Background. Numerous barriers to outpatient colonoscopy completion exist, causing undue procedure cancellations and poor bowel preparation. We piloted a text message navigation program to improve colonoscopy adherence. Method. We conducted a prospective study of patients aged 18 to 75 years scheduled for outpatient colonoscopy at an urban endoscopy center in April 2018. An intervention arm consisting of bidirectional, automated text messages prior to the procedure was compared with a usual care arm. We enrolled 21 intervention patients by phone and randomly selected 50 controls. Outcomes included colonoscopy appointment adherence, bowel preparation quality, and colonoscopy completion. Results. The arms had similar demographics and comorbidities. Intervention patients had higher colonoscopy appointment adherence (90% vs. 62%, p = 0.049). There were no significant differences in preparation quality or procedure completeness. Poststudy surveys indicated high patient satisfaction and perceived usefulness of the program. Conclusion. A bidirectional, automated texting navigation program improved colonoscopy adherence rates as compared with usual care.

IMPORTANCEOutpatient colonoscopy is important for colorectal cancer screening. However, nonadherence and poor bowel preparation are common. OBJECTIVE To determine if an automated text messaging intervention with a focus on informational and reminder functions could improve attendance rates and bowel preparation quality for outpatient colonoscopy. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted in an endoscopy center at an urban academic medical center. Adult patients scheduled for outpatient colonoscopy between January and September 2019 were enrolled by telephone call (early phase) or by automated text message (late phase). Data were analyzed from October 2019 to January 2020. INTERVENTIONSAfter enrollment, patients were randomized in a 1:1 ratio to usual care (ie, written instructions and nurse telephone call) or to the intervention (ie, usual care plus an automated series of 9 educational or reminder text messages in the week prior to scheduled colonoscopy). MAIN OUTCOMES AND MEASURESThe primary outcome was appointment attendance rate with good or excellent bowel preparation. Secondary outcomes included appointment attendance rate, bowel preparation quality (poor or inadequate, fair or adequate, and good or excellent), and cancellation lead time (in days). RESULTS Among 753 patients included and randomized in the trial (median [interquartile range]age, 56 [49-64] years; 364 [48.3%] men; 429 [57.2%] Black), 367 patients were randomized to the intervention group and 386 patients were randomized to the control group. There was no significant difference in the primary outcome between groups (patients attending appointments with good or excellent bowel preparation: intervention, 195 patients [53.1%]; control, 210 patients [54.4%]; P = .73), including when stratified by early or late phase enrollment groups. Similarly, there were no significant differences in secondary outcomes. CONCLUSIONS AND RELEVANCEThis randomized clinical trial found no significant difference in appointment attendance or bowel preparation quality with an automated text messaging intervention compared with the usual care control. Future work could optimize the content and delivery of text message interventions or identify patient subgroups that may benefit from this approach.

S-adenosyl-L-methionine (SAMe) is a naturally occurring substance which is a major source of methyl groups in the brain and has been found in previous studies to be an effective anti-depressant. The aim of this study was to assess the efficacy of oral SAMe in the treatment of depressed postmenopausal women in a 30-day double-blind placebo-controlled randomized trial. During the course of the study, 80 women, between the ages of 45 and 59, who were diagnosed as having DSM-∏I-R major depressive disorder or dysthymia between 6 and 36 months following either natural menopause or hysterectomy, underwent 1 week of single-blind placebo washout, followed by 30 days of double-blind treatment with either SAMe 1,600 mg/day or placebo. There was a significantly greater improvement in depressive symptoms in the group treated with SAMe compared to the placebo group from day 10 of the study. Side effects were mild and transient.

No abstract

137 Background: As the majority of oncology care is delivered in the ambulatory setting, patients and families require reliable and efficient ways to contact the care team with clinical concerns. The Abramson Cancer Center is comprised of 40 medical oncologists seeing over 100,000 annual outpatient visits. Press Ganey phone access satisfaction scores in the 12th percentile reflect patient dissatisfaction with phone communication. We initiated a pilot project to improve phone access. Methods: Baseline data was collected from 3 main sources of patient calls: intake office, administrative assistants, and triage RN’s. Over 2,000 patient calls were tallied during a one week period documenting: time of call; live answer vs voice mail; reason for call; whether and to whom the call was transferred. A subset analysis of calls related to symptom/medication management (SM) was performed via EMR audit to determine: time to call resolution (TTR), % resolved within 2 hours, % documented in the EMR, and % answered live. The TTR of patient SM calls and % resolved in < 2hrs were calculated by comparing the time of call receipt per log to the time of closed phone encounter in the EMR. The percent of calls documented was determined by comparing the call log to corresponding EMR encounters. The percent answered live was determined by review of the call log. As a pilot test of change, all calls in one of the practices were forwarded to a single source (intake office) to ensure live answer. The staff was educated to create an EMR encounter for each SM call and then route the encounter to a clinical pool (RN, APP and MD). An automated report enabled monitoring of key metrics. Results: The goals set for the pilot project were exceeded for 2 of the 3 performance metrics (Table). Conclusions: Within a complicated academic health system, we utilized our EMR and modified our phone triage system to streamline and reduce variation for management of SM calls. 62% of these calls were resolved within 2 hours, and the mean time to resolution of SM calls was reduced from 127 to 87 minutes. [Table: see text]