Bulk Ordering Boosts Lipid Screening Uptake Versus Usual Care

Text bulk ordering and mailed outreach led to a statistically significant increase in lipid screening uptake, compared with usual care at 3 months, but the addition of complementary text message reminders had little to no impact on screening rates.1

This clinical trial, involving approximately 1000 patients overdue for lipid screening, reported a nearly 10% increase in lipid screening uptake, with completion rates of 16% versus 6% for usual care. However, at 6 months, no significant difference was identified between bulk ordering and usual care.

“Bulk ordering associated with mailed outreach is a feasible, low-cost modality that can improve uptake of lipid screening,” wrote the investigative team, led by Catherine Pollak, PhD, direction for research, studies, evaluation, and statistics, Ministry for Health in France. “However, we did not find significant further increases in lipid screening by adding complementary text message reminders and scheduling assistance.”

Evidence-based guidelines recommend the routine assessment of atherosclerotic cardiovascular disease (ASCVD) risk, but many eligible patients are missing key factors in a comprehensive lipid panel, including total and high-density lipoprotein cholesterol (HDL-C) levels.2 Pollak and colleagues cited the potential to leverage the field of behavioral science to gain insight into the impediments of health prevention activities.

In particular, the bulk ordering of lipid panels could present lipid screening to patients as the default choice, to overcome inertia and confirm the recommendation of a primary care clinician. They indicated periodic reminders from health systems could encourage and reinforce healthy behaviors, and reduce logistical barriers to access.3,4

For this pragmatic, randomized clinical trial, the team assessed the impact of mailed outreach with bulk orders, alongside the integration of text messaging and scheduled support, on the completion of lipid screening. Conducted from June to September 2023 at 2 primary care practices, enrolled patients were aged 20–75 years with ≥1 visit in the past 3 years.1

This population was randomized in a 1:2:2 ratio to usual care (group 1), direct outreach and bulk orders (group 2), and bulk order outreach with 3 text message reminders for scheduling assistance (group 3). Among the 1000 participants, the median age was 38 years, 470 (47.0%) were female, and 862 (88.6%) self-reported as White.

At the 3-month mark, lipid screening was completed by 147 of 1000 participants (14.7%), including 12 of 202 (5.9%; 95% CI, 3.4–10.1) receiving usual care, 62 of 394 (15.7%; 95% CI, 12.5–19.7) receiving direct outreach and bulk order, and 73 of 404 (18.1%; 95% CI, 14.6–22.1) receiving bulk order and outreach with text messaging.

Based on these data, bulk order and outreach significantly improved uptake by 9.8% (95% CI, 4.6–15.0; P =.001), compared with usual care. On the other hand, adding text messaging to bulk orders and outreach did not significantly affect the uptake, achieving a non-statistically significant improvement of 2.4% (95% CI, –3.1 to 7.8; P = .43).

At 6 months, lipid screening rates were 15.3% after usual care, 21.1% after direct outreach and bulk order, and 22.5% after bulk order and outreach plus text messaging. Pollak and colleagues identified no significant differences in lipid screening between groups 1 and 2 or groups 2 and 3 at 6 months.

In the same period, ASCVD risk scores were calculated for nearly 75% of patients aged 40–75 years who had completed lipid screening during the intervention. Among this group, Pollak and colleagues identified 11 of 86 (12.7%) patients in groups 3 and 3 at high calculated risk. However, lipid testing was not linked to an increase in the prescription of statin medications.

“To further narrow the gap and achieve guideline adherence, future efforts should focus on more intensive or tailored outreach and reducing barriers to screening through engagement in primary care practices and for patients who have limited engagement with health care,” they wrote.

References

1. Pollak C, Parambath A, Coratti S, et al. Default Bulk Ordering and Text Messaging to Enhance Outreach for Lipid Screening: A Randomized Clinical Trial. JAMA Cardiol. Published online January 29, 2025. doi:10.1001/jamacardio.2024.5281
2. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Sep 10;140(11):e647-e648. doi: 10.1161/CIR.0000000000000724.] [published correction appears in Circulation. 2020 Jan 28;141(4):e59. doi: 10.1161/CIR.0000000000000754.] [published correction appears in Circulation. 2020 Apr 21;141(16):e773. doi: 10.1161/CIR.0000000000000770.]. Circulation. 2019;140(11):e563-e595. doi:10.1161/CIR.0000000000000677
3. Guan H, Yang T, Zhang Y, Shi Y. Time's ticking! Effects of deadline on the utilization of health services: Evidence from a cluster-randomized controlled trial. Soc Sci Med. Published online October 22, 2023. doi:10.1016/j.socscimed.2023.116331
4. Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev. 2010;32(1):56-69. doi:10.1093/epirev/mxq004