Texting messages boost outpatient colonoscopy adherence rate

An automated bi-directional texting program significantly reduced patient no-shows for colonoscopy appointments compared with standard care.

Results of the prospective study, published in the journal Health Education & Behavior, show that the rate of colonoscopy adherence was 90 percent for the intervention approach—dramatically better than the 62 percent adherence rate achieved by the control group who received the standard paper instructions and phone call reminder.

“The arms had similar demographics and comorbidities,” state the authors of the study, which was conducted by Penn Medicine researchers. “There were no significant differences in preparation quality or procedure completeness. Post-study surveys indicated high patient satisfaction and perceived usefulness of the program.”

The automation and two-way texting for the intervention group was powered by Penn Medicine’s Way to Health, a web-based platform that provides researchers with off-the-shelf tools to build customized protocols and offers participants interactive online “homes” that display their progress and report data.

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The Bonjour Sante website. Photographer: Christinne Muschi/Bloomberg

The automated messages patients in the study’s intervention group received included a congratulatory text and colonoscopy date reminder upon enrollment; a reminder with the office’s address linked and a prompt for any questions about the procedure one-week before the appointment; a nudge to pick up prep materials (such as sports drinks and laxatives) from the pharmacy five days prior; and messages to prompt each step of the prep sequence the night before the appointment.

“We think text messaging is successful because it is patient-centered—it is already widely used by our patient population, does not require much effort by the patient to participate, and patients can read or respond whenever they choose,” says Nadim Mahmud, MD, the study’s lead author and a hepatology fellow at the Hospital of the University of Pennsylvania. “Texting is also especially appealing to health systems because it is scalable and efficient—it’s a tactic many others have employed in order to communicate with patients.”

In the next phase of the study, researchers will evaluate the effectiveness of the texting program among a broader population and will automate some aspects of recruitment and engagement, making it easier to scale to routine operations across multiple endoscopy clinics, according to Shivan Mehta, MD, the study’s senior author and an assistant professor of medicine and the associate chief innovation officer at Penn Medicine.

“Automated text messaging and new insights from behavioral science offer opportunities to effectively and efficiently engage with patients before important health prevention activities,” adds Mehta. “It’s also important to keep in mind that these programs should be conducted in close partnership with clinical operations, and that we understand patient perspectives about these interventions.”

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