Non-Attendance to Post-Radiotherapy Follow-Up in Breast Cancer: Efficacy of Mail and Telephone Reminders

Background: To assess the efficacy of two reminder interventions in improving post-radiotherapy followup attendance rates of breast cancer patients. Methods: Three periods of three months were assessed, a baseline period, an intervention period and a confirmation period. In the intervention period, a two-step reminder system was used. This system consisted of a mail reminder (IV1) that was sent to all patients three to four weeks prior to the post-radiotherapy follow-up visit, which was followed by up to two telephone calls (IV2) for all patients who did not attend this follow-up visit. During the confirmation period, IV2 was used exclusively to assess the maximal possible efficacy of the telephone reminder. Results: The non-attendance rate of breast cancer patients was 18.1% (19/105) in the baseline period; this rate decreased to 13.1% in the intervention period (23/176; p=0.33) after IV1 and then decreased to 6.3% (11/176; p=0.03) after IV2. In the confirmation period, 24.4% (42/172) of breast cancer patients did not attend their post-radiotherapy follow-up visit; the non-attendance rate decreased significantly after (exclusive) IV2 from 24.4% (42/172) to 9.3% (16/172; p<0.001). Significance was observed for the first call but not for the second call in the chi-square test. Conclusion: Telephone reminder is an effective tool for improving breast cancer patient adherence to the post-radiotherapy follow-up visit. In this study, the telephone reminder system was more effective than the mail reminder system.

The burden and utility of routine follow-up at one year after primary arthroplasty

Aims Routine surveillance of primary hip and knee arthroplasties has traditionally been performed with office follow-up visits at one year postoperatively. The value of these visits is unclear. The present study aims to determine the utility and burden of routine clinical follow-up at one year after primary arthroplasty to patients and providers. Methods All patients (473) who underwent primary total hip (280), hip resurfacing (eight), total knee (179), and unicompartmental knee arthroplasty (six) over a nine-month period at a single institution were identified from an institutional registry. Patients were prompted to attend their routine one-year postoperative visit by a single telephone reminder. Patients and surgeons were given questionnaires at the one-year postoperative visit, defined as a clinical encounter occurring at nine to 15 months from the date of surgery, regarding value of the visit. Results Compliance with routine follow-up at one year was 35%. The response rate was over 80% for all questions in the patient and clinician surveys. Overall, 75% of the visits were for routine surveillance. Patients reported high satisfaction with their visits despite the general time for attendance, including travel, being over four hours. Surgeons found the visits more worthwhile when issues were identified or problems were addressed. Conclusion Patient compliance with follow-up at one year postoperatively after primary hip and knee is low. Routine visits of asymptomatic patients deliver little practical value and represent a large time and cost burden for patients and surgeons. Remote strategies should be considered for routine postoperative surveillance primary hip and knee arthroplasties beyond the acute postoperative period. Cite this article: Bone Joint J 2020;102-B(7 Supple B):85–89.

Effectiveness of reminder strategies on cancer screening adherence: a randomised controlled trial

BackgroundFew randomised controlled trials (RCTs) have evaluated the different recalling approaches for enhancing adherence to faecal immunochemical test (FIT)-based screening.AimThe authors evaluated the effectiveness of two telecommunication strategies on improving adherence to yearly FIT screening.Design and settingA randomised, parallel group trial was performed in a primary care screening practice.MethodThe authors recruited 629 asymptomatic individuals aged 40–70 years with a negative FIT in 2015 to a population-based screening programme. On participation, they were invited to repeat their second round of FIT in 2016, 12 months after the first test. Each participant was randomly assigned to either interactive telephone reminder (n = 207), short message service reminder (SMS, n = 212), or control, where no additional interventions were delivered after the findings of their first FIT was communicated to the participants (n = 210). Reminders in the intervention groups were delivered 1 month before subjects’ expected return. Additional telephone reminders were delivered 2 months after the expected return date to all subjects who defaulted specimen return. The outcomes included rates of FIT collection and specimen return up to 6 months after their expected return.ResultsAt 6 months, the cumulative FIT collection rate was 95.1%, 90.4%, and 86.5%, respectively, for the telephone, SMS, and control groups (P = 0.010). The corresponding specimen return rate was 94.1%, 90.0%, and 86.0% (P = 0.022). When compared with the control, only subjects in the telephone group were significantly more likely to collect FIT tubes (adjusted odds ratio [AOR] 3.18, 95% confidence interval [CI] = 1.50 to 6.75, P = 0.003) and return completed specimens (AOR = 2.73, 95% CI = 1.35 to 5.53, P = 0.005).ConclusionInteractive telephone reminders are effective at securing previously screened subjects to repeat screening 1 year after a negative finding.

Automated telephone reminders: Potential to improve adherence to adjuvant hormonal therapy among patients with breast cancer.

297 Background: As the U.S. population ages and life expectancy lengthens, the number of new estrogen receptor positive (ER+) breast cancer (bca) cases is expected to grow substantially from the current 150,000/year. Numerous studies show that adjuvant hormonal therapy (AHT) dramatically reduces bca recurrence (by 50%) and mortality (by 30%) among ER+ women. Daily treatment for 5 years is the recommended therapy. Yet, reports of under-utilization are alarming, ranging from 30% to more than 50%. Methods: We examined utilization of AHT among members of Kaiser Permanente Southern California, a nonprofit prepaid health care organization serving 3.6 million socio-economically diverse members. We identified 10,827 women diagnosed with bca between 2000 and 2007 from the plan’s SEER-affiliated cancer registry who were eligible for AHT. We used automated pharmacy records to assess uptake and utilization of AHT (primarily tamoxifen (TAM) and aromatase inhibitors (AIs)). Results: In this insured population, we found 14% of eligible bca survivors did not begin AHT. Among women who started AHT, over 30% had sub-optimal adherence defined as a medication possession ratio <80%. Discontinuation of AHT, defined as >90 days without medication, began in year 1 (7%) and reached 25% by year 5. To address this threat to quality bca care, the health plan recently initiated an innovative automated telephone reminder (ATR) system among women who filled at least 1 prescription for TAM. Each month, ATR calls are made to about 125 women >18 years, who are overdue between 2 and 6 weeks for a refill, and who have not developed intolerance to TAM or switched to an AI. To date, ATR calls have generated no or few complaints. Next steps include evaluation of the impact of the system on adherence to TAM and, subsequently, AIs, and incorporation of electronic prompts to clinical staff for follow-up with non-responders. Conclusions: Monitoring and intervention for improving adherence to AHT needs to begin at initiation and continue across the 5 years of recommended therapy. AVR can reach large numbers of bca survivors and may have the potential to ensure they receive optimal benefit from these life-saving treatments.