Effectiveness of Telephone and Secure Messaging in Communicating Colonoscopy Intervals
Telephone outreach and secure messaging have proven to be more effective in eliciting responses compared to traditional mailed letters when it comes to informing patients with a history of low-risk adenomas about updated colonoscopy intervals, according to a recent randomized trial.
Published in Clinical Gastroenterology and Hepatology, the study led by Jeffrey K. Lee, MD, MPH, a gastroenterologist at Kaiser Permanente Medical Center in San Francisco, showcased response rates within 60 days for the three communication methods used among over 600 post-polypectomy patients. The results were as follows:
– Telephone: 64.5% response rate
– Secure messaging: 51.7% response rate
– Mailed letter: 31.3% response rate
Significant discrepancies in response rates were observed when compared with the traditional mailed letters, with the telephone outreach showing an 18.1% difference and secure messaging showing a 13.1% difference.
Although interventions like these are commonly utilized, their effectiveness in conveying updated colonoscopy intervals had not been rigorously assessed before this study.
The primary objective of the trial was to inform patients with low risk of the recommended interval switch from 5 years to 7-10 years, a change from the longstanding practice since the 1990s. Notably, a higher percentage of patients within the telephone and secure messaging groups chose to transition to the 10-year surveillance interval compared to those in the mailed-letter group.
Factors that positively influenced the adoption of the 10-year interval included a positive fecal immunochemical test-based index colonoscopy and advancing age. On the other hand, factors such as being of Asian or Pacific Islander descent, Hispanic ethnicity, and higher Charlson comorbidity scores were inversely associated with the transition to the longer surveillance interval.
The authors pointed out that disparities based on race and ethnicity could be attributed to cultural differences in care, language barriers with English-based outreach methods, and distrust in the medical system.
Dr. Lee emphasized the importance of providing patients with the choice to follow the updated guidelines or maintain their existing surveillance intervals. The study highlighted the challenges faced by healthcare systems in implementing new recommendations for low-risk patients and reevaluating their follow-up intervals.
Considering that over 5 million surveillance colonoscopies are conducted annually in the US among patients with adenoma history, these findings have significant implications. With the latest guidelines recommending a longer follow-up interval of 7-10 years, healthcare providers are urged to reassess follow-up schedules for low-risk patients previously scheduled for more frequent colonoscopies.
Looking ahead, further research and strategies are needed to ensure effective communication of colonoscopy intervals to patients with low-risk adenomas, promoting adherence to updated guidelines and enhancing the quality of care provided.