Can Bulk Ordering and Text Messaging Increase Lipid Screening?

Patient outreach with bulk ordering may result in higher lipid screening uptake than usual care, according to a recent study published in JAMA Cardiology.

While a comprehensive lipid panel is recommended by guidelines to analyze atherosclerotic cardiovascular disease risk, uptake is low. Therefore, investigators sought to assess whether direct outreach, including bulk orders with and without text messaging, can amplify lipid screening rates.

This was a pragmatic, randomized clinical trial by design which took place from June 6, 2023, to September 6, 2023, across two primary care practices at an academic health system, among 1,000 patients aged 20 to 75 years with at least one primary care visit in the past three years. The population of interest, who were all overdue for lipid screening, were randomized in a 1:2:2 ratio to usual care (group 1), direct outreach and bulk orders (group 2), or bulk order outreach with additional text message reminders for scheduling assistance (group 3). The investigators conducted data analysis from September 2023 to May 2024.

According to the results, at three 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%) of patients receiving direct outreach and bulk order (group 2). Overall, the panel was completed by 73 of 404 patients (18.1%; 95% CI, 14.6% to 22.1%) of individuals receiving outreach, bulk orders, and text message reminders (group 3), which equated to a difference of 2.4 percentage points. However, at six months, there were no significant differences observed in lipid screening between either group 1 vs group 2 or group 2 vs group 3, the investigators noted.

“Bulk orders are a low-cost intervention that may both reduce effort for patients and clinicians and increase uptake of lipid screening; text messaging does not provide significant additional benefit,” the researchers concluded.