重复的自动化移动短信提醒在粪便潜血试验阳性的随访中的应用：随机对照试验。
Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial.
机构信息
Master of Health Administration Program, Department of Management, Bar Ilan University, Ramat Gan, Israel.
Central Laboratory, Meuhedet Health Care, Lod, Israel.
出版信息
JMIR Mhealth Uhealth. 2019 Feb 5;7(2):e11114. doi: 10.2196/11114.
BACKGROUND
Fecal occult blood tests (FOBTs) are recommended by the US Preventive Services Task Force as a screening method for colorectal cancer (CRC), but they are only effective if positive results are followed by colonoscopy. Surprisingly, a large proportion of patients with a positive result do not follow this recommendation.
OBJECTIVE
The objective of this study was to examine the effectiveness of text messaging (short message service, SMS) in increasing adherence to colonoscopy follow-up after a positive FOBT result.
METHODS
This randomized controlled trial was conducted with patients who had positive CRC screening results. Randomization was stratified by residential district and socioeconomic status (SES). Subjects in the control group (n=238) received routine care that included an alert to the physician regarding the positive FOBT result. The intervention group (n=232) received routine care and 3 text messaging SMS reminders to visit their primary care physician. Adherence to colonoscopy was measured 120 days from the positive result. All patient information, including test results and colonoscopy completion, were obtained from their electronic medical records. Physicians of study patients completed an attitude survey regarding FOBT as a screening test for CRC. Intervention and control group variables (dependent and independent) were compared using chi-square test. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs for performing colonoscopy within 120 days for the intervention group compared with the control group while adjusting for potential confounders including age, gender, SES, district, ethnicity, and physicians' attitude.
RESULTS
Overall, 163 of the 232 patients in the intervention group and 112 of the 238 patients in the control group underwent colonoscopy within 120 days of the positive FOBT results (70.3% vs 47.1%; OR 2.17, 95% CI 1.49-3.17; P<.001); this association remained significant after adjusting for potential confounders (P=.001).
CONCLUSIONS
A text message (SMS) reminder is an effective, simple, and inexpensive method for improving adherence among patients with positive colorectal screening results. This type of intervention could also be evaluated for other types of screening tests.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03642652; https://clinicaltrials.gov/ct2/show/NCT03642652 (Archived by WebCite at http://www.webcitation.org/74TlICijl).
背景
美国预防服务工作组建议使用粪便潜血试验（FOBT）作为结直肠癌（CRC）的筛查方法，但只有在阳性结果后进行结肠镜检查才有效。令人惊讶的是，很大一部分阳性结果的患者并未遵循这一建议。
目的
本研究旨在探讨短信（短消息服务，SMS）在提高阳性 FOBT 结果后结肠镜随访依从性方面的有效性。
方法
本随机对照试验纳入了具有阳性 CRC 筛查结果的患者。随机分组按居住地区和社会经济状况（SES）分层。对照组（n=238）接受常规护理，包括向医生提醒阳性 FOBT 结果。干预组（n=232）接受常规护理和 3 次短信 SMS 提醒，以就诊于初级保健医生。从阳性结果起 120 天测量结肠镜检查的依从性。所有患者信息，包括检测结果和结肠镜检查完成情况，均从其电子病历中获得。研究患者的医生完成了一项关于 FOBT 作为 CRC 筛查测试的态度调查。使用卡方检验比较干预组和对照组的变量（依赖和独立）。使用逻辑回归计算干预组与对照组相比在 120 天内进行结肠镜检查的比值比（OR）和 95%置信区间（CI），同时调整年龄、性别、SES、地区、种族和医生态度等潜在混杂因素。
结果
总体而言，干预组 232 例患者中有 163 例和对照组 238 例患者中有 112 例在 FOBT 阳性后 120 天内进行了结肠镜检查（70.3%比 47.1%；OR 2.17，95%CI 1.49-3.17；P<.001）；在调整潜在混杂因素后，这种关联仍然显著（P=.001）。
结论
短信（SMS）提醒是一种有效、简单、经济的方法，可以提高阳性结直肠筛查结果患者的依从性。这种干预类型也可以评估其他类型的筛查测试。
试验注册
ClinicalTrials.gov NCT03642652；https://clinicaltrials.gov/ct2/show/NCT03642652（由 WebCite 存档，http://www.webcitation.org/74TlICijl）。
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