Default Bulk Ordering and Text Messaging to Enhance Outreach for Lipid Screening

Importance A comprehensive lipid panel is recommended by guidelines to evaluate atherosclerotic cardiovascular disease risk, but uptake is low. Objective To evaluate whether direct outreach including bulk orders with and without text messaging increases lipid screening rates. 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. Data analysis was performed from September 2023 to May 2024. Interventions 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). In group 3, participants received an initial, follow-up, and reminder text message. Patients with electronic portal accounts were encouraged to schedule through them, while others received laboratory contact information. Any participant inquiries were answered either with automated responses for common questions or with study team support. Main Outcomes and Measures Proportion of patients who completed a lipid panel within 3 months. 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). 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). 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). At 6 months, there were no significant differences in lipid screening between either group 1 vs group 2 or group 2 vs group 3. Conclusions and Relevance Lipid screening among participants receiving bulk orders and outreach letters increased significantly compared with usual care at 3 months. However, there was no difference at 6 months. 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. Trial Registration ClinicalTrials.gov Identifier: NCT05724615