AA) have the highest lung cancer incidence and mortality compared to other racial and ethnic groups; however, LCS rates were lower among AAs compared to Whites under the 2013 United States Preventive Services Task Force (USPSTF) guidelines. While the expanded 2021 USPSTF criteria will significantly raise the number of AAs eligible for LCS, methods to increase rates of LCS among AA patients will still be needed. We describe the development of the first provider educational tool that focuses on barriers to reduce disparities in LCS. Methods: We completed qualitative interviews with primary care providers (N=9) and AA patients eligible for LCS (N=8; 4 screened, 4 unscreened) to assess barriers to LCS and tobacco cessation. Interviews were recorded and analyzed for common themes, which led to the development of the provider intervention. Results: Among patients, common barriers to LCS were a lack of information on the LCS procedure and associated costs, fear of the results, and transportation issues. Patient barriers to utilization of evidence-based cessation treatments included tobacco use stigma, cost of cessation aids, and inconsistent provider communication. Providers acknowledged time constraints during patient visits, lack of standardized training on documenting tobacco use, and the required LCS shared-decision making conversation as barriers to providing LCS referrals and cessation treatment. Both providers and patients noted that LCS rates may be increased by providing patient-facing information on the screening process and by facilitating provider referrals, which are essential for LCS. Based on these findings, we developed a self-directed 30-minute e-learning Health Disparities module that addresses: 1) disparities in the burden of lung cancer; 2) disparities in smoking patterns and utilization of evidence-based smoking cessation treatments; 3) patient barriers to LCS; and 4) resources for providers to address common LCS barriers (e.g., patient reminders to support scheduling the scan, offering transportation options). Experts in health disparities (N=6) and LCS (N=9) provided detailed critiques of the module content and presentation. Conclusions: We identified barriers to LCS and tobacco cessation from the perspectives of providers and AA patients. These findings informed the development of a brief web-based provider educational module to raise awareness about lung cancer and tobacco-related disparities and to provide resources to reduce barriers in diverse patient populations. We have begun a RCT to compare the Health Disparities module to an existing provider module on LCS to evaluate the impact on primary care providers' knowledge, attitudes, and LCS referrals of AA and White patients. These findings will provide preliminary evidence on provider education that can be easily disseminated to address health disparities in LCS and smoking cessation treatments. Citation Format: Laney Smith, Daisy Dunlap, Randi Williams, Andrea Shepherd, Allison Windels, Maria Geronimo, Vicky Parikh, Chavalia J. Breece, Namita Puran, Eric Anderson, Lucile Adams-Campbell, Kathryn Taylor. Developing provider education to address barriers and reduce disparities in lung cancer screening and smoking cessation treatment among underserved patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-067.

Pharmacists\u2019 and patients\u2019 perceptions about the importance of pharmacist services types to improve medication adherence among patients with diabetes in Indonesia

BackgroundVarious pharmacist services are available to improve medication adherence, including consultation, brochure, etc. Challenges arise on which services are best implemented in practice. Knowledge about patients’ and pharmacists’ preferences can help to prioritize services. This study explores the pharmacists’ and patients’ perceptions about the importance of pharmacist services to improve medication adherence among patients with diabetes in Indonesia.MethodsThis questionnaire-based cross-sectional study involved adult outpatients with diabetes type 2 and pharmacists from community health centers (CHCs) and hospitals in Surabaya, Indonesia. Random sampling was used to identify 57 CHCs in the study. In addition, based on convenient sampling, three hospitals participated. All pharmacists working at the CHCs and hospitals, who were willing to participate, were included in the study. For patients, minimum sample size was calculated using Slovin’s formula.Patients and pharmacists were asked to rank five pharmacist service types (consultation, brochure/leaflet, patient group discussion, medication review, and phone call refill reminder) according to their importance to improve medication adherence. A face validity test of the self-developed questionnaire was conducted before the data collection. Rank ordered probit models were estimated (STATA 15th software).ResultsA total of 457 patients from CHCs, 579 patients from hospitals, and 99 pharmacists from both medical facilities were included. Consultation (CHC patients 56.0% vs hospital patients 39.7% vs pharmacists 75.2%) and brochure (CHC patients 23.2% vs hospital patients 27.5% vs pharmacists 11.9%) were the most preferred pharmacist services. Patients with experience getting medication information from pharmacists valued consultation higher than brochure and patient group discussions. Older patients ranked a brochure higher than other services. Patients without formal education in CHCs had a lower probability of giving a high rank to a brochure to improve medication adherence. There was significant positive correlation between the ranking of phone call refill reminder and medication review (0.6940) for patients in CHCs.ConclusionFor both patients and pharmacists, consultation, brochure, and group discussion were the highest-ranked services. Education, age, experience with pharmacist services, and medical facility features need to be considered when evaluating which pharmacist services to implement in Indonesia.

Early Findings from the Development and Validation of the Patient/Caregiver-Reported Hydroxyurea Evaluation of Adherence for Life (HEAL) Scale

Introduction: Until recently, hydroxyurea (HU) was the only FDA-approved treatment for sickle cell disease (SCD). Despite well-documented benefits, HU is underutilized in the US. Not all patients treated with HU have a clinical response, and nonadherence to treatment is a common reason for non-response. While not fully understood, reasons for nonadherence involve concerns about side effects, benefit, and knowledge. We report on the validation of our patient- and caregiver-reported Hydroxyurea Evaluation of Adherence for Life (HEAL) scale to assess adherence among persons with SCD.Methods: Persons with SCD who had HU prescribed for ≥ 6 months prior to enrollment were eligible for our IRB-approved single site prospective study. A focus group and pilot study helped refine HEAL scale items. The scale consisted of 24 items with 8 subscales (Dose, Remember, Plan, Cost, Understand, Benefit/Harm [one subscale], Laboratory, and Pharmacy). To validate psychometric properties of HEAL we enrolled 40 pediatric and adult participants. We collected demographic information, relevant biomarkers, and medication possession ratio (MPR) at baseline and throughout the study period. Validity measures included a global adherence rating (GAR) from subjects and a visual analog scale (VAS) rating from subjects and from two healthcare providers per subject. Cronbach's alpha (α) was calculated to assess internal consistency reliability of the scale and subscales. Pearson product-moment correlations (r) between adherence measures and scale and subscale scores were used to assess validity. Principal component analysis was used to evaluate correlated factors (using eigenvalues >1) and a pattern matrix was used to create composite scales.Results: Participants included 24 adults (self-report) and 16 children (caregiver-report). Self- versus caregiver-report subsamples differed in age but not in gender or race. Median participant age was 30 years (range 1.8 - 65.0 years). 24 subjects (60%) were female; and 31 (77.5%) had HbSS.All items and subscales were negatively skewed. Three subscales (Dose, Cost, Effectiveness) comprising 9 items demonstrated ceiling effects. Three items (one in Dose and two in Cost) had restricted variance, defined as ≥ 75% of cases scoring at ceiling (e.g., score of 7) or skewness >2.Principal component analysis revealed two composite scales: 1. Administer (Dose [0.539], Remember [.740], Plan [.688], Pharmacy [.683]); and 2. Value (Cost [-.584], Effectiveness [-.916], Understand [-.831]).Correlations of adherence measures to Dose and Remember subscales, Total scale, and composite Administer scale were r= 0.340, 0.472, 0.380 and 0.321 respectively indicating validity of these HEAL components.Test-retest reliability of the overall scale was good (kappa = 0.82); and acceptable (kappa > 0.6) on all subscales but Cost (kappa = 0.06).Patient report VAS correlated significantly with Dose and Remember subscales, Administer composite scale, and Total scale score.Discussion: Our data show HEAL subscales and composite scales have strong internal consistency and test-retest reliability. HEAL item and subscale distributions indicate high levels of adherence but sufficient variability for analysis and valid use. Data showed that the Of all subscales the Remember subscale correlated most with adherence measures indicating a critical aspect of patient adherence. The Cost subscale data demonstrated poor internal consistency reliability.Adherence to HU is important because of its positive impact on patient quality of life when taken as directed. A self-/caregiver-report adherence scale that identifies areas where a patient needs additional support or resources may help increase adherence and improve quality of life. In previous research, implementation of a text message reminder for patients prescribed HU was associated with improved HU treatment adherence. The HEAL scale may help identify patients who would benefit most from targeted text message reminders.While cost was not a barrier among participants in this study, that may not be the case for patients in other clinical settings. A larger study sample will enhance assessment of reliability and validity of HEAL scale and subscales and describe adherence in a broader patient population. Our initial findings support the use of HEAL, the first adherence scale to monitor HU adherence in patients with SCD. DisclosuresMeier: CDC,: Other: grant funding; Global Blood Therapeutics: Other: Steering Committee membership, grant funding; NHLBI: Other: Data Safety Monitoring Board membership; Novartis,: Other: Data Safety Monitoring Board membership; NovoNordisk: Membership on an entity's Board of Directors or advisory committees; Forma Therapeutic: Membership on an entity's Board of Directors or advisory committees; CVS Caremark: Consultancy; Indiana Department of Health: Other: grant funding .

SP10.2.10Efficacy of Outpatient Appointment Reminders in Colorectal Surgery: A Prospective Analysis

Abstract Introduction There is increasing mandate to improve attendance in outpatient clinics to support delivery of High-Quality Care. Non-attendance in Colorectal Cancer (CRC) has clinical and financial implications. Patient appointment reminders (letters, text-messages and telephone) have been implemented to reduce non-attendance. We examine the efficacy of patient appointment reminders in CRC patients. Methods A prospective study was conducted for 3-months in our CRC department surveying patients on their appointment reminders. Non-attending patients were surveyed via telephone to ascertain cause of non-attendance and preference of patient reminders. Data collected was analysed on SPSS. Results 547 patients were prospectively surveyed. 19% did not receive appointments letters, from which 73% were made aware via Text message and 25% via Phone calls. 50% received letters > 2 weeks’ notice. 183 patients did not attend (DNA) their appointment from which 100 were successfully surveyed through telephone. 60% of patients did not received an appointment reminder (letter), or received it following the date of their appointment. 79% patients preferred to be contacted via text messaging or an appointment app vs 13% via letters. Cost analysis releveled significant losses due to missed appointments. Conclusion Patient appointment reminders are fundamental in reducing non-attendance in clinics. Our study demonstrates that appointment letters are an unreliable method of patient communication. In an ever-increasing digital age, methods such as timely text-messages or an appointment app for CRC patients’ needs urgent implementation as per patient preferences. Further research is required to assess non-attendance and causality in other specialities for comparison.

S250 Increasing Fecal Immunochemical Test Return Rates by Patient Reminders: A Quality Improvement Study

Introduction: The incidence of colorectal cancer (CRC) in the United States is increasing, and it remains the second leading cause of cancer death in the United States for men and women combined. The American Cancer Society now recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high sensitivity stool-based test or structural (visual) examination, depending on patient preference and test availability. The primary objective of this quality improvement project was to determine if reminder methods, such as telephone or letter reminders, increased the return rate of fecal immunochemical tests (FIT) for colorectal cancer screening. Methods: At public outreach events and daily clinics in the West Texas Panhandle area, participants in the GET FIT program were provided with FIT kits after completing the education on colorectal cancer. Participants who fit the inclusion criteria and had received a FIT kit from the program were included. They were instructed on how to perform the test and mail it back. Participants that did not return the completed kits within two weeks were reminded either by 1) through a reminder letter or 2) by telephone every 2 weeks (+/- 3 days) for 60 days or 5 attempts to contact. We de-identified and analyzed the FIT kit return data from June-November 2019 before instituting these reminder methods. We then calculated the change in return rates from December 2019 to February 2020. Our goal was to increase the FIT return rates by 25% over the baseline return rate. Results: The pre-intervention return rate of kits for June-November 2019 was 67.58%, and the postintervention return rate for December 2019-February 2020 was 81.87%. This rate was equal to an approximately 21% increase in return rates. The average return rate of FIT kits overall was 72.34%. The average rate of returned new patient kits was 69%, and the average % of new patient return kits was 68.51%. We also noticed a significant increase in return of FIT tests after a community cancer screening in October 2019. Conclusion: Fecal immunohistochemical test (FIT) remains one of the primary options for colorectal cancer screening. Due to its lower cost and noninvasiveness, FIT was offered to patients at average risk.We did achieve a significant increase in return rates, although we did not meet our target goal for this project. Our project was limited to studying 3 months post-intervention due to the COVID pandemic and barrier in returning tests. (Table Presented).

Feasibility of a multifaceted implementation intervention to improve attendance at diabetic retinopathy screening in primary care in Ireland: a cluster randomised pilot trial

ObjectivesDiabetic retinopathy screening (DRS) uptake is suboptimal in many countries with limited evidence available on interventions to enhance DRS uptake in primary care. We investigated the feasibility and preliminary effects...

S307 The FIT Initiative: A VA Quality Improvement Initiative to Improve Colorectal Cancer Screening

Introduction: The fecal immunochemical test (FIT) is a validated test for colorectal cancer screening for average risk individuals over the age of 45 as per the latest guidelines from the United States Preventative Task Force1. Using antibody-hemoglobin complexes, the test identifies human hemoglobin in a stool sample with a sensitivity of 74% and specificity of 94%1,2. A positive FIT test requires a follow-up colonoscopy for the detection and removal of pre-cancerous lesions. During the fiscal year (FY) 2020, 62% of returned FIT kits at the Veterans Administration Hospital were sent back incorrectly. This inefficiency led to increased cost/wasted product, delay in cancer detection, and dissatisfaction for patients and providers alike. Furthermore, the COVID-19 pandemic urged social distancing measures, which increase FIT kit usage since in-person colonoscopies were deferred. Methods: The ambulatory quality improvement project sought out root causes for the incorrectly returned FITs and proposed PDSA cycles based on a series of approved action plans. The multidepartment team composed of individuals from lab, nursing, administrative staff, and primary care came together virtually and discovered 6 major root causes. The 80/20 rule was applied to our pareto chart of root concerns and a frequency vs risk chart was made to highlight our major problems. Our assessment showed that lack of written collection date was the biggest issue and thus a PICK chart was assembled to prioritize our future solutions. Our multi-pronged PDSA (Plan, Do, Study, Act) cycle attempted to set up redundant patient reminders, centralize the FIT dispersal process and make the patient-FIT interface more user-friendly. All our PDSA solutions were implemented over the course of 4 months. Results: Preliminary data has shown that the average percentage of incorrectly returned FITs due to lack of written collection date has decreased by 38.56% as of May 2021. Conclusion: As with any quality improvement process, an overhaul in process can bring up new issues. Due to frequent assessments through this project, we were able to troubleshoot a number of human factor engineering issues that arose between staff and FIT kits. Our aim is to continue these efforts throughout FY 2021 and attempt to improve our FIT screening capability at the VA.

The effectiveness of person-centred quality improvement strategies on the management and control of hypertension in primary care: A systematic review and meta-analysis.

To evaluate the effectiveness of person-centred quality improvement strategies on the management and control of adults with hypertension in primary care. A systematic review and meta-analysis was conducted using the Medline, Cochrane Central Register for Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, and APA PsycINFO databases (January 1980 to March 2020). Randomized controlled trials that evaluated person-centred quality improvement strategies for the management and control of essential hypertension among adults ( 18 years) in primary care were included. Random effects models were used to estimate weighted mean differences (WMD) for the change in systolic and diastolic blood pressures (SBP, DBP) from baseline; risk ratios (RR) were calculated for the proportion of participants achieving target blood pressures, for each quality improvement strategy assessed. A qualitative review of the implementation details of the interventions was conducted to identify common components of interventions that were effective in improving blood pressure outcomes. Eight studies were included (total of 5654 patients). Findings favour use of person-centred quality improvement interventions over usual care (RR=1.23 [95% CI: 1.01; 1.48]) for improving blood pressure outcomes. Self-management (RR=1.43 [95% CI: 1.23; 1.65]) had the greatest effects on blood pressure targets. Clinician education resulted in the greatest SBP reduction (WMD:6.09 mmHg [95% CI: 2.32; 9.85]), while patient education and patient reminder systems (both WMD:4.86 mmHg [95% CI: 0.88; 8.83]) saw the most improvements in DBP. While interventions varied in their strategy implementation, common features of effective interventions included tailored communication with patients, use of health information technology, and multidisciplinary collaboration. Person-centred quality improvement strategies were effective in improving blood pressure outcomes. Further research is needed regarding the context of implementing interventions to provide greater insight into the components of a person-centred quality improvement intervention most effective in improving hypertension outcomes.

Effect of Personalized Messages Sent by a Health System\u2019s Patient Portal on Influenza Vaccination Rates: a Randomized Clinical Trial

BackgroundAdult influenza vaccination rates are low. Tailored patient reminders might raise rates.ObjectiveEvaluate impact of a health system’s patient portal reminders: (1) tailored to patient characteristics and (2) incorporating behavioral science strategies, on influenza vaccination rates among adults.DesignPragmatic 6-arm randomized trial across a health system during the 2019–2020 influenza vaccination season. The setting was one large health system—53 adult primary care practices.ParticipantsAll adult patients who used the patient portal within 12 months, stratified by the following: young adults (18–64 years, without diabetes), older adults (≥65 years, without diabetes), and those with diabetes (≥18 years).InterventionsPatients were randomized within strata to either (1) pre-commitment reminder alone (1 message, mid-October), (2) pre-commitment + loss frame messages, (3) pre-commitment + gain frame messages, (4) loss frame messages alone, (5) gain frame messages alone, or (6) standard of care control. Patients in the pre-commitment group were sent a message in mid-October, asking if they planned on getting an influenza vaccination. Patients in loss or gain frame groups were sent up to 3 portal reminders (late October, November, and December, if no documented influenza vaccination in the EHR) about importance and safety of influenza vaccine.Main MeasuresReceipt of 1 influenza vaccine from 10/01/2019 to 03/31/2020.Key Results196,486 patients (145,166 young adults, 29,795 older adults, 21,525 adults with diabetes) were randomized. Influenza vaccination rates were as follows: for young adults 36.8%, for older adults 55.6%, and for diabetics 60.6%. On unadjusted and adjusted (for age, gender, insurance, race, ethnicity, and prior influenza vaccine history) analyses, influenza vaccination rates were not statistically different for any study group versus control.ConclusionsPatient reminders sent by a health system’s patient portal that were tailored to patient demographics (young adults, older adults, diabetes) and that incorporated two behavioral economic messaging strategies (pre-commitment and loss/gain framing) were not effective in raising influenza vaccination rates.Trial RegistrationThis trial was registered with ClinicalTrials.gov (NCT04110314).

Successful Multi-Level HPV Vaccination Intervention at a Rural Healthcare Center in the Era of COVID-19.

Objectives: To develop and test a human papillomavirus (HPV) vaccination intervention that includes healthcare team training activities and patient reminders to reduce missed opportunities and improves the rate of appointment scheduling for HPV vaccination in a rural medical clinic in the United States.Methods: The multi-level and multi-component intervention included healthcare team training activities and the distribution of patient education materials along with technology-based patient HPV vaccination reminders for parents/caregivers and young adult patients. Missed vaccination opportunities were assessed pre- and post-intervention (n = 402 and n = 99, respectively) by retrospective chart review and compared using Pearson χ2. The patient parent/caregiver and young adult patient population (n = 80) was surveyed following the reminder messages and penalized logistic regression quantified unadjusted odds of scheduling a visit.Results: Missed opportunities for HPV vaccination declined significantly from the pre-intervention to the post-intervention period (21.6 vs. 8.1%, respectively, p = 0.002). Participants who recalled receipt of a vaccination reminder had 7.0 (95% CI 2.4–22.8) times higher unadjusted odds of scheduling a visit compared with those who did not recall receiving a reminder. The unadjusted odds of confirming that they had scheduled or were intending to schedule a follow-up appointment to receive the HPV vaccine was 4.9 (95% CI 1.51–20.59) times greater among those who had not received the vaccine for themselves or for their child.Conclusions: Results from this intervention are promising and suggest that vaccination interventions consisting of provider and support staff education and parent/caregiver and patient education materials, and reminders can reduce missed opportunities for vaccinations in rural settings.

Case Study of a Comprehensive Team-Based Approach to Increase Colorectal Cancer Screening.

IntroductionColorectal cancer is the second leading cause of cancer deaths among men and women in West Virginia. In addition, 51% of all colorectal cancers diagnosed in West Virginia from 2012 to 2016 were detected at either regional (31%) or distant (20%) stages indicating a need for improved early detection.MethodsWest Virginia University Cheat Lake Physicians participated in the West Virginia Program to Increase Colorectal Cancer Screening, a program of Cancer Prevention and Control at the WVU Cancer Institute. As a result, Cheat Lake Physicians assembled a team of health care professionals to implement evidence-based interventions and system changes including provider assessment and feedback, patient reminders, accurate data capture, and tracking of CRC screening tests.ResultsThese efforts resulted in a 15.8% increase in colorectal cancer screening rates within one year of implementation. Additionally, the clinic achieved a 66% return rate for Fecal Immunochemical Test kits, an inexpensive, stool-based colorectal cancer screening test.ImplicationsThe utilization of a team-based approach to patient care yields positive results that can be carried over to other cancer and disease prevention efforts in primary care clinics.

310-OR: Five-Year Trends in American Diabetes Association Recommended Metabolic Screening for Youth Prescribed Antipsychotic Medications

Importance: In recent decades, youth have increasingly been prescribed antipsychotic medications to treat a range of mental health conditions. These medications are associated with metabolic disturbances elevating type 2 diabetes risk, but ADA-recommended metabolic screening rates have stagnated at low levels (<50%) for youth treated with antipsychotics. We examined 5-year metabolic screening trends and predictors for this population in a large, integrated health system. Methods: In this serial cross-sectional study, we assessed metabolic screening (fasting glucose or hemoglobin A1c test) from health record data for 4,541 youth age 10-21 starting antipsychotic treatment in Kaiser Permanente Northern California during 2013-2017. We evaluated time and demographic predictors of metabolic screening within 2 years of medication start using logistic regression. To understand screening trends by age, sex, and racial groups, we estimated additional models with time x group interaction terms. Results: Participants were mean ± SD age 16.9 ± 3.0; 52% were boys. Half were racial minorities (22% Hispanic/Latino; 13% Black; 12% Asian/Nat. Hawaiian/Pac. Islander [ANHPI]). Screening significantly increased over the 5 cohort years (adj. rates rising from 54% to 64%). Younger participants, girls, and ANHPI and Hispanic/Latino participants had higher screening rates overall (all p<0.05); time trends did not differ by age, sex, or race. Conclusions and Relevance: In this large health system, which has established processes to promote preventive care (e.g., automatic patient reminders), metabolic screening has increased for youth treated with antipsychotics and exceeds those reported in other samples. Future research should examine processes contributing to this upward trend and identify remaining barriers to achieving ADA-recommended metabolic screening rates for this vulnerable population. Disclosure L. Hsueh: None. N. Slama: None. S. Spalding: None. S. Sterling: None. E. Iturralde: None. Funding Permanente Medical Group

Gastroenterology visitation and reminders predict surveillance uptake for patients with adenomas with high-risk features

Individuals diagnosed with colorectal adenomas with high-risk features during screening colonoscopy have increased risk for the development of subsequent adenomas and colorectal cancer. While US guidelines recommend surveillance colonoscopy at 3 years in this high-risk population, surveillance uptake is suboptimal. To inform future interventions to improve surveillance uptake, we sought to assess surveillance rates and identify facilitators of uptake in a large integrated health system. We utilized a cohort of patients with a diagnosis of ≥ 1 tubular adenoma (TA) with high-risk features (TA ≥ 1 cm, TA with villous features, TA with high-grade dysplasia, or ≥ 3 TA of any size) on colonoscopy between 2013 and 2016. Surveillance colonoscopy completion within 3.5 years of diagnosis of an adenoma with high-risk features was our primary outcome. We evaluated surveillance uptake over time and utilized logistic regression to detect factors associated with completion of surveillance colonoscopy. The final cohort was comprised of 405 patients. 172 (42.5%) patients successfully completed surveillance colonoscopy by 3.5 years. Use of a patient reminder (telephone, electronic message, or letter) for due surveillance (adjusted odds = 1.9; 95%CI = 1.2–2.8) and having ≥ 1 gastroenterology (GI) visit after diagnosis of an adenoma with high-risk features (adjusted odds = 2.6; 95%CI = 1.6–4.2) significantly predicted surveillance colonoscopy completion at 3.5 years. For patients diagnosed with adenomas with high-risk features, surveillance colonoscopy uptake is suboptimal and frequently occurs after the 3-year surveillance recommendation. Patient reminders and visitation with GI after index colonoscopy are associated with timely surveillance completion. Our findings highlight potential health system interventions to increase timely surveillance uptake for patients diagnosed with adenomas with high-risk features.

A Clinical Perspective on the Role of Electronic Devices in Monitoring and Promoting Adherence in Airways Disease.

Poor adherence to treatment is a common reason why patients with chronic disease have worse outcomes than might be expected. Poor treatment adherence is of particular concern among people with airways disease because, apart from not taking treatment as prescribed, inhaled medication can also be administered incorrectly. Recently, a number of technological advances that accurately document when an inhaled treatment has been used and, in certain instances, how it was used have been developed. There is good evidence from a number of research groups that these devices, either by patient reminders or physician feedback, promote adherence to inhaled treatments. What is less certain is how, in a real-world setting, these devices change outcomes. In this perspective article, the role of electronic devices in quantifying treatment use and addressing poor treatment adherence and their potential role in clinical practice outside of clinical validation trials are described.

Real-world Utilisation of the Rivastigmine Transdermal Patches Accompanying the Use of Risk Minimisation Tools in Patients with Dementia.

Transdermal patches are convenient to use, especially in Rotkreuz ZG Rotkreuz ZG patients with Alzheimer's disease (AD)-associated dementia. However, various identified risks of errors in administering the patches cannot be disregarded. Patient Reminder Cards (PRCs, included a Medication record sheet [MRS]) have been recently introduced as a risk minimisation tool to prevent incorrect patch use (IU). This study aimed to assess the effectiveness of PRCs to prevent IU and to investigate the dose titration pattern of rivastigmine patches in a real-world setting. This multinational, observational, 11-month study included patients with AD currently using rivastigmine patches (4.6 mg/day, 9.5 mg/day, 13.3 mg/day) accompanied by a caregiver. Study outcomes were IU, including multiple patch use (MPU), incorrect patch placement, other IUs, perceived usefulness of the PRCs, and titration patterns of the patches. Of the total 614 patients included, most were aged ≥ 65 years and had mild-to-moderate AD. Before and during the study, 27.7% and 18.0% of patients reported IU, respectively. Most patients used MRS, and 73.5% rated it 'helpful' and reported lower rates of IU than those who reported it 'not helpful' (13.9%-16.5% vs. 20.2%). Overall, 141 patients had dose titrations, with 75.8% being up-titrated from 4.6 mg/day to 9.5 mg/day after a mean duration of 58 days. Safety findings were consistent with the established profile for the rivastigmine patch. PRC was effective as a risk minimisation tool in limiting the inappropriate use of rivastigmine patches. The majority of patients requiring dose-change were up-titrated to 9.5 mg/day patches.

Improving Advance Care Planning Documentation Using Reminders to Patients and Physicians: A Longitudinal Study in Primary Care.

Documenting advance care planning (ACP) in primary care requires multiple triggers. New Medicare codes make it easier for providers to bill for these encounters. This study examines the use of patient and provider reminders to trigger advance care planning discussions in a primary care practice. Secondary outcome was billing of new ACP billing codes. Patients 75 years and older scheduled for a primary care appointment were screened for recent ACP documentation in their chart. If none was found, an electronic or mail message was sent to the patient, and an electronic message to their provider, about the need to have discussion at the upcoming visit. Chart review was performed 3 months after the visit to determine if new ACP discussion was documented in the chart. In the 3 months after the reminder had been sent to patients and providers, new ACP documentation or billing was found in 28.8% of the patients. Most new documentation was health care decision maker (75.6% of new documentation) with new DNR orders placed for 32.3% of these patients. The new Medicare billing code was filled 10 times (7.8%). Reminders sent to both patients and providers can increase documentation of ACP during primary care visits, but rarely triggers a full ACP conversation.

Impfen gegen Influenza – Internationale Bestandsaufnahme und Perspektiven für Deutschland

BackgroundThe current SARS-CoV-2 pandemic requires high influenza vaccination rates for the chronically ill in order to avoid additional strain on the health care system. Despite clear evidence of the safety and effectiveness of influenza vaccination, vaccination coverage has internationally remained at inadequate levels in recent years. The general practitioner is of central importance for the care of this population. Therefore, the aim of this systematic review was to evaluate various measures in general practice to increase seasonal influenza vaccination rates for the chronically ill, taking into account various international health systems. MethodsA systematic literature search was carried out in MEDLINE, CENTRAL, EMBASE and ERIC as well as manually in trial registers and literature lists. Only randomized controlled studies were taken into account. The methodology was defined in advance in a study protocol and published (PROSPERO CRD42018114163). ResultsA total of 14 studies within the framework of a national health service (United Kingdom), a state (Australia) and social (Switzerland) health insurance system and a private health care system (USA) were included in our review. Analog patient reminders and automated physician reminders as well as changes in professional roles have led to a significant increase in influenza vaccination rates, but only in the private health care system. In the national health service, none of the interventions we analyzed achieved a significant increase in vaccination rates, although the National Health Service in the United Kingdom documented relatively good basic influenza vaccination rates before the studies were carried out, regardless of the intervention. Good results were achieved in the social and state health insurance systems of Switzerland and Australia by training events for practice teams and SMS reminders. ConclusionsIn Germany, training events for medical teams and centrally organized invitation and monitoring systems might improve vaccination rates among the chronically ill. That the federal government pays for the vaccination costs seems to ensure a good basic influenza vaccination coverage for indicated patients in various health systems.