Alison T Brenner1,2, Jewels Rhode1, Jeff Y Yang3, Dana Baker4, Rebecca Drechsel5, Marcus Plescia5, Daniel S Reuland1,2, Tom Wroth6, Stephanie B Wheeler1,7. 1. Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 4. Community Care Partners of Greater Mecklenburg, Charlotte, North Carolina. 5. Mecklenburg County Public Health Department, Charlotte, North Carolina. 6. Community Care Network of North Carolina, Raleigh, North Carolina. 7. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Abstract
BACKGROUND: Colorectal cancer (CRC) screening is effective but underused. Screening rates are lower among Medicaid beneficiaries versus other insured populations. No studies have examined mailed fecal immunochemical testing (FIT)-based outreach programs for Medicaid beneficiaries. METHODS: In a patient-level randomized controlled trial, a mailed CRC screening reminder plus FIT, sent from an urban health department to Medicaid beneficiaries, was compared with the same reminder without FIT. The reminder group could request FIT. Completed FIT kits were processed by the health department laboratory. Respondents were notified of normal results by mail. Abnormal results were given via phone by a patient navigator who provided counselling and assistance with follow-up care. The primary outcome was FIT return. RESULTS: In all, 2144 beneficiaries at average CRC risk were identified, and there was no evidence of screening with Medicaid claims data. To the reminder+FIT group, 1071 were randomized, and 1073 were randomized to the reminder group; 307 (28.7%) in the reminder+FIT group and 347 (32.3%) in the reminder group were unreachable or ineligible (previous screening). The FIT return rate was significantly higher in the reminder+FIT group than the reminder group (21.1% vs 12.3%; difference, 8.8%; 95% confidence interval, 3.7%-13.9%; P < .01). Eighteen individuals (7.2%) who completed FIT tests had abnormal results, and 15 were eligible for follow-up colonoscopy; 66.7% (n = 10) completed follow-up colonoscopy. CONCLUSIONS: A health department-based, mailed FIT program targeting Medicaid beneficiaries was feasible. Including a FIT kit resulted in greater screening completion than a reminder letter alone. Further research is needed to understand the comparative cost-effectiveness of these interventions.
RCT Entities:
BACKGROUND:Colorectal cancer (CRC) screening is effective but underused. Screening rates are lower among Medicaid beneficiaries versus other insured populations. No studies have examined mailed fecal immunochemical testing (FIT)-based outreach programs for Medicaid beneficiaries. METHODS: In a patient-level randomized controlled trial, a mailed CRC screening reminder plus FIT, sent from an urban health department to Medicaid beneficiaries, was compared with the same reminder without FIT. The reminder group could request FIT. Completed FIT kits were processed by the health department laboratory. Respondents were notified of normal results by mail. Abnormal results were given via phone by a patient navigator who provided counselling and assistance with follow-up care. The primary outcome was FIT return. RESULTS: In all, 2144 beneficiaries at average CRC risk were identified, and there was no evidence of screening with Medicaid claims data. To the reminder+FIT group, 1071 were randomized, and 1073 were randomized to the reminder group; 307 (28.7%) in the reminder+FIT group and 347 (32.3%) in the reminder group were unreachable or ineligible (previous screening). The FIT return rate was significantly higher in the reminder+FIT group than the reminder group (21.1% vs 12.3%; difference, 8.8%; 95% confidence interval, 3.7%-13.9%; P < .01). Eighteen individuals (7.2%) who completed FIT tests had abnormal results, and 15 were eligible for follow-up colonoscopy; 66.7% (n = 10) completed follow-up colonoscopy. CONCLUSIONS: A health department-based, mailed FIT program targeting Medicaid beneficiaries was feasible. Including a FIT kit resulted in greater screening completion than a reminder letter alone. Further research is needed to understand the comparative cost-effectiveness of these interventions.
Authors: Ann Oluloro; Amanda F Petrik; Ann Turner; Tanya Kapka; Jennifer Rivelli; Patricia A Carney; Somnath Saha; Gloria D Coronado Journal: J Community Health Date: 2016-08
Authors: Stephanie B Wheeler; Tzy-Mey Kuo; Ravi K Goyal; Anne-Marie Meyer; Kristen Hassmiller Lich; Emily M Gillen; Seth Tyree; Carmen L Lewis; Trisha M Crutchfield; Christa E Martens; Florence Tangka; Lisa C Richardson; Michael P Pignone Journal: Health Place Date: 2014-07-24 Impact factor: 4.078
Authors: Michael V Maciosek; Leif I Solberg; Ashley B Coffield; Nichol M Edwards; Michael J Goodman Journal: Am J Prev Med Date: 2006-07 Impact factor: 5.043
Authors: Amit G Singal; Samir Gupta; Celette Sugg Skinner; Chul Ahn; Noel O Santini; Deepak Agrawal; Christian A Mayorga; Caitlin Murphy; Jasmin A Tiro; Katharine McCallister; Joanne M Sanders; Wendy Pechero Bishop; Adam C Loewen; Ethan A Halm Journal: JAMA Date: 2017-09-05 Impact factor: 56.272
Authors: Amy B Knudsen; Ann G Zauber; Carolyn M Rutter; Steffie K Naber; V Paul Doria-Rose; Chester Pabiniak; Colden Johanson; Sara E Fischer; Iris Lansdorp-Vogelaar; Karen M Kuntz Journal: JAMA Date: 2016-06-21 Impact factor: 56.272
Authors: John M Inadomi; Sandeep Vijan; Nancy K Janz; Angela Fagerlin; Jennifer P Thomas; Yunghui V Lin; Roxana Muñoz; Chim Lau; Ma Somsouk; Najwa El-Nachef; Rodney A Hayward Journal: Arch Intern Med Date: 2012-04-09
Authors: Peter S Liang; Chelle L Wheat; Anshu Abhat; Alison T Brenner; Angela Fagerlin; Rodney A Hayward; Jennifer P Thomas; Sandeep Vijan; John M Inadomi Journal: Am J Gastroenterol Date: 2015-11-03 Impact factor: 10.864
Authors: Amanda F Petrik; Beverly Green; Jennifer Schneider; Edward J Miech; Jennifer Coury; Sally Retecki; Gloria D Coronado Journal: J Gen Intern Med Date: 2020-10-26 Impact factor: 5.128
Authors: Jennifer Coury; Edward J Miech; Patricia Styer; Amanda F Petrik; Kelly E Coates; Beverly B Green; Laura-Mae Baldwin; Jean A Shapiro; Gloria D Coronado Journal: Implement Sci Commun Date: 2021-01-11
Authors: Gloria D Coronado; Beverly B Green; Imara I West; Malaika R Schwartz; Jennifer K Coury; William M Vollmer; Jean A Shapiro; Amanda F Petrik; Laura-Mae Baldwin Journal: Cancer Date: 2019-10-28 Impact factor: 6.860
Authors: Rachel B Issaka; Nkem O Akinsoto; Erica Strait; Van Chaudhari; David R Flum; John M Inadomi Journal: Therap Adv Gastroenterol Date: 2020-09-09 Impact factor: 4.409
Authors: Beverly B Green; Laura-Mae Baldwin; Imara I West; Malaika Schwartz; Gloria D Coronado Journal: J Prim Care Community Health Date: 2020 Jan-Dec
Authors: Laura F Gruner; Efrat L Amitay; Thomas Heisser; Feng Guo; Tobias Niedermaier; Anton Gies; Michael Hoffmeister; Hermann Brenner Journal: Cancers (Basel) Date: 2021-03-25 Impact factor: 6.639
Authors: Jordan J Karlitz; A Mark Fendrick; Jay Bhatt; Gloria D Coronado; Sushanth Jeyakumar; Nathaniel J Smith; Marcus Plescia; Durado Brooks; Paul Limburg; David Lieberman Journal: Popul Health Manag Date: 2021-12-24 Impact factor: 2.290