Introdução à Medicina’s Annual Assignment

2006/2007

Impact of appointment reminders via Short Message

Service in aSecondary Hospital

This study aims to measure the changes in

outpatient’s attendance and non-attendance rates

according to the sending or not of an appointment

reminder via Short Message Service in a

Secondary Hospital.

Objective

Introduction

• Problem: failure to attend outpatients appointments. [Hashim, 2001]

• Reasons for non-attendance: Forgetfulness (which is the most important for our work) ; Long distance from home to health services and trip cost; Inconvenient time of appointment (incompatible with work

schedule). [McClure, 1996]

• Consequences of non-attendance: Missed opportunities for diagnosis and treatment; Reduced opportunities for hospital revenue; Extended time patients have to wait for an appointment

booking. [Downer, 2005]

Emerging technology of Short Message Service is starting to be

used to remind patients about their appointments...

• Portugal: this method is starting to be used in some hospitals such as Santa Maria and the one of our study S. Sebastião. [http://www.telecom.pt/InternetResource/PTSite/PT/DestaquesHP/smsconsultas.htm]

• Advantages of this method: it is cheap; it is computorized; no need for many human resources; easy to apply.

Pictures taken in S. Sebastião Hospital to show the hardware used to send the text messages.

• Conclusions of previous studies conducted in Portugal

related to Hospital S. Sebastião

improving patients attendance, reflected by:

general reduction in the no-attendance rate of 14% in

general appointments;

most extreme case of Paediatrics with a reduction of 50%;

recovering of about 900 appointments per month;

account for nearly 15.000 euros per month. (information given by administrative services of Hospital S. Sebastião)

• Study design: Experimental study – Intervention Study

• Population: All patients of S. Sebastião Hospital, who have cellular phone number registered at the system.

• Sample’s selection: The sample consists of the set of the Hospital’s patients who have appointments in the days we are performing the study.

Participants and Methods

Flowchart: Selection of Participants

• Methods:

Selection of the days for the study (5 working days) Messages sent from 8th to 15th March for the appointments on

days 12th to 19th March.

The hospital sends appointment reminders randomly and alternately to the participants of the sample.

The messages are sent two working days before the appointment.

Finally the results of those who attended the appointment and those who did not, in both groups, reminded and non-reminded are collected.

• Data Analysis (using SPSS program):

1. Statistical analysis, comparing the percentage of attendances and non-attendances in reminded and non-reminded groups;

2. We are studying if the attendance rate varies

according to some of the following variables:

• Gender

• Age Groups

• Date of the appointment (Day of the week)

• Hour of the appointment (Morning, Afternoon)

• Number of messages previously sent

• Episode (Outpatients visits, Sessions, Exams, Analysis, Hospitalizations)

3. Chi-square test for each of the variables mentioned before and contingency tables.

4. That will allow us to conclude if there is any relationship between the sending of text messages as appointment reminders and the patients’ attendance.

Flowchart: description of methods

Results

NOTE:The missing data are the results we haven’t yet received due to the fact that we had to present this work on the 21st March, thus they collected the data before some appointments had

happened so we don’t have the attendances rates of those appointments.

General tableGeneral table

Difference of the non-attendance rate after reminder: 14,5 – 11,9 = 2,6%

Episode: Outpatients visits

Episode: Exams

Episode: Analysis

Author*Type of sample

selection

Type of reminder

Durability of the study

Time between the

reminder and the

appointment

Dimensionof the

sample(number of individuals)

Outcome**

Difference of the non-attendance rate after reminder

Jeffrey M

Non-randomized

Telephone call

7 months

Not mentioned

515 Positive Not mentioned

Downer SR

Non-randomized

SMS 3 months

Not mentioned

45110 Positive 9.7%

Downer SR

Non-randomized

SMS 1 month 3 working days

2864 Positive 9.2%

Muhamad

Randomized Telephone call

Not mentioned

1 day 823 Positive 7%

Leong KC Randomized

Telephone call and

SMS3 months 1-2 days 993 Positive

SMS – 10,9%

Telephone call – 11,5%

Comparison of data collected

Author*

Type of sample

selection

Type of reminder

Durability of the study

Time between the

reminder and the

appointment

Dimensionof the

sample(number of individuals)

Outcome**

Difference of the

non-attendance rate after

reminder

Ritchie PD

Randomized Telephone call

Not mentioned

1 to 3 days 400 Positive 15,6%.

Hardy KJ

Non-randomized

Information pack and telephone

call

Not mentioned

2 weeks(information

pack)1 week

(phone call)

325 Positive 10,4 %

O’Brien G

Randomized Telephone call

11 months 1 day 703 Positive 26,1%

Sawyer SM

Randomized Telephone call

Not mentioned

1 day 171 Positive 12%

Comparison of data collected (cont.)

Comparison of data collected (cont.)

Author* Type of sample

selection

Type of reminder

Durability of the study

Time between

the reminder and the appoint-

ment

Dimensionof the

sample(number of individuals)

Outcome**

Difference of the non-attendance rate after reminder

Cardoso LA

Randomized SMS 6 working

days

2 days 3899 Positive 2.6%2.6%

*We chose to mention only one of the authors.

**We rated this item with “positive” or “negative”. We consider a positive outcome when the sending of reminders improved the attendance; a negative outcome means that with this procedure we notice a lower attendance rate or no change between attendance in reminded group or not-reminded.

References(in order of appearance)

• Hashim MJ, Franks P, Fiscella K. Effectiveness of Telephone Reminders in Improving Rate of Appointments Kept at an Outpatient Clinic: A Randomized Controlled Trial. J Am Board Fam Pract. 2001 May-Jun;14(3):193-6.

• McClure RJ, Newell SJ, Edwards S. Patient characteristics affecting attendance at general outpatient clinics. Abstract. 1996 Feb;74(2):121-5.

• Downer SR, Meara JG, Da Costa AC. Use of SMS text messaging to improve outpatient attendance. Med J Aust. 2005 Oct 3;183(7): Haynes 366-8.

• Hardy KJ, O'Brian SV, Furlong NJ. Information given to patients before appointments and its effect on non-attendance rate. Abstract. 2001 Dec 1;323(7324):1298-300.

• Haynes JM, Sweeney EL. The Effect of Telephone Appointment-Reminder Calls on Outpatient Absenteeism in a Pulmonary Function Laboratory. Respir Care. 2006 Jan;51(1):36-9.

• Neal RD, Hussain-Gambles M, Allgar VL, Lawlor DA, Dempsey O. Reasons for and consequences of missed appointments in general practice in the UK: questionnaire survey and prospective review of medical records. Abstract. 2005 Nov 7;6:47.

Work done by: Class 4 of the Medicine Course 2006/2007 FMUP

Ana Luísa CostaAna Margarida Cunha

Catarina DiasDenise SousaDuarte Silva

Inês SilvaJoão Costa

Leila CardosoLília Valente

Manuel TinocoMariana Lima

Pedro PachecoSara Viana

Orientation by:

Dr. Ricardo Correia

Prof. Dr. Altamiro da Costa Pereira