Introdução à Medicina’s Annual Assignment 2006/2007 Impact of appointment reminders via Short Message Service in a Secondary 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. [ s.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 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 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 Dimension of the sample (number of individuals) Outcome ** Difference of the non- attendance rate after reminder Jeffrey M Non- randomized Telephone call 7 months Not mentioned 515PositiveNot mentioned Downer SR Non- randomized SMS 3 months Not mentioned 45110Positive9.7% Downer SR Non- randomized SMS1 month3 working days 2864Positive9.2% Muham ad RandomizedTelephone call Not mentioned 1 day823Positive7% Leong KCRandomized Telephone call and SMS 3 months1-2 days993Positive 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 Dimension of the sample (number of individuals) Outcome ** Differen ce of the non- attendan ce rate after reminder Ritchie PD RandomizedTelephone call Not mentioned 1 to 3 days400Positive15,6%. Hardy KJ Non- randomized Information pack and telephone call Not mentioned 2 weeks (information pack) 1 week (phone call) 325Positive10,4 % O’Brien G RandomizedTelephone call 11 months1 day703Positive26,1% Sawyer SM RandomizedTelephone call Not mentioned 1 day171Positive12% 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 Dimension of the sample (number of individuals) Outcome ** Difference of the non- attendance rate after reminder Cardoso LA RandomizedSMS6 working days 2 days3899Positive2.6% *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 May- Jun;14(3): McClure RJ, Newell SJ, Edwards S. Patient characteristics affecting attendance at general outpatient clinics. Abstract Feb;74(2): Downer SR, Meara JG, Da Costa AC. Use of SMS text messaging to improve outpatient attendance. Med J Aust Oct 3;183(7): Haynes

Hardy KJ, O'Brian SV, Furlong NJ. Information given to patients before appointments and its effect on non-attendance rate. Abstract Dec 1;323(7324): Haynes JM, Sweeney EL. The Effect of Telephone Appointment- Reminder Calls on Outpatient Absenteeism in a Pulmonary Function Laboratory. Respir Care 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 Nov 7;6:47.

Work done by: Class 4 of the Medicine Course 2006/2007 FMUP Ana Luísa Costa Ana Margarida Cunha Catarina Dias Denise Sousa Duarte Silva Inês Silva João Costa Leila Cardoso Lília Valente Manuel Tinoco Mariana Lima Pedro Pacheco Sara Viana Orientation by: Dr. Ricardo Correia Prof. Dr. Altamiro da Costa Pereira