Default Bulk Ordering and Text Messaging to Enhance Outreach for Lipid Screening: A Randomized Clinical Trial.

Background

To evaluate whether direct outreach including bulk orders with and without text messaging increases lipid screening rates.

评估直接外展服务，包括批量订购并结合短信通知，是否能提高脂质筛查率。

DESIGN, SETTING, AND PARTICIPANTS: Pragmatic randomized clinical trial conducted from June 6, 2023, to September 6, 2023, at 2 primary care practices at an academic health system among patients aged 20 to 75 years with at least 1 primary care visit in the past 3 years who were overdue for lipid screening.

设计、设置和参与者：2023年6月6日至2023年9月6日，在一个学术健康系统的2个初级保健实践中进行的实用随机临床试验，研究对象为年龄在20至75岁之间，过去3年内至少有1次初级保健就诊记录，且需要进行血脂筛查的患者。

Data analysis was performed from September 2023 to May 2024.

数据分析是从2023年9月到2024年5月进行的。

Methods

Eligible patients were randomized in a 1:2:2 ratio to usual care (group 1), direct outreach and bulk orders (group 2), and bulk order outreach with additional text message reminders for scheduling assistance (group 3).

符合条件的患者按照1:2:2的比例随机分配到常规护理（第1组）、直接外展和批量订购（第2组）以及批量订购外展并附加短信提醒以协助安排预约（第3组）。

In group 3, participants received an initial, follow-up, and reminder text message.

在第3组中，参与者收到了初始、跟进和提醒短信。

Patients with electronic portal accounts were encouraged to schedule through them, while others received laboratory contact information.

鼓励拥有电子门户网站账户的患者通过这些账户进行预约，而其他患者则收到了实验室的联系信息。

Any participant inquiries were answered either with automated responses for common questions or with study team support.

对于参与者的任何询问，都通过自动回复常见问题或研究团队支持来回答。

main_outcomes_and_measures

Proportion of patients who completed a lipid panel within 3 months.

在3个月内完成血脂检查的患者比例。

Results

Among the 1000 participants, the median (IQR) age was 38 (28-55) years; 470 (47.0%) were female; and 22 (2.3%) were Asian, 38 (3.9%) were Black, 32 (3.2%) were Hispanic or Latino, and 862 (88.6%) were White (race and ethnicity were based on self-reported data).

在1000名参与者中，中位年龄为38岁（四分位数间距为28-55岁）；女性占470人（47.0%）；亚洲人22人（2.3%），黑人38人（3.9%），西班牙裔或拉丁裔32人（3.2%），白人862人（88.6%）（种族和民族数据基于自我报告）。

At 3 months, a lipid panel was completed by 12 of 202 patients (5.9%; 95% CI, 3.4% to 10.1%) receiving usual care (group 1) vs 62 of 394 patients (15.7%; 95% CI, 12.5% to 19.7%) receiving direct outreach and bulk order (group 2), a difference of 9.8 percentage points (95% CI, 4.6 to 15.0; P = .001).

在3个月时，202名接受常规护理的患者（组1）中有12名（5.9%；95%置信区间，3.4%至10.1%）完成了血脂检测，而394名接受直接外展和批量订购的患者（组2）中有62名（15.7%；95%置信区间，12.5%至19.7%）完成了血脂检测，差异为9.8个百分点（95%置信区间，4.6至15.0；P = .001）。

The panel was completed by 73 of 404 patients (18.1%; 95% CI, 14.6% to 22.1%) receiving outreach, bulk order, and text message reminders (group 3), for a difference of 2.4 percentage points (95% CI, -3.1 to 7.8; P = .43) vs outreach with bulk order alone (group 2).

在接受外展、批量订购和短信提醒的404名患者中，有73名（18.1%；95%置信区间，14.6%至22.1%）完成了血脂检测（组3），与仅接受外展和批量订购的患者（组2）相比，差异为2.4个百分点（95%置信区间，-3.1至7.8；P = .43）。

At 6 months, there were no significant differences in lipid screening between either group 1 vs group 2 or group 2 vs group 3.

在6个月时，组1与组2或组2与组3之间的血脂筛查没有显著差异。

conclusions_and_relevance

Lipid screening among participants receiving bulk orders and outreach letters increased significantly compared with usual care at 3 months.

与常规护理相比，接受批量订单和外展信件的参与者在3个月时的血脂筛查显著增加。

However, there was no difference at 6 months.

然而，在6个月时没有差异。

More than 80% of patients did not follow through with lipid screening despite the intervention, and there was no additional increase in lipid testing at 3 months among participants receiving bulk ordering and supplemental text messaging.

尽管进行了干预，但超过80%的患者没有完成血脂筛查，且在使用批量订购和补充短信通知的参与者中，3个月时血脂检测的增加并不明显。

trial_registration

ClinicalTrials.gov Identifier: NCT05724615.

临床试验注册号：NCT05724615。