Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial

Details

• Alternative Title:
  Cancer
• Personal Author:
  Brenner, Alison ; Rhode, Jewels ; Yang, Jeff Y ; Baker, Dana ; Drechsel, Rebecca ; Plescia, Marcus ; Reuland, Daniel S ; Wroth, Tom ; Wheeler, Stephanie
• 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.
  
  
• Subjects:
  Aged Colonoscopy Colorectal Neoplasms Early Detection Of Cancer Feces Female Humans Immunochemistry Male Medicaid Middle Aged Postal Service

  More +
• Source:
  Cancer. 124(16):3346-3354
• Pubmed ID:
  30004577
• Pubmed Central ID:
  PMC6446899
• Document Type:
  Journal Article
• Funding:
  T32 DK007634/DK/NIDDK NIH HHSUnited States/ ; U48 DP005017/DP/NCCDPHP CDC HHSUnited States/
• Place as Subject:
  United States
• Volume:
  124
• Issue:
  16
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8fb8041ad76c7692a7192657df13c910174cedb6c7ca451326f0d95939da86c6
• Download URL:
  https://stacks.cdc.gov/view/cdc/77250/cdc_77250_DS1.pdf
• File Type:
  [PDF - 276.31 KB ]