Reminder Calls Research Articles

An RCT of Fecal Immunochemical Test Colorectal Cancer Screening in Veterans Without Recent Primary Care

The use of screening can prevent death from colorectal cancer, yet people without regular healthcare visits may not realize the benefits of this preventive intervention. The objective of this study was to determine the effectiveness of a mailed screening invitation or mailed fecal immunochemical test in increasing colorectal cancer screening uptake in veterans without recent primary care encounters. Three-arm pragmatic randomized trial. Participants were screening-eligible veterans aged 50-75 years, without a recent primary care visit who accessed medical services at the Corporal Michael J. Crescenz Veteran Affairs Medical Center between January 1, 2017, and July 31, 2017. All data were analyzed from March 1, 2018, to July 31, 2018. Participants were randomized to (1) usual opportunistic screening during a healthcare visit (n=260), (2) mailed invitation to screen and reminder phone calls (n=261), or (3) mailed fecal immunochemical test outreach plus reminder calls (n=61). The main outcome under investigation was the completion of colorectal cancer screening within 6 months after randomization. Of 782 participants in the trial, 53.9% were aged 60-75 years and 59.7% were African American. The screening rate was higher in the mailed fecal immunochemical test group (26.1%) compared with usual care (5.8%) (rate difference=20.3%, 95% CI=14.3%, 26.3%; RR=4.52, 95% CI=2.7, 7.7) or screening invitation (7.7%) (rate difference=18.4%, 95% CI=12.2%, 24.6%; RR=3.4, 95% CI=2.1, 5.4). Screening completion rates were similar between invitation and usual care (rate difference=1.9%, 95% CI= -2.4%, 6.2%; RR=1.3, 95% CI=0.7, 2.5). Mailed fecal immunochemical test screening promotes colorectal cancer screening participation among veterans without a recent primary care encounter. Despite the addition of reminder calls, an invitation letter was no more effective in screening participation than screening during outpatient appointments. This study is registered at clinicaltrials.gov NCT02584998.

Abstract C129: Do phone-based discussions about the importance of colorectal cancer screening delivered before a fecal immunochemical test (FIT) mailing improve return rates?

Abstract Patients who have never completed a fecal immunochemical test (FIT) may benefit from phone-based discussions about the importance of colon cancer screening before receiving the FIT in the mail. Colorectal cancer is the second-leading cause of cancer death in the United States, and screening rates are disproportionately low among Latinxs. In 2015, only 63% of eligible adults, and 50% of Latinxs, were up to date with colorectal cancer screening recommendations. Mailed FIT outreach programs have been shown to improve colorectal cancer screening rates in community health centers, with improvements ranging from 22% – 45%. Despite the widespread use of primers and reminders for mailed FIT outreach programs, data are sparse on how these communications influence FIT completion rates. Data from our previous evaluation of mailed FIT outreach showed that adults who have never completed a FIT have a much lower FIT return rate than adults who have (17.1 vs 45.1; p < 0.01). As part of the Participatory Research to Advance Colon Cancer Prevention (PROMPT), which involved a partnership with a Los Angeles-based community health center that provides medical services to 300,000 patients annually (82% are Latinx), we tested whether patients who had never completed a FIT could benefit from phone-based discussions about the importance of colorectal cancer screening. Eligible patients were 50-74, due for their screening, and assigned to a wedge 1 clinic (n = 8 clinics; 6,872 patients). A total of 2,825 patients had no electronic health record evidence of having completed a prior FIT. These patients were randomized to receive the text primer (n = 1,622) or live call primer (n = 1,203). All live primer calls were delivered by bilingual health education staff trained by the research team. Patients were then mailed a FIT kit with an introductory letter and wordless instructions on completing the FIT, followed by two automated phone call reminders and live reminder calls delivered by the care team. We used logistic regression to compare the effectiveness of live call vs text message primers on FIT completion rates 3 months after the FIT mailing. Randomized patients (who had never completed the FIT) had a mean age of 58 years (SD, 6.0), 51% were female, and 80% Latinx. In the text primer arm, the overall FIT completion rate was 14.7%, and 14.6% among those who were successfully delivered the text primer. In the live call arm, the overall FIT completion rate was 18.8%, and 30.0% among those who had a discussion with health education staff. Controlling for age, preliminary analyses indicate that patients who received a live call were 1.35 times more likely to complete a FIT within 3 months of the mailing than those who received a text message primer (OR=1.35 [1.10, 1.64]). Live phone call primers, delivered before the FIT is mailed, boost screening rates among those who have never completed a FIT. Note: This abstract was not presented at the conference. Citation Format: Jamie Thompson, Denis Nyongesa, Amanda Petrik, Melissa Castillo, Gloria Coronado. Do phone-based discussions about the importance of colorectal cancer screening delivered before a fecal immunochemical test (FIT) mailing improve return rates? [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 C129.

1173 Reducing Cancellation and Improving the Patient’s Experience Through Quality Improvement Process

Abstract Introduction Sleep study volume in our system has increased by 23% from 2017 to 2019 which makes unfilled sleep beds a significant concern. Cancellation rate impacts our sleep bed access. We hypothesized cancellation can be improved through quality improvement process which could ultimately lead to improve patient satisfaction. Methods A multi-disciplinary team was assembled to examine potential contributing factors. Using the Model for Improvement we developed, tested and implemented interventions using tools such as PDSA cycles, process map and a simplified FMEA (Failure Modes and Effects Analysis). A Key Driver Diagram helped guide our journey to improve the cancellation rate. We developed a Parent Advisory Group to help us with ideas to identify how we could improve the cancellation rate. Results The cancellation was 21% prior to the implementation of our interventions. To improve these measures, we have implemented several interventions. The content of our sleep study preparation handbook was improved, increased distribution of the education handbook and developed a series of sleep study videos which are available for viewing prior to the study to prepare patients and families. In addition, we standardized our process of reminder calls in the call center and sleep lab by defining roles and responsibilities. This improved our ability to answer questions and identify and mitigate barriers they may have. We implemented transportation assistance to patients who have transportation barriers and created a waitlist protocol to assist families with a preferred date. After 2 years of interventions, the cancellation rate has decreased from 21% to 14.7%. Interestingly, as we improved our cancellation rate, the overall patient satisfaction has been improved from 83% to 88%. Conclusion Using the Model for Improvement, we improved education, communication and scheduling processes, which has reduced cancellation rate and consequently improved patient satisfaction. Support

Abstract 242: Evaluating the Impact and Barriers to a Collaborative Physician-pharmacist Care Model to Control Hypertension in a Low-income Population

Objectives: Physician-pharmacist collaborative practice models have emerged as an effective model for managing hypertension (HTN). We implemented this model in a low-income, hospital-based cardiology clinic and sought to identify programmatic features necessary to control HTN in this vulnerable population. Methods: Patients with persistently elevated blood pressure (>130/80) were referred by their primary cardiologist. Patients were excluded if they were pregnant, had acute kidney injury, or acute cardiovascular complaints including anginal chest pain, decompensated heart failure, or unstable arrhythmia. The initial pharmacist appointment occurred within 2 weeks of referral, with the goal of bi-weekly visits for 6 weeks or until blood pressure was controlled. Patients were prescribed home blood pressure cuffs and given specific instructions for home-based monitoring. Telehealth visits were made available to interested patients. During each encounter, pharmacists assessed response and side effects to medication, adherence, lifestyle behaviors, stressors, and social barriers to blood pressure control. Clinical management and barriers to HTN control were reviewed at standing weekly staff meetings that included cardiologists and pharmacists. Early results: Among 35 people referred, 22 patients attended at least one pharmacist visit. A total of 139 reminder or follow-up calls were made for these 22 patients. Among the first 35 referrals (mean age 58; 57% male; 65% African American or Latinx), 26% have documented substance use disorders, 34% have a mental health comorbidity, 20% were not taking their medications as prescribed on intake, and 17% had side effects from 2 or more prior antihypertensive medications. Medications adjustments were made in 21/43 patient visits (49% of visits). In 8/43 visits more than 1 medication change was made. The most common patient reported barriers to care include transportation (20%) and language barriers (11%). Discussion and Future Direction: Managing HTN in a low-income population requires attention to the social and contextual factors impacting blood pressure control. We plan to: 1) support the uptake of telehealth to address issues of transportation and access; 2) pilot blue-tooth connected blood pressure cuffs to facilitate home monitoring and management; and 3) partner with community health workers to assess best practices for capturing and addressing social determinants of health in the clinical setting.

Abstract 247: Process Improvement Initiatives to Reduce No Show Rates in Rural Communities

Objective: A large pediatric academic medical center (AMC) acquired an out-of-state private cardiology practice serving rural communities and without an EMR. No show rates at the private practice consistently ranged from 20-40%, compared to 11% at the AMC. No shows contribute to inefficient use of clinician time and access to care challenges for other patients. Upon acquisition, process improvement efforts began with the goal of decreasing the abnormally high no show rates. Methods/Findings: Under private practice, staff scheduled patient appointments without inquiring for their availability and then notified patients of their appointment date and time via letter 10 days prior to the scheduled appointment and then by phone 2 days prior to the appointment. Immediately following the acquisition in December 2018, staff began calling patients to inquire when they would like to be scheduled based on their availability. Patients were scheduled six months out, so the true impact of this process change would be fully realized in May 2019. Once an EMR was implemented, a dashboard was created to monitor no show rate data and identify trends. After six months, no show rates only slightly improved, so in addition to the automated emails, calls, or text reminders from the scheduling center, a dedicated staff member began making reminder calls to patients the day before their appointment. As a result of the process improvement efforts, no show rates decreased from a high of 42% to 16% in eight months. Further, to better understand why patients were not showing for their appointments, staff began calling patients after a no-show appointment to determine if there were barriers for not showing and offering to reschedule the appointment. Data collected shows that out of 470 no show appointments from May 2019 to December 2019, 117 patients had disconnected phone numbers, 230 had appointment reminder messages left on their voicemail, 68 did not answer the call and did not have voicemail to leave a message and 55 patients confirmed their appointment with staff, but did not show for the appointment. Of the 470 no shows, 394 were pediatric patients and 76 were adults. Data shows 185 out of 470, or 39% of reminders never reached the patient, and an additional 49% went to voicemail and may not have been heard. Conclusion: No show appointments negatively impact clinic efficiencies and the ability to provide care to the greatest number of patients. When a patient doesn’t show for their appointment, they are non-compliant with their recommended care and reserve a clinic appointment that another patient may need. Small tests of change were made in phases to ensure appointments were convenient for patients and families and metrics were set and tracked to monitor improvement. By implementing new patient-centric processes and data tracking, more patients in rural communities receive the required follow up CHD care, leading to improved outcomes.

Feasibility and Accuracy of Blood Pressure Measurement by Patients with Left Ventricular Assist Devices (LVAD)

Blood pressure (BP) control reduces stroke in LVAD patients. Home monitoring is key for optimal control. Measurement by Doppler is the most reliable non-invasive method. No study assessed the feasibility of Doppler BP obtained by LVAD patients and caregivers. From 3-11/2018, 12 ambulatory patients with Heartware HVAD were recruited and taught to measure BP in 7 steps (1: quiet sitting, 2: cuff placement, 3: find radial artery flow, 4: inflate cuff, 5: deflate cuff, 6: find BP, 7: record BP). All received manual cuffs and Dopplers to check BP up to 3 times/day for 6 weeks, and had weekly reminder phone calls. They were observed to check BP at routine visits, and completed a survey at end of study. We made no medication changes based on home BP. Seven patients (median age 57yrs [IQ 44-67], median VAD support 39 days [IQ 32-48], 1 on support for > 1yr) completed the study. Median number of recorded BP was 42 (IQ 22-78). At enrollment, 4 patients easily learned 7 steps, 2 needed reteaching for step 3 or 5, and 1 needed reteaching for both. At follow-up, all completed 7 steps and obtained BP that modestly agreed with BP measured by staff (κ=0.25, 31% agreement, p=0.0002). Diurnal variation (higher afternoon BP) was seen in 2 patients; the rest had no change from morning to evening (Figure). Reasons for BP check failure were "forgetfulness", "too busy", "too sick", or "no help/did not seek help". Of the 5 patients who dropped out (median age 38yrs, support duration > 9 months), 3 needed reteaching for steps 3-6. Of the 2 patients who easily learned the steps, 1 lost caregiver and was hospitalized too frequently, the other was non-compliant. No one completely failed BP education after reteaching. This pilot study demonstrated feasibility of home BP monitoring by Doppler in select patients. Those who failed to obtain daily BP checks tended to have poor social support or were not proficient in the 7-step method. Further data are needed to define and prognosticate diurnal BP variation in LVAD patients.

Partnering with parents to remove barriers and improve influenza immunization rates for young children.

Despite the ongoing public health initiatives to increase pediatric influenza immunization rates to 80%, only a few US health centers have been able to meet this goal. The suboptimal immunity to influenza poses individual and societal risks for vaccine-preventable cases of influenza and its complications. At a diverse, urban, family health center, its influenza immunization rate of 44% represented the lowest uptake rate compared with all other early childhood vaccines, increasing the risk of morbidity and mortality in young children, including hospitalization and death. To identify key barriers to influenza immunization, the investigators interviewed parents of children aged 6 through 24 months at this urban family health center via randomized sampling using an open-ended telephone survey. Based on the concerns parents expressed through the survey, a program was designed and implemented that included reminder calls, parent education, proactive appointment scheduling, and social media reminders. After implementing a parent-driven quality-improvement program for 6 months during influenza season, the health center's pediatric influenza immunization rates rose to 57% compared with 44% during the year before. Childhood immunization is a critical priority to protect the health and wellness of children. Increasing parent engagement in discussions about increasing immunization rates not only promotes awareness surrounding vaccines but also allows primary care providers to learn from parents to create a patient-centered immunization program. Programs that specifically target immunization efforts toward parental concerns have the potential for increased vaccine acceptance and improved health outcomes.

The Effect of an Integrated Health System Specialty Pharmacy on HIV Antiretroviral Therapy Adherence, Viral Suppression, and CD4 Count in an Outpatient Infectious Disease Clinic.

Adherence to antiretroviral (ARV) therapy is critical in order to achieve and maintain viral suppression and improve immune function. Clinical pharmacists and pharmacies focused on human immunodeficiency virus (HIV) have demonstrated the ability to increase ARV medication adherence and subsequently have a positive effect on these lab markers. To evaluate the effect of an integrated health system specialty pharmacy service with a clinic-embedded, HIV-trained pharmacist and pharmacy technician on ARV medication adherence rate, viral load, and CD4 count. This was a single-center, retrospective cohort study conducted from August 7, 2017, to June 30, 2018, at an indigent outpatient infectious disease clinic within Atrium Health (AH), a not-for-profit health system based in Charlotte, NC. The intervention group (opt-in group) received HIV patient care that involved the health system specialty pharmacy service. Once a patient was enrolled in the specialty pharmacy service, medication reconciliation was completed by the pharmacist, financial assistance and prior authorizations were completed if needed; prescriptions were delivered to the patient; and monthly refills calls were conducted to assess adherence, tolerability, and medication changes. The control group (opt-out group) received HIV patient care that did not incorporate the health system specialty pharmacy. The primary endpoints were medication adherence, viral suppression, and CD4 counts. Within-group comparisons from baseline to follow-up were made along with group-to-group comparisons. Adherence was calculated using medication possession ratio. For those patients using Atrium Health Specialty Pharmacy Service (AH SPS; n = 46), the overall median adherence rate was higher at 100% versus only 94% for those patients (n = 50) that opted out of the service (P < 0.01). All but 3 patients (21.7% at baseline vs. 6.5% at follow-up, P = 0.03) using AH SPS reached viral suppression, and all but 1 had improved immune function with a CD4 count of 200 or greater by the end of the observation period (P = 0.03). The change in viral suppression and CD4 count of 200 or greater was not statistically improved between baseline and follow-up in those opting out of using AH SPS. When comparing the 2 groups at reaching these endpoints, there was no statistically significant difference in viral suppression and CD4 count. AH SPS was able to demonstrate improved ARV adherence in those patients using an integrated specialty pharmacy with an embedded pharmacy team, coordinated monthly medication delivery, and refill reminder and adherence calls. This in turn led to improved viral suppression and immune markers by the end of the observation window for patients using AH SPS. No outside funding supported this study. The authors have nothing to disclose.

Universal Health Literacy Precautions Are Associated With a Significant Increase in Medication Adherence in Vulnerable Rheumatology Patients.

ObjectiveOur objective was to determine the impact of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, on medication adherence, patient satisfaction, and feasibility in all patients; its effect on the clinical disease activity index (CDAI) was studied in a rheumatoid arthritis (RA) subpopulation.MethodsData collected during a 6‐month prospective quality assurance intervention was compared with data from a prior 6‐month period. Interventions included 1) encouraging questions, 2) teach‐back communication, and 3) brown‐bag medication review. Analysis was performed using linear regression or generalized estimating equation (GEE) regression.ResultsDuring the intervention period, 46 physicians completed 1737 patient visits. Questions were encouraged, and teach‐back communication was performed in more than 90% of visits. Brown‐bag medication reviews were performed in 47% of visits overall and 69% of visits in a subgroup that received additional reminder calls. Visit duration and patient satisfaction were not significantly increased. Adherence for rheumatology‐related medications that were prescribed both before and during the intervention increased by 22% (P ≤ 0.001; by GEE). Teach‐back communication predicted a statistically significant improvement in medication adherence in this subpopulation (by linear regression). The mean CDAI did not improve; however, African American race and Hispanic ethnicity were associated with a decreased CDAI (by GEE).ConclusionImplementation of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, improved medication adherence in our safety‐net clinic, with particularly strong effects seen with teach‐back communication. In certain populations, use of the toolkit may also improve RA disease activity. This is the first study to document improved medication adherence with this intervention in a real‐world setting.

Facilitating Visit Attendance with Staff Reminder Calls in a Safety-Net Clinic.

Facilitating Visit Attendance with Staff Reminder Calls in a Safety-Net Clinic.

Free online chlamydia and gonorrhoea urine test request in Queensland: sexually transmissible infections testing can be hard for young people even if the process is easy.

Online options to request sexually transmissible infections testing are increasingly popular and a free online chlamydia and gonorrhoea urine testing service is available for people living in Queensland, Australia. Data from 3 August 2017 to 31 August 2019 provide information for 1316 reminder calls to young people (aged 16-29 years) to encourage sample submission. The reminder calls generated few additional samples for testing, suggesting young people may have changed their mind about using the service, sought testing elsewhere or were reluctant to talk further about their original decision to request a test online.

Nudges to Increase Completion of Welfare Applications: Experimental Evidence from Michigan

The Temporary Assistance for Needy Families (TANF) program provides cash assistance to very-low-income families with children. Application procedures to receive TANF benefits, however, often involve substantial transaction costs likely to reduce take-up. We estimate, through a randomized controlled trial design, the effects of a detailed telephone-call reminder to increase TANF application completion in southwest Michigan, where applicants must visit a regional public employment office at least four times to be eligible for benefits. We do not find that personalizing reminder calls increased participation in the initial appointment at the public employment office. However, conditional on attending the initial session, applicants who received reminder calls before additional appointments were more likely to complete all application requirements, compared to those who did not receive reminders. Evidence suggests that reminder calls increase attendance at public employment office appointments but that personalizing such calls has limited impact.

Evaluation of a Phone Call Reminder Strategy in the Surveillance of Patients with Gastric Precancerous Lesions Lost to Follow-Up

Background: Surveillance of gastric precancerous lesions (GPL) may reduce gastric cancer (GC)-related mortality, but some patients with GPL are lost to follow-up. Objective: The aim of this study was to evaluate the feasibility and efficacy of a “phone-call” strategy in surveillance of the lost to follow-up patients. Patients and Methods: Among all the patients diagnosed with GPL (atrophic gastritis, intestinal metaplasia, low-grade dysplasia) between 2000 and 2015, we identified those who should undergo surveillance endoscopy according to the current guidelines. They were contacted by telephone and invited to undergo endoscopy with gastric biopsies for histological analysis. Results: Among 535 patients with GPL, 134 were contacted. Sixty-two (46%) could not be joined, 36 did not have endoscopy for other reasons, and finally, 36 patients (22 males, median age 65 years) were included. After the median time interval of 57 months between 2 endoscopies, 18 patients showed stability, 11 regression, and 7 progression of GPL, including 1 patient who developed GC. Conclusion: Despite several telephone calls, only one-third of the contacted patients could be brought to surveillance endoscopy. Most of the patients showed stability of GPL, but 1 progressed to GC and could be successfully treated.

Automated Reminders Improve Retinal Screening Rates in Low Income, Minority Patients with Diabetes and Correct the African American Disparity.

Diabetic retinopathy (DR) is a major cause of blindness in the United States. Prevention relies on periodic DR screening, yet overall national screening rates are not optimal, especially in low-income, minority patients. We prospectively evaluated show rates for prescheduled teleretinal DR screening appointments in diabetic patients (n = 301) in a large safety-net clinic in South Central Los Angeles. Patients were predominately African American (n = 88) and Latino (n = 200). Patients received either usual care telephone reminders or automated reminder calls in addition to usual care. The overall mean (SEM) show rate for DR screening, irrespective of reminder method, was low: 54+1.03%. Show rates with usual care alone were 46.3+2.6%, and with automated reminders added, 59.9+1.47% (p = 0.036). Show rate with usual care amongst African Americans was 23.6+6.46% compared with 53.2+3.41% for Latinos (p = 0.025). When automated calling was added, the show rate doubled amongst African Americans, to 51.6+3.96% (p = 0.002) with a slightly higher, non-significant show rate in Latinos. In summary, show rates for pre-scheduled teleretinal DR screening appointments were low with usual care alone in a safety-net clinic, with evidence for a racial disparity amongst low-income, minority patients with diabetes. Addition of a pre-recorded automated reminder call improved show rates, and corrected much of the racial disparity observed. Greater focus on failed appointments as an explanation for low DR screening rates and racial disparities, and as a potentially remediable target with automated reminders, may improve DR screening rates and reduce blindness in low-income minority patients with diabetes.

Does a tailored intervention to promote adherence in patients with chronic lung disease affect exacerbations? A randomized controlled trial

BackgroundPoor medication-adherence is common in chronic lung patients, resulting in reduced health-outcomes and increased healthcare-costs. This study aimed to investigate the impact of an acoustic reminder and support calls on adherence to inhaled therapy in asthma and COPD patients and to determine their effect on exacerbations.MethodsThis single-blinded randomized controlled trial investigated asthma and COPD patients during 6 months in an ambulatory setting. The intervention consisted of daily alarm clock and support phone calls, whenever use of rescue medication doubled or inhaled medication was not taken as prescribed. Primary outcome was time to next exacerbation. Frequency of exacerbations, adherence to inhaled medication and quality of life scores were secondary outcomes. Cox and Poisson regression were used to determine intervention effect on time to exacerbation and frequency of exacerbations, respectively.ResultsSeventy-five participants were assigned to the intervention group and 74 to usual follow-up care. During a median follow-up of 6.2 months, 22 and 28% in the intervention and control groups respectively, experienced at least one exacerbation. Intervention had no effect on time to first exacerbation (HR 0.65, 95% CI 0.21 to 2.07, P = .24), but showed a trend toward a 39% decreased frequency of exacerbations (RR = 0.61, 95% CI 0.35 to 1.03, P = .070) for the adjusted models, respectively. The intervention group had significantly more days with 80–100% taking adherence regarding puff inhalers (82 ± 14% vs. 60 ± 30%, P < .001) and dry powder capsules (90 ± .10% vs. 80 ± 21%, P = .01). Timing adherence in participants using puff inhalers was higher in the intervention group (69 ± 25% vs. 51 ± 33%, P < .001). No significant differences in QoL were found between the two groups.ConclusionParticipants assigned to the intervention group had significantly better taking and timing adherence of inhaled medication resulting in a trend towards a decreased frequency of exacerbations. However, no effect on time to next exacerbation was observed.Trial registrationClinicalTrials.gov: NCT02386722, Registered 14 February 2014.

Comparing Telephone Counseling With Reminding to Promote On-Time Repeated Mammography: A Randomized Trial in a Cohort With 4 Years Follow-Up.

Background. Long-term continuous adherence to biennial screening mammograms as guidelines recommend remains low. Limited evidence suggests that reminder calls may increase short-term adherence as much as telephone counseling, but research is needed comparing the long-term effects of these two approaches. Purpose. To compare the impacts of two telephone outreach interventions and mailed reminders on 4-year continuous mammography adherence. Method. A cohort of 3,215 women, age 50 to 81 years, was selected from 30,160 women from a 4-year randomized trial of three interventions to promote biennial mammography: reminder letter only (LO), letter plus reminder call (RC), and two letters plus educational material and a counseling call (CC). Women selected remained eligible for the trial all 4 years and received annual interventions as needed. The proportion with a mammogram in the last 24 months was determined at baseline and four annual time points. Results. Continuous adherence at all four time points was higher in the RC (78.8%) and CC arms (78.8%) than in the LO arm (75.1%; p < .001). Multivariable analysis confirmed this finding: CC (odds ratio = 1.27; 95% confidence interval = [1.01, 1.61]) and RC (odds ratio = 1.23; 95% confidence interval = [0.98, 1.56]). Only 27.8% of women eligible for an initial counseling call actually received counseling. Conclusions. Compared with letters alone, outreach calls can modestly increase continuous mammography adherence among insured women with consistent primary care. Telephone counseling was no more effective than a reminder call, possibly due to limited acceptance of counseling calls by women who may find them unwelcome or unnecessary.

Factors impacting attrition of vulnerable women from a longitudinal mental health intervention study.

This study explored factors associated with attrition of vulnerable women from a community-based, longitudinal mental health intervention study. The study employed a quasi-experimental, nonequivalent comparison group pretest-posttest design. The intervention consisted of six, 90-min meetings featuring education and support. One hundred and eighteen women aged 18-88years enrolled from four urban neighborhoods. The team used the Generalized Anxiety Disorder-7, the Primary Health Questionnaire-9, a self-care knowledge for anxiety and depression instrument, and demographics to measure variables. Sessions occurred at trusted neighborhood sites. The team provided transportation, child care, and reminder calls or texts. Community health workers actively encouraged participants to continue in the study. The researchers did not offer financial incentives. Completion of the intervention involved attending four of six sessions. The study had a 39% attrition rate. Results, using a Chi-square test for independence, indicated significant associations between attrition, neighborhood/homelessness, and family income. Additionally, there were significant associations between attrition, a past diagnosis of anxiety, and a lack of concurrent therapy for anxiety/depression. This study identified social determinants and mental health factors linked to the attrition of urban, ethnically diverse, and impoverished women from longitudinal intervention studies.

Feasibility of Electronic Monitoring of Daily Oral Medications in Adolescents with Sickle Cell Disease

Background: The field has made significant strides in understanding the mechanisms underlying pediatric sickle cell disease (SCD), and the coming years will likely see the approval of several new medications to treat SCD. The impact of these medications on clinical outcomes, however, will be dependent on patient adherence. Adolescents with SCD are at particular risk for non-adherence, and as disease management increasingly includes self-administration of oral medications, adherence assessment will become a critical component of research on medication effectiveness and clinical care. While electronic monitoring devices (bottles with computer chips that record date- and time-stamps of device openings) such as MEMS® bottles are considered the "gold standard" for adherence assessment in other populations, their feasibility among adolescents with SCD remains unknown. Objectives: The primary aims of this study were to examine data on MEMS® bottle use among adolescents (ages 13-21 years) with SCD to: 1) evaluate the feasibility of MEMS® bottle use; and 2) elicit barriers and facilitators to MEMS® bottle use. Methods: As part of a larger study of a self-management intervention, adolescents were asked to use a MEMS® bottle to store and administer their daily oral medication (hydroxyurea or deferasirox) for the 18-week study duration. The larger study included baseline, post-treatment, and follow-up assessments, at which adolescents were asked to provide their MEMS® bottle for data download. Descriptive statistics were calculated to assess multiple domains of MEMS® bottle feasibility including: initial uptake (% enrolled), MEMS® initiation (% initiated), and MEMS® sustained use (% completed; % provided bottles for download ±2 weeks of scheduled study visit = "on time"). Barriers and facilitators to MEMS® use were elicited via adolescent self-report. Results: In the larger study, 18 non-Hispanic African-American adolescents (M = 17.8 years, SD = 2.6; 61% male) with HbSS were asked to use a MEMS® bottle to store their hydroxyurea (n = 14) or deferasirox (n = 4). Initial uptake was 94.7%, with 18 of 19 eligible adolescents enrolling in the study. Of the 18 enrolled adolescents, all initiated MEMS® use (100%) and 11 sustained MEMS® use through the final study endpoint (61.1%). Eight (44.4%) and 2 (11.1%) adolescents provided their MEMS® bottle for download "on time" at post-treatment (42 days) and follow-up (126 days), respectively. Barriers to MEMS® use included medication changes (i.e., medication holds, dose timing changes) and transitioning from pediatric to adult care. Facilitators included tip sheets (e.g., places to store bottle, reminder to place refills in bottle) and reminder calls. Participants took a median of 26.2% of doses using the MEMS® across the 126 days (SD = 22.4; range 0.79% - 79.3%), illustrating that electronic monitoring devices are not a solution to medication adherence, but are one component of an adherence support strategy. See Figure 1 for adherence rates over time. Discussion: Data suggest that MEMS® are acceptable to adolescents with SCD. Ensuring sustained MEMS® use, however, will likely require additional supports. For example, electronic monitors which automatically transmit data in real-time via Bluetooth or cellular connections would eliminate the need for adolescents to bring bottles to study visits for data downloads. Researchers and clinicians interested in using electronic monitoring devices are encouraged to consider remote monitoring capabilities along with other device features when selecting a product. Larger studies are needed to evaluate concordance between rates of adherence obtained via electronic monitoring and other assessments and to validate electronically-monitored medication adherence with clinically-relevant outcomes for adolescents with SCD. Figure 1 Disclosures Quinn: Celgene: Membership on an entity's Board of Directors or advisory committees; Amgen: Other: Research Support.

553 Exploring Methods to Reduce Colonoscopy Cancellations

INTRODUCTION: Colonoscopy cancellation negatively impacts endoscopy center efficiency and physician productivity. According to previous studies, the rates of colonoscopy cancellations within 24 hours were reported to be 2-4% (1,2). Using an automated call system to make reminder calls and informing patients of a cancellation fee, may be methods to reduce cancellations. Our aim is to evaluate the effectiveness of these methods in reducing late cancellations. METHODS: A prospective and retrospective study done at Sierra Nevada Gastroenterology Medical Associates and Sierra Endoscopy Center in Grass Valley, CA from Nov 2, 2018 to May 2, 2019. All enrolled patients had colonoscopy issues addressed by a physician at an office visit prior to scheduling. A reminder phone call was made by an automated calling system 48 hours prior to the colonoscopy. Results were compared to previous studies where a nurse gave the reminder call. Another group of patients were informed of a policy that a cancellation fee may be charged for late cancellation. Data was compared from this current study group to similar groups in 2009-11 and 2016-17 (1,2) to see if there were any significant factors that influenced colonoscopy cancellation rates. RESULTS: 138 from a total of 2310 pts (6%) cancelled their colonoscopy within 24 hours of their scheduled procedure time when receiving the automated reminder phone call. 2-4% of pts cancelled their colonoscopy when receiving a personal reminder call from a nurse (1,2).Knowledge of a cancellation fee did not reduce the amount of cancellations. CONCLUSION: Using an automated phone call system to make reminder phone calls led to a higher cancellation rate (6%) when compared to a personal reminder phone call from a nurse (2-4%). Potential reasons are that the patient may not pick up the phone thinking it was a robocall, wrong phone numbers, deleted messages, and difficulty understanding automated messages. Even though no late fees were actually charged, just the knowledge of a potential cancellation fee was not a deterrent for cancellation. Type of insurance was the most significant factor influencing colonoscopy cancellation, as the rate of cancellation was directly related to the increase in Medicaid insured patients and inversely related to the number of privately insured patients. Personal issues were the most frequent cause for last minute cancellations. Anticipating and addressing these issues at the time of scheduling may be the most effective way of reducing cancellation rates.

Promoting Cancer Screening in Partnership With Health Ministries in 9 African American Churches in South Los Angeles: An Implementation Pilot Study.

Purpose and ObjectivesWe conducted a pilot study to assess the degree to which an intervention led by community health advisors (CHAs) to promote cancer screening was delivered as intended and to estimate the potential effect of the intervention on receipt of screening. In contrast to previous studies and to maximize its potential public health impact, the intervention targeted 4 screening tests and only participants who were not up to date with screening guidelines for at least 1 cancer. Because CHAs had to both determine baseline adherence and provide counseling on 4 screening tests, the protocol was complex. Complex protocols can reduce implementation fidelity.Intervention ApproachIn partnership with health ministries at 9 African American churches in South Los Angeles, we conducted a 1-group pretest–posttest pilot study to assess the feasibility of implementing the intervention. CHAs recruited and obtained consent from church members aged 50 to 75 years; assessed adherence to national screening guidelines for breast, cervical, colorectal, and prostate cancer; and provided evidence-based strategies (one-on-one counseling, print materials, reminder calls) to encourage screening for tests that were overdue.Evaluation MethodsWe assessed implementation fidelity by reviewing baseline screening assessments and counseling scripts completed by CHAs. We estimated potential effect of the intervention on receipt of screening by using data from 3-month follow-up surveys, conducted by the research team, of participants who were nonadherent at baseline.ResultsFrom June 2016 to June 2018, 44 CHAs conducted baseline assessments of 775 participants, of whom 338 (44%) were nonadherent to national guidelines for 1 or more cancer screening tests. CHAs provided counseling to most nonadherent participants. At follow-up, about one-third of participants reported that they had discussed cancer screening with their provider and a smaller proportion reported receipt of a screening test; 13% of men and 25% of women reported receipt of colorectal cancer screening.Implications for Public HealthThis study demonstrates that with training and ongoing technical assistance, CHAs at African American health ministries can implement complex research protocols with good fidelity.