Use of text message reminders to improve uptake in a population-based breast cancer screening program, Catalonia (Spain) Montse Garcia 1 , Llúcia Benito 1 , Carmen Vidal 1 , Josep M. Borràs 2 , Víctor Moreno 1 1. Cancer Prevention and Control Program, Catalan Institute of Oncology, IDIBELL, L’Hospitalet (Spain); 2. Catalan Cancer Plan, Catalan Health Department, L’Hospitalet (Spain) UICC World Cancer Congress 28 August 2012, Montreal
Background Non-attendance for routine screening appointments 1) results wasted resources 2) disturbs the planned work-schedules 3) impacts patient outcomes because of missed opportunities for diagnosis and treatment. Objective ! To analyze the effect of a mobile text message service reminder on the uptake of screening mammogram in Catalonia, Spain.
Methods Screening procedure Study Population Data collection & analysis ! A biennial screening program for breast cancer addressed to women aged 50-69 years who lived in the area (n= 171,000). ! BCSP is located in Catalonia, Screening a region in the north-east of Area Spain
Methods Screening procedure Study Population Data collection & analysis Population density (people per km 2 )
Methods Screening procedure Study Population Data collection & analysis INTERVENTION GROUP Invitation letter + SMS reminder STUDY POPULATION n=3,719 (29.1%) Women who had a OUTCOME scheduled appointment Mammogram for a mammogram (October, 2011) (June - July, 2011) CONTROL GROUP n=8,715 n=12,786 Invitation letter only n=9,067 (70.9%)
Methods Screening procedure Study Population Data collection & analysis Variables ! Dependent: Timely participation in the Breast Cancer Screening Program (mammogram) ! Independent: • Age group: ○ 50-59 years, ○ 60-69 years • We recoded the variable ‘screening units’ according with the population growth from 2003 to 2010 and rurality (%) of the municipalities to assess ‘accessibility’: ○ Easily-to-reach areas ○ Hard-to-reach areas • Screening behavior: ○ [Previously] Unscreened: women who had never had a prior mammogram ○ [Previously] Screened: women with at least one prior mammogram Analysis ! Multivariate logistic regression models
Results Multivariate analysis Are SMS reminders effective? Adjusted CI95% OR* 50-59 years 1 Age 60-69 years 0.96 (0.95-0.96) No 1 SMS reminders Yes 1.84 (1.56-2.18) No 1 Previously Screened Yes 14.62 (13.04-16.39) Easily to reach pop. 1 Accessibility Hard to reach pop. 0.84 (0.75-0.93) * Odds ratios adjusted by Age, SMS reminders, previous participation, accessibility and the following interaction terms: SMS_previous participation (p-value=0.000) + SMS_accessibility (p-value=0.000)
Results Interaction terms Timely participation according to previous screening behavior and SMS reminders 100 89.4 Invitation letter only 90 83.9 SMS Reminders 80 70 Participation (%) 21.7% 60 52.2 50 5.5% 40 30.5 30 20 10 0 Previously Screened Previously Unscreened n=4,093 n=8,382
Results Interaction terms Timely participation according to accessibility and SMS reminders 100 Invitation letter only SMS Reminders 90 78.4 80 71.1 66.3 70 65.0 Participation (%) 12.1% 60 6.1% 50 40 30 20 10 0 Easily to reach areas Hard to reach areas n=5,875 n=6,911
Results Rescheduled appointments Rescheduled appointments Women who received only the invitation letter rescheduled their appointment (n=636): 7.0%; 95%CI: 6.9-7.9 Women who received the SMS reminder rescheduled their appointment (n= 308 ): 8.3%; 95%CI:7.3-9.2 Timely participation (mammogram) among women who had rescheduled their appointments Women who received only the invitation letter rescheduled their appointment (n=513): 80.7%; 95%CI: 77.6-83.7 Women who received the SMS reminder rescheduled their appointment (n= 224 ): 74.2.%; 95%CI:69.2-79.1
Conclusions ! Sending text messages to patients’ mobile phone number three days before their scheduled appointments reduces failure to attend rate at relatively low cost. ! The breast cancer screening program could use text messaging as an alternative approach to contact hard to reach population.
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