Reminder Phone 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.

Improving measles vaccine uptake rates in Nigeria: An RCT evaluating the impact of incentive sizes and reminder calls on vaccine uptake.

To assess the impact of increasing incentive size and reminder calls on the measles vaccine uptake rate. Randomized controlled trial, randomized at individual level, stratified by clinic. Nigeria. 1088 caregivers with children aged nine months or older; had received at least one previous conditional cash transfer (CCT) at a program clinic, had received their Penta-3 immunization but had not yet received their measles immunization, and the caregiver had provided a phone number. Nine clinics were randomized to two models; caregivers in Model 1 received a default of 2000 Nigerian Naira (NGN) for completing the measles vaccine, and those in Model 2 received by 3000 NGN. Caregivers from the respective clinics were then randomized to one of the four arms: 1) control (baseline amount of 2000 NGN or 3000 NGN), 2) baseline amount plus a reminder call, 3) baseline amount plus 1000 NGN and a reminder call, and 4) baseline amount plus 3000 NGN and a reminder call. Receipt of measles vaccine as reported on a child health card. Overall, there was no clear trend that increasing the incentive amount resulted in an increase in vaccine uptake rates. In Model 1 households, an additional 1000 NGN and 3000 NGN resulted in a 6.4 percentage point (95% CI: -2.3-15, p-value = 0.15) and 11.8 percentage point (95% CI: 3.9-19.6, p-value = 0.003) increase in the probability of completing the measles vaccines, respectively. This increase, however, was only significant for the 3000 NGN increase. On the other hand, in Model 2 households, increasing the incentive by 1000 NGN and 3000 NGN increased the probability by 3.3 (95% CI: -3.8-10.4, p-value = 0.36) and 3.3 (95% CI: -3.7-10.4, p-value = 0.35) percentage points. These increases were not statistically significant. Adding reminder calls to CCTs increased the probability of completing the measles vaccine; caregivers who received reminder calls plus CCTs were 5.1 percentage points more likely to get their children vaccinated (95% CI: 0.50-9.8, p-value = 0.03) compared to those who received CCTs and did not receive a reminder call. These results were largely driven by caregivers who went to clinics in Model 1. A combination of increasing incentive amounts and reminder calls modestly improves measles immunization rates. However, this program also shows that there is substantial regional heterogeneity in response to both incentives and calls. While one possible conclusion is that a larger incentive and phone reminders are more likely to work in higher income and higher baseline coverage settings, the study is not designed to evaluate this claim. Rather, policymakers could consider experimenting with a similar low-cost calling study as part of the design of other cash transfer programs to identify whether adding reminder phone calls could increase the impact of the program.

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.

The impact of translated reminder letters and phone calls on mammography screening booking rates: Two randomised controlled trials.

IntroductionParticipation in mammographic screening for breast cancer in Australia is approximately 54% among the general population, but screening among women from some culturally and linguistically diverse (CALD) backgrounds is lower. BreastScreen Victoria apply strategies to increase screening including reminder letters and phone calls; however, these are usually provided in English. Using intervention strategies generated from the Ophelia (OPtimise HEalth LIteracy and Access) community co-design process, translated mammography reminder letters and in-language phone calls were tested within two randomised control trials (RCTs).Methods and analysisWomen aged 50–75 years who were due for their 2-yearly screening mammography (for RCT#1) or were under-screened, i.e. ≥27 months since last screen (for RCT#2) were randomised into intervention or control groups. RCT#1 compared sending women routine reminder letters (English only) with translated (Arabic or Italian) letters. RCT#2 compared reminder telephone calls to women in their preferred language (Arabic or Italian) to no telephone call. The primary outcome for each trial was screening booking rates within 14-days. Primary outcomes were tested using Pearson’s chi-square test. Rates within language group (incidence ratio: IR) were compared using the Cochran-Mantel-Haenszel test.ResultsFor RCT#1 (letters) 1,032 women were randomised into the intervention arm or to usual care. Uptake of screening bookings was similar between both groups, with no differences observed by language group. For RCT#2 (phone calls), 195 women were randomised to the intervention group or to usual care. Overall, 64.2% of women in the intervention arm and 6% in the control arm booked a screening appointment within 14 days (p<0.0001). The IR (95%CI) of booking was 10.1 (3.9, 26.3) times higher among Italian women, and 11.6 (2.9, 46.5) times higher among Arabic women in the intervention compared to usual care groups.Discussion and conclusionA service improvement initiative derived from community members and breast screen providers was found to be highly effective. This evidence informed the service provider, BreastScreen Victoria, who have implemented these improvements into routine practice to improve screening among CALD groups and reduce health inequalities.

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.

1047P - The effect of multiple interventions for women at risk for cervical cancer on their health responsibility, beliefs regarding cervical cancer, and having screening: A randomized controlled experiment

BackgroundThis study is a pretest-posttest, randomized, controlled experimental study that was intended to analyze the effect of multiple initiatives on beliefs about cervical cancer, health responsibility, and screening participation. MethodsThe group that was addressed were women between 40 and 55 years of age who were at risk of cervical cancer. The study was carried out between March 13 and June 18, 2017 in a primary health care center. The sample for this study included 134 women (experimental group: 64; control group; 67). The 14 weeks of sessions involving the experimental group included group training and delivery of brochures on cervical cancer, training and counseling during home visits, reminder phone calls, and delivery of materials, all aimed to increase motivation to be screened regularly for cervical cancer. The control group maintained their routine practices. To prevent any ethical violations, the group training as well as the brochures, magnets, and mugs that were given to the experimental group before the sessions were provided after the post-tests to the control group as well. The study data were collected using an information form, the Cervical Cancer and Pap-Smear Test Health Belief Model Scale, the Healthy Lifestyle Behaviors Scale II (Health Responsibility), and The Assessment Form for Undergoing Pap-Smear Test. The data were analyzed using dependent groups t test and independent groups t test. ResultsAfter the multiple interventions, there was a significant difference between the test and control groups’ Health Responsibility, Pap smear benefit and motivation, Pap smear obstacle and health motivation scores (p<0.05). After multiple interventions, the participation rate of women in the experimental group to cervical cancer screening was found to be 93% and the rate of cervical cancer screening was significantly higher than in the control group (p<0.05). ConclusionsIn the light of the results of these studies, it may be suggested to conduct studies in factorial design where the effectiveness of different methods to increase participation in cervical cancer screening is evaluated. Clinical trial identificationNCT03076879, 26 September 2017. Legal entity responsible for the studyBusra Altinel. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

1213 Barriers in Completion of H. pylori Eradication Testing in Predominantly Underserved Hispanic Resident Clinic: A Quality Improvement Project

INTRODUCTION: We present a quality improvement study at a resident clinic serving predominantly underserved Hispanic/Latino patients to assess physician and patient adherence to completing H. Pylori stool test of cure, and provide sustainable interventions to increase rates of eradication. METHODS: A database of patients who had confirmed H. Pylori via stool testing from July 9, 2015–June 30, 2017 was created and reviewed retrospectively. The primary endpoint was to determine the rate of eradication confirmation and observe barriers in providing the standard of care. Secondary outcomes include delay in collection and treatment. Data analysis was completed with the student's T-Test and Z-Test. RESULTS: A total of 102 patients with confirmed H. Pylori were included in this study. Patient population was predominantly identified as Hispanic (72 patients), and English was the primary language in 59 (57.8%) patients. Average delay in collection of primary stool samples to make the diagnosis of H. Pylori was 7.14 days. Men vs. women average delay in completion of initial H. Pylori testing was noted to be 10 days vs. 4.9 days with a T-Score of 1.01 (P = 0.312). Hispanic vs. non-Hispanic patients average delay in completion of initial H. Pylori testing was noted to be 8.8 days vs. 3.5 days with a T-Score of 1.40 (P = 0.165). Standard of care treatment was prescribed for 90 (89.2%) patients. Primary care physicians ordered confirmation of eradication for 78 (76.4%) patients, and 63 (61.7%) patients successfully completed eradication testing. Men vs. women in completion of eradication testing were noted to be 61% vs. 79% with a Z-Score of -2.19 (P = 0.02). Completion rate of stool eradication testing amongst patients was found to be 79.5%. CONCLUSION: Key findings include 24% of patients were not ordered eradication testing likely secondary to high physician turnover. 20% of our patients that were ordered eradication testing did not complete it, due to improvement in initial symptoms and the cumbersome stool testing process. We plan to improve compliance by offering same day urea breath testing on site, which is a simpler, less time-consuming test for patients. Community outreach, H. pylori education pamphlets in Spanish and English, reminder phone calls, and standardized physician templates for H. pylori testing are also being considered and implemented at our clinic to improve the overall rate of successfully treating H. pylori infection.

103. IMPROVING SCREENING LAB COMPLIANCE IN AN URBAN PEDIATRIC PRACTICE

Background Screening laboratory evaluations are important components of pediatric primary care. Current AAP guidelines recommend hemoglobin and lead screening at 12 months as well as lipid screening between 9-11 years. Health disparities, including variable access to transportation, contribute to failure to complete recommended screening labs at an underserved urban pediatric clinic. Following urban clinic relocation from site 1 to site 2 and subsequent loss of on-site phlebotomy, the average lab completion rate declined significantly. Aim Statement Our primary aim is to increase the rate of screening lab completions in our urban pediatric population to 75% by December 2018. Interventions A multidisciplinary team completed a Quality Improvement study to evaluate barriers to completing screening labs. Standardized phone calls to families with incomplete labs were made and fishbone diagrams were created to categorize barriers. A process map was created to understand the steps required to complete screening labs. Interventions included: reminder phone calls, standardized instructions placed into After Visit Summary (directions to the lab location, lab hours and public transportation routes to the lab), initiation of access to onsite phlebotomy, and training of on site clinic staff in phlebotomy. Measures Outcome measures were the percent of patients with completed screening labs. Process measures included percentage of patients without complete labs who received follow-up phone calls. Balancing measures were allocation and cost of staff resources. Plan Do Study Act (PDSA) methodology was used to implement and test interventions. Statistical process control charts were used to analyze the impact of interventions. Results 473 charts were reviewed. Average screening lab completion at Site 1 was 79% with decline to baseline of 21% with move to clinic Site 2. Lab completion rates increased to mean of 42% with initial interventions in action period. Lab completion increased to 90% with special cause improvement after on site staff phlebotomy training. Cost analysis data pending. Conclusions and Next Steps Significant increase was noted in lab completion upon the addition of on-site lab phlebotomy at site 2. Initial interventions did not lead to increased compliance rates further highlighting the importance of accessibility in an urban population. Urban underserved clinics may consider addition of on-site phlebotomy to continue to close the gaps in health disparity.

MON-118 PEXIP PILOT PHARMACY REVIEW – VIDEOHEALTH CONSULTS PUSHING PHARMACISTS INTO PATIENTS’ HOMES USING SMART TECHNOLOGY

Home haemodialysis patients have their biochemistry reviewed by a multidisciplinary team monthly. Having accurate medication records are essential to maximise efficient patient care. Incorrect information can lead to inappropriate treatment plans and medication misadventure. Due to logistical constraints, home haemodialysis patients are often unable to be reviewed by a clinical pharmacist at the time of their medical appointment. One strategy to increase patient access to a clinical pharmacist was to trial using videohealth technology allowing pharmacists to remotely review the patient in their home. In collaboration with the home haemodialysis nursing staff, patients suitable for technology-assisted pharmacist review were identified using the following criteria:Greater than 6 months since last pharmacist review ORPharmacist would be unavailable at their upcoming outpatient appointment ORMedication issues were identified during monthly multidisciplinary team review ANDThe patient had access to an appropriate device (e.g. computer, laptop, tablet, smart phone) Identified patients were contacted by phone and invited to participate. Once the videohealth appointment was booked the patient was emailed instructions on how to download and use the required application, “Pexip”. 13 patients were identified as appropriate candidates for a pharmacist videohealth appointment. Of these, 11 patients could be contacted and 7 agreed to proceed. Videohealth consults were successfully completed for 4 patients and the remaining 3 were aborted and changed to phone reviews due to the patient experiencing technical difficulties. Of the 7 patients who agreed to a videohealth consult, 5 failed to log in at the scheduled time and had to be reminded via phone. Of the 4 successful videohealth reviews, 2 patients were able to show their medication in both original packets and dose administration aid, 1 was on dialysis and unable to access their medications and the final patient was at their workplace and did not have their medications with them. All 4 patients provided positive feedback that they would be willing to use videohealth again. Videohealth technology was successfully used to provide a pharmacist review to home haemodalysis patients who otherwise may not have been seen in a timely manner. All patients expressed satisfaction with the service. Advantages over a telephone consult include the ability to read non-verbal communication, see the patient’s own medication and the generation of activity based funding comparable to a face-to-face consult. The pilot has identified some issues including patient understanding, expectations and readiness for the consult. An administration officer support is vital as many patients required reminder phone calls prior to their scheduled appointment time. As staff and patient familiarity with videohealth technology improves, increased patient uptake will hopefully allow expansion of this service. The advantages to patients in terms of convenience and time saved could also be explored in the future.

Barriers and facilitators of follow-up among women with precancerous lesions of the cervix in Cameroon: a qualitative pilot study.

PurposeThis pilot study explores the barriers to adherence to follow-up among women with cervical precancer in urban Cameroon. While follow-up of women with a positive screening of cervical precancer is the most important aspect of cervical cancer secondary prevention, women with cervical precancer do not adhere frequently to recommended follow-up schedule in Cameroon. The aim of the study was to explore and describe the barriers and facilitators to follow-up for cervical precancer among women infected and uninfected with HIV in Cameroon.Participants and methodsA qualitative research design was used to answer the research questions. Participants included eight HIV-infected and -uninfected women diagnosed with cervical precancer and 19 nurses. Data were collected by in-depth individual patient interviews and focus groups with nurses. An interview guide with open-ended questions, using the social ecological model as a framework, included questions that addressed the complexities of the lives of individuals and professionals within a relational context. The interviews were audio-taped and transcribed verbatim in English language. Thematic analysis of data was completed with no epistemological or theoretical perspective underpinning the analyses.ResultsFour major themes emerged from the study. They were clinic, personal, and social barriers, and strategies to improve follow-up.ConclusionThe use of reminder phone calls and fee reduction, coupled with peer counseling and navigation of women who have been diagnosed with cervical precancer, could be effective ways of improving adherence to follow-up. Further research is needed to explore the same phenomenon among women in rural areas, especially those who were initially attended to in mobile clinics.

Evaluating the Effect of Using Mobile Phone Reminders on the Adherence to Children and Young Adults With Type 1 Diabetes Attending Outreach Appointments

Effective management of Type 1 Diabetes Mellitus (T1DM) requires that people living with the condition attend regular clinical visits. The Rwanda Diabetes Association (RDA) asks young T1DM patients to attend quarterly outreach visits, and prior to the visits, RDA issues reminders via local radio stations. However, adherence in attending clinical appointments has remained low.Since Rwanda has a high mobile phone penetration rate, a pilot intervention study was conducted exploring the use of mobile phone call reminders and Short Message Service (SMS) messages to increase T1DM patients’ attendance of RDA’s quarterly outreach visits. The control group was exposed to only the regular radio broadcast, while the intervention group received reminder phone calls or SMS messages 72 hours prior to their appointments in addition to the regular radio broadcast.The attendance rate was significantly different between the 14 control patients and 35 intervention patients, with 23.3% (3/14) and 76.7% (27/35) attending visits, respectively (P=0.048). The results suggest that using mHealth methods (phone call/SMS reminders) can be effective in improving health outcomes, improving the adherence of T1DM patients to follow-up visits with minimal added cost. The total cost was 0.37 USD per person, compared to potential 672.40 USD for each lost treatment, indicating the intervention is cost-effective in that it minimizes loss to follow up in resource-limited settings. Further research is needed to evaluate the feasibility of scaling up the pilot project and to understand whether improved attendance is sustained long-term.

An Ambulatory Care Clinic and Community Pharmacy Collaboration to Address Prescription Abandonment.

The purpose of this research is to evaluate a collaborative workflow aimed at decreasing prescription abandonment. A federally qualified health center and a 340B contracted grocery store-based community pharmacy. An ambulatory care clinic with an established partnership with a community pharmacy chain identified a need to decrease prescription abandonment rates. A process was developed whereby an ambulatory care pharmacy technician received a report from the pharmacy of prescriptions filled for at least 7 days since the initial fill date and at risk for abandonment at the community pharmacy. The pharmacy technician identified health-system barriers, attempted to remedy any identified barriers, and conducted patient reminder phone calls. Health-system barriers were classified by the following categories: incorrect contact information at the community pharmacy, incorrect 340B copayment, incorrect insurance information at the community pharmacy, and need for prior authorization. A prospective cohort study was conducted from February 2016 to April 2016 in order to evaluate the effectiveness of this workflow. 551 prescriptions and 350 patients were included in this cohort. Of the 551 prescriptions, 362 had at least one identified barrier that may have led to prescription abandonment. There were 111 health-system identified barriers, and 96 of these barriers were acted upon. Additionally, there were 459 patient identified barriers, and 179 of these barriers were acted upon. When a pharmacy technician was able to identify and act upon at least one barrier, 106 prescriptions (46.9%) were picked-up from the pharmacy. From the information gathered in this quality improvement project, operational changes have been implemented at the ambulatory care clinic and community pharmacy as a means to further decrease modifiable health-system barriers that may lead to prescription abandonment.

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

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

Reducing Rejected Fecal Immunochemical Tests Received in the Laboratory for Colorectal Cancer Screening.

Colorectal cancer (CRC) screening decreases CRC incidence; however, many patients are not successfully screened. To improve screening rates at our institution by decreasing the rate of rejected fecal immunochemical tests (FITs), a means of CRC screening, from 28.6% to <10% by December 2017. Specimens were rejected for the following reasons: expired specimen, lack of recorded collection date/time, lack of physician orders, incomplete patient information, and illegible handwriting. Multidisciplinary teams devised the following interventions: FIT envelope reminder stickers, automated FIT patient reminder phone calls, a laboratory standard operating procedure, an accessioning process at satellite laboratories, revisions to a clinical reminder when offering FIT, and provision of FIT-compatible printers to clinics. Total specimens received each month ranged from 647 to 970. Fecal immunochemical test rejection rates fell from 28.6% in June 2017 to 6.9% in December 2017 with a statistically significant decrease (p-value = .015) between the intervention period (May 2017-October 2017) and the postintervention period (November 2017-May 2018). Targeted interventions with stakeholder involvement are essential in reducing the rejection rate. The decreased rejection rate saves resources by decreasing the need to rescreen patients whose specimens were rejected, and may improve CRC screening rates.

Breast Screening Reminder Letters and Phone Calls to Women in Their Language

Background: BreastScreen Victoria (BSV) provides free breast screening to women aged 40+; targeting women aged 50-74. The program reduces breast cancer-related deaths by up to 28%. BSV aims to ensure equitable participation by all women in the target population. However, women from Arabic and Italian speaking backgrounds have lower breast screening participation compared with English-speaking women. A needs analysis involving consultation with Arabic and Italian speaking women found that invitation letters and calls are important enablers to breast screening, however language is a barrier. Women suggested sending reminder letters and making outbound reminder calls in their language. Aim: The aim of this study was to determine whether, and to what extent, reminder letters and phone calls in language resulted in increased screening rates in Arabic and Italian women. Methods: Two randomized control trials ran in 2017. TRIAL 1: Women due for a routine breast screen who speak Italian or Arabic at home were randomized into one of two trial arms: women in the intervention arm received a reminder letter in language (with the English version enclosed also), and women in the control arm received a reminder letter in English only. 1032 women were included in the study; comprising 322 Arabic and 710 Italian women. TRIAL 2: Lapsed women (had not had a breast screen within 27 months) who speak Italian or Arabic at home were randomized into one of two trial arms: women in the intervention arm received an outbound call in language inviting them to book an appointment; women in the control arm did not receive a call. 219 lapsed screeners were included; comprising 93 Arabic and 126 Italian women Results: TRIAL 1: • Women in the intervention arm more frequently booked (61.2%) compared with the control group (59.8%). However, this difference was not statistically significant. • For Italian women, 64.5% in the intervention group and 66.2% in the control group booked a screening appointment within 30 days of the mail out. Among Arabic women, the rates were 53.1% and 47.5% respectively. TRIAL 2: • Women in the intervention group were 10.7 times more likely to make a booking (42.9%) compared with the control group (4%). The effect was larger for Arabic than for Italian women. Conclusion: Sending reminder letters to Italian and Arabic women in their own language did not result in a statistically significant increase in bookings. Making reminder phone calls to Italian and Arabic women in their own language did result in a large, statistically significant increase in bookings and attendance.

Improvement of appointment compliance in an underserved lupus clinic

BackgroundTo identify major obstacles to appointment compliance and quantify a measurable effect of a simple phone call intervention on the clinic show rate.MethodsWe retrospectively looked at the show rates from November 1st, 2013 to June 30th, 2014 at our Lupus clinic, which is located in Bronx, NY. The scheduled patient chart was crosschecked if the patient made it to the appointment by verifying the provider note. A patient survey was implemented over a period of 8 weeks from July 1st, 2014 to August 12th, 2014. A reminder phone call intervention 2–3 days prior to the visit was planned. The intervention was implemented from September 1st, 2014 to April 30th, 2015. Data was analyzed after the end of the intervention period.ResultsIn the pre-intervention period, our clinic show-rate was 207/352 (58.8%) The pilot survey had a total of 43 responses. The most common reason for a missed appointment was ‘forgot about the appointment’ (45.5%). Reminder phone calls were the preferred intervention (76.74%), which patients’ thought might help to keep scheduled appointments. In the intervention period, 283 of the scheduled 378 appointments were completed (74.8) in the lupus clinic. The difference in the show rate before and after the intervention by Pearson’s Chi-squared test with Yates continuity correction was statistically significant with a p-value of 0.0062.ConclusionA simple telephone call reminder significantly improves clinic show rates in an underserved Lupus clinic, which can help improve health parameters in the Lupus population.

Implementation of a Facility Based County Surveillance System Using Epi Info

ObjectiveThe Florida Department of Health in Hillsborough County (DOH-Hillsborough) routinely reviews the ESSENCE-FL system to assess syndromic trends in emergency department (ED) and urgent care data (UCC). Collection of this type of symptom data from long term care facilities (LTCFs) and child care centers is of interest in order to better understand how these illness patterns present in vulnerable populations outside of the EDs.IntroductionSurveillance in nursing homes (Enserink et al., 2011) and day care facilities (Enserink et al., 2012) has been conducted in the Netherlands, but is not commonly practiced in the United States (Buehler et al., 2008). Outbreaks of illnesses within these facilities are required to be reported to the Epidemiology Program, however a small fraction of outbreaks reported come from LTCFs. Without regular communication between LTCFs and the Epidemiology Program, it is likely that many outbreaks are going unreported due to lack of awareness of the reporting requirements by facility staff. To better understand the prevalence of illness in LTCFs and improve communication between LTCFs and DOH-Hillsborough a weekly surveillance survey was created using Epi Info web survey.MethodsThe online facility search tool from the Agency for Healthcare Administration (AHCA) was used to query assisted living facilities and nursing homes in Hillsborough County in July 2017. The information provided included the number of beds a facility is licensed to have. Interest in participation was solicited from larger LTCFs within the county in August 2017 and 23 facilities volunteered to receive weekly surveys, with a total volume of 3,276 beds. A form was created in Epi Info to capture weekly information per facility of the number of residents and staff with new onset of various symptoms. Symptom groups include GI, rash, respiratory, and those with respiratory symptoms who also have a fever (to assess influenza-like illness); number of positive flu tests for the week is also asked. Starting with week 38, an email has been sent once a week to participating facilities with a link to the Epi Info web survey (Figure 1) and instructions to fill out the information for the previous week.ResultsTo date, 12 weeks of information has successfully been captured in Epi Info and transferred to Microsoft Excel for graphical visualization of percentage of residents/staff reported each week in the county with new onset of the above symptoms. Low levels of illness (&lt;6%/week of total reported residents/staff) have been reported for various syndromes each week. Over the 12 week period an average of 3.9 facilities submit data per week, with a total of 10 of 23 facilities participating at least once. In week 42 phone calls were made to faclities that had not submitted any responses in an attempt to elicit more participation and troubleshoot any problems faclities may have encountered. Prior to week 42, an average of 3.2 facilties reported per week. After reminder phone calls were conducted, the average number of responses for weeks 42-48 was 4.4 with the highest in week 42 (6 responses). Starting in week 42 the survey has also been implemented for 15 child care facilities, with four participating over the seven weeks with an average of 2.1 responses per week.ConclusionsSince implementation, the main limitation with the data collection is lack of regular participation from facilities.The current goal of the project is to increase the number of regular responses from both LTCFs and child care facilities. The phone calls made in week 42 increased the response rate for LTCFs, particularly for that week. Preliminary results from the first 12 weeks of data indicate that using Epi Info web survey as a syndromic surveillance tool for local facilities has potential if regular participation can be acheived.ReferencesBuehler, J., Sonricker, A., Paladini, M., Soper, P., Mostashari, F. (2008), Syndromic Surveillance Practice in the United States: Findings from a Survey of State, Territorial, and Selected Local Health Departments. Advances in Disease Surveillance, 6:3.Enserink, R., Meijer, A., Dijkstra, F., van Benthem, B., van der Steen, J. T., Haenen, A., van Delden, H., Cools, H., van der Sande, M., Veldman-Ariesen, M.-J. and on behalf of the Sentinel Surveillance Network on Infectious Diseases in Nursing Homes Study Group (2011), Absence of Influenza A(H1N1) During Seasonal and Pandemic Seasons in a Sentinel Nursing Home Surveillance Network in the Netherlands. J Am Geriatr Soc, 59: 2301–2305. doi:10.1111/j.1532-5415.2011.03715.xEnserink, R., Noel, H., Friesema, I., de Jager, C., Kooistra-Smid, A., Kortbeek, L., Duizer, E., van der Sande, M., Smit, H., van Pelt, W. (2012), The KIzSS network, a sentinel surveillance system for infectious diseases in day care centers: study protocol. BMC Infectious Diseases, 12:259. doi:10.1186/1471-2334-12-259

Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments

Transportation barriers contribute to missed primary care appointments for patients with Medicaid. Rideshare services have been proposed as alternatives to nonemergency medical transportation programs because of convenience and lower costs. To evaluate the association between rideshare-based medical transportation and missed primary care appointments among Medicaid patients. In a prospective clinical trial, 786 Medicaid beneficiaries who resided in West Philadelphia and were established primary care patients at 1 of 2 academic internal medicine practices located within the same building were included. Participants were allocated to being offered complimentary ride-sharing services (intervention arm) or usual care (control arm) based on the prescheduled day of their primary care appointment reminder. Those scheduled on even-numbered weekdays were in the intervention arm and on odd-numbered weekdays, the control arm. The primary study outcome was the rate of missed appointments, estimated using an intent-to-treat approach. All individuals receiving a phone call reminder were included in the study sample, regardless of whether they answered their phone. The study was conducted between October 24, 2016, and April 20, 2017. A model of providing rideshare-based transportation was designed. As part of usual care, patients assigned to both arms received automated appointment phone call reminders. As part of the study protocol, patients assigned to both arms received up to 3 additional appointment reminder phone calls from research staff 2 days before their scheduled appointment. During these calls, patients in the intervention arm were offered a complimentary ridesharing service. Research staff prescheduled rides for those interested in the service. After their appointment, patients phoned research staff to initiate a return trip home. Missed appointment rate (no shows and same-day cancellations) in the intervention compared with control arm. Of the 786 patients allocated to the intervention or control arm, 566 (72.0%) were women; mean (SD) age was 46.0. (12.5) years. Within the intervention arm, 85 among 288 (26.0%) participants who answered the phone call used ridesharing. The missed appointment rate was 36.5% (144 of 394) for the intervention arm and 36.7% (144 of 392) for the control arm (P = .96). The uptake of ridesharing was low and did not decrease missed primary care appointments. Future studies trying to reduce missed appointments should explore alternative delivery models or targeting populations with stronger transportation needs. clinicaltrials.gov Identifier: NCT02955433.

A pragmatic trial to improve adherence with scheduled appointments in an inner-city pain clinic by human phone calls in the patient's preferred language

Study objectiveWe investigated if human reminder phone calls in the patient's preferred language increase adherence with scheduled appointments in an inner-city chronic pain clinic. We hypothesized that language and cultural incongruence is the underlying mechanism to explain poor attendance at clinic appointments in underserved Hispanic populations. DesignPragmatic randomized controlled clinical trial SettingInnercity academic chronic pain clinic with a diverse, predominantly African-American and Hispanic population PatientsAll (n=963) adult patients with a scheduled first appointment between October 2014 and October 2015 at the Montefiore Pain Center in the Bronx, New York were enrolled. InterventionsPatients were randomized to receive a human reminder call in their preferred language before their appointment, or no contact. MeasurementsWe recorded patients' demographic characteristics and as primary outcome attendance as scheduled, failure to attend and/or cancellation calls. We fit Bayesian and classical multinomial logistic regression models to test if the intervention improved adherence with scheduled appointments. Main resultsAmong the 953 predominantly African American and Hispanic/Latino patients, 475 patients were randomly selected to receive a language-congruent, human reminder call, while 478 were assigned to receive no prior contact, (after we excluded 10 patients, scheduled for repeat appointments). In the experimental group, 275 patients adhered to their scheduled appointment, while 84 cancelled and 116 failed to attend. In the control group, 249 patients adhered to their scheduled appointment, 31 cancelled and 198 failed to attend. Human phone reminders in the preferred language increased adherence (RR 1.89, CI95% [1.42, 1.42], (p<0.01). The intervention seemed particularly effective in Hispanic patients, supporting our hypothesis of cultural congruence as possible underlying mechanism. ConclusionsHuman reminder phone calls prior in the patient's preferred language increased adherence with scheduled appointments. The intervention facilitated access to much needed care in an ethnically diverse, resource poor population, presumably by overcoming language barriers.

Assessing and Promoting the Wellness of United States Ophthalmology Residents: A Survey of Program Directors

To report on the status of residency-based wellness initiatives in ophthalmic graduate medical education and identify strategies for promoting ophthalmology resident wellness by surveying US ophthalmology program directors (PDs). The PDs were each sent an e-mail containing a link to an anonymous online 15-question survey. The PDs also received a letter with the survey link and a $1 incentive. After 2 weeks, nonresponders received 2 weekly reminder e-mails and phone calls. Descriptive statistics were used to analyze the multiple choice responses and categorize the free response answers. National survey. All 111 US ophthalmology PDs were invited to participate. Of 111 PDs, 56 (50%) responded; 14 (26%) of 53 respondents reported that their programs faced an issue involving resident depression, burnout, or suicide within the last year; 25 (45%) of 56 reported that their department had a resident wellness program. Respondents without wellness programs reported a shortage of time (19/30; 63%) and lack of training and resources (19/30; 63%) as barriers to instituting these programs. Respondents reported that the Accreditation Council for Graduate Medical Education could better promote resident wellness by providing training resources for burnout and depression screening (35/53; 66%), resilience skills building (38/53; 72%), and wellness program development (36/53; 68%). This survey suggests that there is a substantial burden of burnout and depression among residents in ophthalmic graduate medical education and that this burden can be addressed by promoting the training of educators to recognize the signs of burnout and depression, and providing resources to develop and expand formal wellness programs.