Trial Information

Use of Telehealth In-Home Messaging to Improve GI Endoscopy Completion Rates

Background:

Low endoscopy completion rates are a major problem nationwide and in the VA. For clinics,
delays or failure to complete exams can cause clinic inefficiencies, such as increased wait
times for needed procedures, lost capacity, and increased costs. For patients, delays
reduce the chance for recommended timely screening consistent with practice guidelines and
for diagnostic tests, can cause significant anxiety, delayed treatment and possibly poorer
prognosis. This study tests whether an Interactive Voice Response (IVR) messaging system is
equally effective in motivating patients to complete a flexible sigmoidoscopy or colonoscopy
as usual clinical care practices, which include reminder phone calls from clinic nurses.
This is the first study to evaluate the use of IVR for endoscopy completion and the first to
compare it to the effectiveness of phone calls from nurses prior to an endoscopy
appointment.

Objectives:

The primary set of objectives was to test whether IVR messaging was equivalent to clinic
usual care (UC) practices in motivating patients to attend a scheduled flexible
sigmoidoscopy or colonoscopy appointment and to adequately prepare for the exam. Secondary
objectives included comparing patient satisfaction with UC and IVR phone calls and assessing
if IVR or UC was more effective for sub-groups that may have more difficulty with
preparation, including those with poor physical and mental functioning, health literacy,
social support and trust in physicians and those with spinal cord injury, paraplegia, PTSD,
or with little intention to be tested for colorectal cancer in the future.

Methods:

This was a stratified 3-arm randomized controlled trial among patients with upcoming
flexible sigmoidoscopy or colonoscopy appointments. All patients who had a colonoscopy or
flexible sigmoidoscopy appointment scheduled from August 20, 2007 through October 31, 2008
were assessed for inclusion in this study. Patients were not considered eligible if, based
on a medical record review prior to randomization, they had unreliable means of receiving
the intervention or the intervention would have provided inappropriate or inaccurate
information. The three study arms included: 1) UC (nurse phone call 7 days prior to the
procedure); 2) IVR7 (call from IVR system 7 days prior to procedure); and, 3) IVR3 (call
from IVR system 3 days prior to procedure). One week after the initial appointment
self-administered surveys were sent to all participants to assess satisfaction with
reminder/motivation calls. Appointment and gastrointestinal (GI) procedure data were
extracted from medical record files to assess study outcomes. The principal outcome measures
were (1) attendance at the scheduled endoscopy appointment; (2) adequate preparation for the
exam; (3) patient satisfaction with reminder/motivation telephone calls.

Status:

Complete