Enhancing Stroke Awareness and Activation among High-Risk Populations: A Randomized Direct Mail Intervention in Diverse Healthcare Settings

Résumé fourni par la source

Abstract Background Many patients are unaware of their stroke risk. The purpose of this research was to compare the effect of behaviorally tailored mailed messages on patient activation to reduce stroke risk. Methods We used electronic health records to construct Framingham Stroke Risk Scores (FSRS) in primary care patients from one Veterans Health Administration (VA) and one non-VA healthcare system, Eskenazi Health System (EHS). Four stroke risk messages were developed through patient interviews: standard, incentive ($5 gift card), salience, and incentive plus salience. Patients in the highest FSRS quintile were randomly assigned to receive one of the messages. All letters asked the patient to call a stroke prevention coordinator. Response to the messages was modeled separately in the two cohorts using logistic regression. Results From 6,695 eligible patients, 2,084 EHS patients (mean age 65.6, 36% male, 68% Black, mean FSRS 13.1) and 1,759 VA patients (mean age 75.6, 99% male, 86% White, mean FSRS 18.6) received a letter. Rates of calls to the coordinator were 13% among the EHS and 23% among the VA cohort. The EHS cohort was significantly more likely to respond to the incentive message compared to the standard message (OR = 1.97 [1.17, 3.09]), and the VA cohort was more likely to respond to the incentive plus salience message (OR = 1.50 [1.02, 2.22]). Older age (for VA) and Black race (for EHS) were also significantly associated with response. Among individuals calling the coordinator, 30% of the EHS cohort and 26% of the VA cohort were unaware they had stroke risk factors. Conclusions A mailed message including a $5 incentive was more effective than a standard message in engaging high-risk patients with their healthcare system; including a salience message may also be important in some patient populations. Many primary care patients are unaware of their stroke risk.

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