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Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial
  • Published Date:
    July 13 2018
  • Source:
    Cancer. 124(16):3346-3354
  • Language:
    English


Public Access Version Available on: August 01, 2019 information icon
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Details:
  • Keywords:
  • Pubmed ID:
    30004577
  • Pubmed Central ID:
    PMC6446899
  • Description:
    Background:

    Colorectal cancer (CRC) screening is effective but underutilized. Screening rates among Medicaid beneficiaries are lower than for other insured populations. No studies have examined a mailed fecal immunochemical testing (FIT)-based outreach programs for Medicaid beneficiaries.

    Methods:

    We conducted a patient-level randomized controlled trial comparing a mailed CRC screening reminder with and without a FIT from an urban health department to Medicaid beneficiaries. The Reminder Group could request a FIT. Completed FITs were processed by the health department lab. Respondents were notified of normal results by mail. Abnormal results were given via phone from a patient navigator who provided counselling and assistance with follow-up care. The primary outcome was FIT return.

    Results:

    We identified 2,144 beneficiaries at average CRC risk and no evidence of screening using Medicaid claims data. We randomized 1,071 to the Reminder+FIT Group and 1,073 to the Reminder Group, of whom 307 (28.7%) in the Reminder+FIT Group and 347 (32.3%) in the Reminder Group were unreachable or ineligible (previous screening). FIT return was significantly higher in the Reminder+FIT Group than the Reminder Group (21.1% vs 12.3%; difference 8.8%; 95% CI 3.7%, 13.9%; p<0.01). Eighteen (7.2%) individuals who completed FIT tests had abnormal results, and 15 were eligible for follow-up colonoscopy; 66.7% (10) completed a 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 comparative cost-effectiveness of these interventions.

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