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Randomized Controlled Trial
. 2018 Aug;124(16):3346-3354.
doi: 10.1002/cncr.31566. Epub 2018 Jul 13.

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

Alison T Brenner  1   2 , Jewels Rhode  1 , Jeff Y Yang  3 , Dana Baker  4 , Rebecca Drechsel  5 , Marcus Plescia  5 , Daniel S Reuland  1   2 , Tom Wroth  6 , Stephanie B Wheeler  1   7
Affiliations
Randomized Controlled Trial

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

Alison T Brenner et al. Cancer. 2018 Aug.

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.

Keywords: Medicaid beneficiaries; cancer prevention; colorectal cancer screening; fecal immunochemical testing; randomized control trial (RCT).

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Conflict of interest statement

Conflicts of interest:

The authors report no conflicts of interest.

Figures

Appendix Figure 1.
Appendix Figure 1.
Comparative Effectiveness of Mailed Reminder (Reminder + FIT vs. Reminder Only), by Study Subgroup, Standard Intention-to-Treat Analysis
Figure 1.
Figure 1.
Study Population Flow Chart
Figure 2.
Figure 2.
Comparative Effectiveness of Maile d Reminder (Reminder + FIT vs. Reminder Only), by Study Subgroup, Modified Intention-to-Treat Analysis
See this image and copyright information in PMC

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