Randomized Trial of Patient Outreach Approaches to De-implement Outdated Colonoscopy Surveillance Intervals.

Autor:	Lee JK; Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California. Electronic address: jeffrey.k.lee@kp.org., Koripella PC; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California., Jensen CD; Division of Research, Kaiser Permanente Northern California, Oakland, California., Merchant SA; Division of Research, Kaiser Permanente Northern California, Oakland, California., Fox JM; Department of Gastroenterology, Kaiser Permanente San Rafael Medical Center, San Rafael, California., Chang SX; Department of Gastroenterology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California., Dang CH; Department of Gastroenterology, Kaiser Permanente San Leandro Medical Center, San Leandro, California., Velayos FS; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California., Boparai ES; Department of Gastroenterology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California., Evans NS; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California., Leung LJ; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California., Badalov JM; Division of Research, Kaiser Permanente Northern California, Oakland, California., Quesenberry CP; Division of Research, Kaiser Permanente Northern California, Oakland, California., Corley DA; Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California., Levin TR; Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Gastroenterology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California.
Jazyk:	angličtina
Zdroj:	Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2024 Jun; Vol. 22 (6), pp. 1315-1322.e7. Date of Electronic Publication: 2024 Jan 06.
DOI:	10.1016/j.cgh.2023.12.027
Abstrakt:	Background and Aims: Guidelines now recommend patients with low-risk adenomas receive colonoscopy surveillance in 7-10 years and those with the previously recommended 5-year interval be re-evaluated. We tested 3 outreach approaches for transitioning patients to the 10-year interval recommendation. Methods: This was a 3-arm pragmatic randomized trial comparing telephone, secure messaging, and mailed letter outreach. The setting was Kaiser Permanente Northern California, a large integrated healthcare system. Participants were patients 54-70 years of age with 1-2 small (<10 mm) tubular adenomas at baseline colonoscopy, due for 5-year surveillance in 2022, without high-risk conditions, and with access to all 3 outreach modalities. Patients were randomly assigned to the outreach arm (telephone [n = 200], secure message [n = 203], and mailed letter [n = 201]) stratified by age, sex, and race/ethnicity. Outreach in each arm was performed by trained medical assistants (unblinded) communicating in English with 1 reminder attempt at 2-4 weeks. Participants could change their assigned interval to 10 years or continue their planned 5-year interval. Results: Sixty-day response rates were higher for telephone (64.5%) and secure messaging outreach (51.7%) vs mailed letter (31.3%). Also, more patients adopted the 10-year surveillance interval in the telephone (37.0%) and secure messaging arms (32.0%) compared with mailed letter (18.9%) and rate differences were significant for telephone (18.1%; 97.5% confidence interval: 8.3%-27.9%) and secure message outreach (13.1%; 97.5% confidence interval: 3.5%-22.7%) vs mailed letter outreach. Conclusions: Telephone and secure messaging were more effective than mailed letter outreach for de-implementing outdated colonoscopy surveillance recommendations among individuals with a history of low-risk adenomas in an integrated healthcare setting. (ClinicalTrials.gov, Number: NCT05389397). (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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