Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial. Issue 16 (13th July 2018)

• Record Type: Journal Article
• Authors: Brenner, Alison T.; Rhode, Jewels; Yang, Jeff Y.; Baker, Dana; Drechsel, Rebecca; Plescia, Marcus; Reuland, Daniel S.; Wroth, Tom; Wheeler, Stephanie B.
• Is Part Of: Cancer. Volume 124:Issue 16(2018)
• Page Start: 3346
• Page End: 3354
• Publication Date: 2018-07-13
• Subjects: cancer prevention -- colorectal cancer screening -- fecal immunochemical testing -- Medicaid beneficiaries -- randomized control trial (RCT); Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.31566
• Languages: English
• ISSNs: 0008-543X

Abstract

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. Abstract : A feasible patient‐level randomized controlled trial has been conducted to compare a mailed colorectal cancer screening reminder plus a fecal immunochemical testing kit from an urban health department with the same reminder without the kit. The results indicate that including a fecal immunochemical testing kit results in greater screening completion than a reminder letter alone.