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

Area of Science:

• Cardiovascular Disease Prevention
• Public Health Interventions
• Health Services Research

Background:

• Guidelines recommend comprehensive lipid panels for atherosclerotic cardiovascular disease risk assessment.
• Low uptake of recommended lipid screening poses a challenge in primary care settings.

Purpose of the Study:

• To evaluate the effectiveness of direct outreach strategies, including bulk orders and text messaging, in increasing lipid screening rates.
• To assess the impact of these interventions on patient adherence to lipid testing guidelines.

Main Methods:

• A pragmatic randomized clinical trial was conducted across two primary care practices.
• Patients overdue for lipid screening were randomized to usual care, direct outreach with bulk orders, or outreach with bulk orders and text message reminders.
• Lipid panel completion within 3 months was the primary outcome measure.

Main Results:

• Lipid panel completion at 3 months was significantly higher in the direct outreach and bulk order group (15.7%) compared to usual care (5.9%).
• The addition of text message reminders did not yield a significant additional increase in lipid testing at 3 months (18.1% vs 15.7%).
• No significant differences in lipid screening rates were observed between groups at the 6-month follow-up.

Conclusions:

• Direct outreach with bulk orders can improve short-term lipid screening rates compared to usual care.
• Text message reminders did not provide additional benefit for lipid testing uptake in this intervention.
• High rates of non-adherence persisted, indicating a need for further strategies to improve sustained lipid screening.