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Werner K, Alsuhaibani SA, Alsukait RF, Alshehri R, Herbst CH, Alhajji M, Lin TK. Behavioural economic interventions to reduce health care appointment non-attendance: a systematic review and meta-analysis. BMC Health Serv Res 2023; 23:1136. [PMID: 37872612 PMCID: PMC10594857 DOI: 10.1186/s12913-023-10059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/24/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Appointment non-attendance - often referred to as "missed appointments", "patient no-show", or "did not attend (DNA)" - causes volatility in health systems around the world. Of the different approaches that can be adopted to reduce patient non-attendance, behavioural economics-oriented mechanisms (i.e., psychological, cognitive, emotional, and social factors that may impact individual decisions) are reasoned to be better suited in such contexts - where the need is to persuade, nudge, and/ or incentivize patients to honour their scheduled appointment. The aim of this systematic literature review is to identify and summarize the published evidence on the use and effectiveness of behavioural economic interventions to reduce no-shows for health care appointments. METHODS We systematically searched four databases (PubMed/Medline, Embase, Scopus, and Web of Science) for published and grey literature on behavioural economic strategies to reduce no-shows for health care appointments. Eligible studies met four criteria for inclusion; they were (1) available in English, Spanish, or French, (2) assessed behavioural economics interventions, (3) objectively measured a behavioural outcome (as opposed to attitudes or preferences), and (4) used a randomized and controlled or quasi-experimental study design. RESULTS Our initial search of the five databases identified 1,225 articles. After screening studies for inclusion criteria and assessing risk of bias, 61 studies were included in our final analysis. Data was extracted using a predefined 19-item extraction matrix. All studies assessed ambulatory or outpatient care services, although a variety of hospital departments or appointment types. The most common behaviour change intervention assessed was the use of reminders (n = 56). Results were mixed regarding the most effective methods of delivering reminders. There is significant evidence supporting the effectiveness of reminders (either by SMS, telephone, or mail) across various settings. However, there is a lack of evidence regarding alternative interventions and efforts to address other heuristics, leaving a majority of behavioural economic approaches unused and unassessed. CONCLUSION The studies in our review reflect a lack of diversity in intervention approaches but point to the effectiveness of reminder systems in reducing no-show rates across a variety of medical departments. We recommend future studies to test alternative behavioural economic interventions that have not been used, tested, and/or published before.
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Affiliation(s)
- Kalin Werner
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Sara Abdulrahman Alsuhaibani
- Nudge Unit, Ministry of Health, Riyadh, KSA, Saudi Arabia
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, KSA, Saudi Arabia
| | - Reem F Alsukait
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, KSA, Saudi Arabia
- Health, Nutrition and Population Global Practice, The World Bank, Washington, D.C, USA
| | - Reem Alshehri
- Nudge Unit, Ministry of Health, Riyadh, KSA, Saudi Arabia
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, Washington, D.C, USA
| | - Mohammed Alhajji
- Nudge Unit, Ministry of Health, Riyadh, KSA, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, KSA, Saudi Arabia
| | - Tracy Kuo Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
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Chen BK, Dunsiger SI, Pinto BM. Cost-effectiveness of peer-delivered physical activity promotion and maintenance programs for initially sedentary breast cancer survivors. Transl Behav Med 2023; 13:683-693. [PMID: 37155603 PMCID: PMC10496440 DOI: 10.1093/tbm/ibad026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The evidence for the survival and health benefits of physical activity (PA) among cancer survivors is well documented. However, it has been challenging to maintain PA among cancer survivors. To evaluate the cost-effectiveness of peer support to encourage maintenance of moderate-to-vigorous physical activity (MVPA) among breast cancer survivors. Participants were randomized into Reach Plus Message (weekly text/email messages), Reach Plus Phone (monthly phone calls) or Reach Plus (a self-monitoring intervention) over 6 months after an initial adoption phase. We calculated the incremental cost-effectiveness ratios (ICER) in terms of quality-adjusted years life years (QALYs) and self-reported MVPA, from the payer's budgetary and societal perspectives over 1 year. Intervention costs were collected via time logs from the trainers and peer coaches, and participant costs from the participants via surveys. For our sensitivity analyses, we bootstrapped costs and effects to construct cost-effectiveness planes and acceptability curves. The intervention that provides weekly messages from peer coaches has an ICER of $14,446 per QALY gained and $0.95 per extra minute of MVPA per day over Reach Plus. Reach Plus Message has a 49.8% and 78.5% probability of cost-effectiveness respectively when decision makers are willing to pay approximately $25,000 per QALY and $10 per additional minute of MVPA. Reach Plus Phone, which requires tailored monthly telephone calls, costs more than Reach Plus Message but yields less QALY and self-reported MVPA at 1 year. Reach Plus Message may be a viable and cost-effective intervention strategy to maintain MVPA among breast cancer survivors.
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Affiliation(s)
- Brian K Chen
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, 915 Green Street Suite 354, Columbia, SC 29208, USA
| | - Shira I Dunsiger
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University, Box G-121-8 Providence, RI 02912, USA
| | - Bernardine M Pinto
- Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Room 302B, Columbia, SC 29208, USA
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Hamilton K, Short S, Cudby K, Werner M, O'Connor-Robertson O, Larkins W, Prangley D, Ibrahim A, Leung B, Norris P, Dockerty JD. Role of communication in successful outpatient attendance in a New Zealand hospital: a qualitative study. Intern Med J 2023; 53:1648-1653. [PMID: 37743236 DOI: 10.1111/imj.15892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/23/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND There are significant implications for both patients and providers when patients do not attend outpatient specialist appointments. Nonattendance has an impact on the efficiency of health care, provider resources and patient health outcomes. AIMS In this qualitative study we aimed to gather insights on how Dunedin Hospital notifies patients about their appointments, the implications for the hospital and for patients and how the system could be improved. METHODS We interviewed 13 hospital staff members and nine patients who volunteered to participate because they had missed appointments as a result of communication problems. Interviews were transcribed and analysed thematically using NVivo software. RESULTS Dunedin Hospital relies heavily on posted letters to inform people about their appointments, with some also receiving reminder texts closer to the time of the appointment. Frustration with the current system was a common theme among both patients and staff. Almost all patients had missed an appointment because of a letter not arriving. While most patients found that the text reminders were helpful, most said they were sent too late and did not allow enough time for arrangements to be made for their appointments. Almost all patients experienced treatment delays, which caused distress. Most patients believed a self-booking system would improve the ability to attend their appointments, and most of them wanted to be notified of appointments via email. CONCLUSIONS We recommend that a patient-oriented approach to communication should be implemented, and alternative methods of communication should be explored.
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Affiliation(s)
- Kara Hamilton
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sophie Short
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Kathryn Cudby
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Max Werner
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - William Larkins
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Devon Prangley
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ali Ibrahim
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Brian Leung
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- Va'a o Tautai - Centre for Pacific Health, University of Otago, Dunedin, New Zealand
| | - John D Dockerty
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Set KK, Bailey J, Kumar G. Reduction of No-Show Rate for New Patients in a Pediatric Neurology Clinic. Jt Comm J Qual Patient Saf 2022; 48:674-681. [PMID: 36243658 DOI: 10.1016/j.jcjq.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The rate of patients not keeping their appointments at our children's hospital outpatient pediatric neurology clinic (no-shows) was high. We conducted a quality improvement project to reduce no-show rates and improve operational efficiency. Specifically, we aimed to decrease the new patient no-show mean rate from 7% to 4% at the main campus and from 17% to 12% at the south campus. METHODS After reviewing the previous literature on this topic and institutional data, we used the simplified failure mode and effects analysis (sFMEA) to identify the key drivers. Of the patients at the main campus who failed to keep their appointment, 84% had not confirmed their appointment. Errors in inpatient/family contact information, limited use of the electronic patient portal, and miscommunication were other key drivers identified. Three Plan-Do-Study-Act (PDSA) cycles were completed over seven months. The key interventions we implemented were bidirectional text triage, telephone reminders, and promoting the use of the electronic patient portal. A run chart was used to assess the results of these interventions. RESULTS A statistically significant shift was noted in the run chart for the median rate of no-shows, which declined from 7% to 4% at the main campus and 17% to 10% at the south campus. CONCLUSION We were able to successfully reduce no-shows among new patients in the neurology clinic. The limitations of our study include unknown external factors, the potential impact of COVID-19, and the brief length of the study.
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Picou EM. Hearing Aid Benefit and Satisfaction Results from the MarkeTrak 2022 Survey: Importance of Features and Hearing Care Professionals. Semin Hear 2022; 43:301-316. [PMCID: PMC9715311 DOI: 10.1055/s-0042-1758375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The hearing aid market is rapidly evolving with advancements in features and potential changes in service delivery models, including the new over-the-counter device category. Data from the MarkeTrak 2022 survey indicate most hearing aid owners report regular quality-of-life benefits from hearing aids, even more than in previous surveys. The increased likelihood of hearing aid benefits might be attributable to modern hearing aid features advancements, such as wireless connectivity and rechargeable batteries. Hearing aid satisfaction rates have been relatively stable over the years, indicating that more than 80% of hearing aid owners are satisfied with their devices. Hearing aid satisfaction rates do not appreciably vary by fitting channel; hearing aid owners fitted in person, fitted remotely, or self-fit are similarly likely to report high satisfaction with their device. However, only respondents in the in-person channel gave establishment ratings (reflecting their willingness to recommend) that resulted and reflected a positive net promoter score. Given the potential for net promoter scores to be related to brand growth and customer loyalty, this finding has implications for the development of over-the-counter hearing aid service-delivery models. Additional work is warranted to explore the factors that negatively affect hearing aid owners' satisfaction with the companies delivering limited services.
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Affiliation(s)
- Erin M. Picou
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee,Address for correspondence Erin M. Picou, Au.D., Ph.D. 1215 21st Avenue S, Room 8310, Nashville, TN 37232
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Bagheri F, Behnam F, Galavi Z, Ahmadian L. The use of various appointment systems among patients visiting academic outpatient centers in Kerman and the evaluation of patients’ perspective and satisfaction. BMC Health Serv Res 2022; 22:1344. [DOI: 10.1186/s12913-022-08635-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/04/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
To optimize appointment systems, it is necessary to assess their users’ perspectives. This study aims to determine the use of various appointment systems among patients in academic outpatient centers and to investigate their perspectives and satisfaction.
Methods
This survey study was conducted on 332 patients or those accompanying patients in academic outpatient centers. A five-part questionnaire consisting of (1) demographic information, (2) willingness to use systems, (3) problems when using these systems, (4) problems after reserving the appointment, (5) recommendations and critics was used. The relationship between the system of interest and the available tools was examined by the Chi-square test, and the relationship between demographic characteristics and satisfaction was assessed using multiple regression.
Results
The participants’ overall satisfaction towards appointment systems, regardless of the type of system, was 49.12 ± 16.04 (out of 100). Satisfaction with the appointment system using Unstructured Supplementary Service Data (USSD) was significantly higher than the other two systems (p = 0.03). Web-based application and Interactive Voice Response (IVR) were the most frequently used systems with 61% and 48%, respectively. More than half of those who had access to a telephone (56%) preferred the IVR appointment system, and most of those who had Internet access (71%) preferred the web-based application (p < 0.05). Among 137 participants who had access to both the Internet and telephone, 49% (n = 67) stated that they would rather arrange their appointment through the web-based application.
Conclusion
The web-based application and IVR are the most frequently used and favorable appointment system among the patients or those accompanying patients. Despite the availability of the infrastructure, the participant had moderate satisfaction with these systems due to their failures. Therefore, to have more efficient systems and increase patients or those accompanying patients satisfaction with these systems, healthcare authorities should have a plan to solve the problems of these systemes and use the capacity of information resources to inform the community regarding these systems.
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Molokwu JC, Dwivedi A, Alomari A, Guzman J, Shokar N. Effect of Text Message Reminders on Attendance at Cervical Cancer Screening Appointments in a Predominantly Hispanic Population. HISPANIC HEALTH CARE INTERNATIONAL 2022:15404153221098950. [PMID: 35522229 DOI: 10.1177/15404153221098950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hispanic women have the highest rates of incident cervical cancer in the United States (U.S.) and are 1.9 times more likely to die from cervical cancer than non-Hispanic Whites. Objective: Assess the impact of text message reminders on cervical cancer screening attendance and completion. Design: Pragmatic non-randomized study design using propensity matched analysis. Setting: Community-dwelling low-income females in the U.S./Mexico border community. A total of 2,255 mainly Hispanic females aged 21-65. Methods: Text message reminders in addition to usual care (telephone call reminders). Results: After adjusting for significant factors and propensity score matching, individuals in the text reminder group had 11% lower screening incidence than individuals without text reminders (risk difference [RD] = -0.11, 95% CI: -0.16, -0.05; p < .001). Conclusion: Participants with text reminders were less likely to complete cervical screening than usual practice in a predominantly Hispanic population. Our study demonstrates that reminders' content rather than method may be vital to improving our population's cancer screening rates.
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Affiliation(s)
- Jennifer C Molokwu
- Department of Family and Community Medicine, Paul L. Foster School of Medicine, 37316Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.,Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, 37316Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Alok Dwivedi
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, 37316Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Adam Alomari
- Department of Family and Community Medicine, 158161Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, Population Health MSC31015, El Paso, TX, USA
| | - Jesus Guzman
- Department of Internal Medicine, 37316Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Navkiran Shokar
- Department of Population Health, 21976Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Fortuna RJ, Tobin DG, Sobel HG, Barrette EP, Noroha C, Laufman L, Huang X, Staggers KA, Nadkarni M, Lu LB. Perspectives of internal medicine residency clinics: A national survey of US medical directors. EDUCATION FOR HEALTH (ABINGDON, ENGLAND) 2022; 35:58-66. [PMID: 36647933 DOI: 10.4103/efh.efh_75_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Ambulatory training is an integral component of internal medicine residency programs, yet details regarding operational processes in resident continuity clinics remain limited. METHODS We surveyed a convenience sample of medical directors of residency practices between 2015 and 2019 (n = 222) to describe and share operational and scheduling processes in internal medicine resident continuity clinics in the US. RESULTS Among residency practices, support for the medical director role ranged substantially, but was most commonly reported at 11%-20% full-time-equivalent support. By the end of the survey period, the majority of programs (65.1%) reported obtaining patient-centered medical home (PCMH) certification (level 1-3). For new patient appointments, 34.9% of programs reported a 1-7 day wait and 25.8% reported an 8-14 day wait. Wait times for new appointments were generally shorter for PCMH certified practices (P = 0.029). No-show rates were most commonly 26%-50% for new patients and 11%-25% for established patients. Most programs reported that interns see 3-4 patients per ½-day and senior residents see 5-6 patients per ½-day. Most interns and residents maintain a panel size of 51-120 patients. DISCUSSION Creating high-performing residency clinics requires a focus on core building blocks and operational processes. Based on the survey results and consensus opinion, we provide five summary recommendations related to (1) support for the medical director leadership role, (2) patient-centered and coordinated models of care, (3) support for patient scheduling, (4) recommended visit lengths, and (5) ancillary support, such as social work.
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Affiliation(s)
- Robert J Fortuna
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Daniel G Tobin
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Halle G Sobel
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Ernie-Paul Barrette
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Craig Noroha
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Larry Laufman
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Xiaofan Huang
- Biostatics, Baylor College of Medicine, Houston, TX, USA
| | | | - Mohan Nadkarni
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Lee B Lu
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Roseland ME, Shankar PR, Houck G, Davenport MS. Targeting Missed Care Opportunities Using Modern Communication Methods: A Quality Improvement Initiative to Improve Access to CT and MRI Appointments. Acad Radiol 2022; 29:395-401. [PMID: 33762152 DOI: 10.1016/j.acra.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the impact of automated text and phone call reminder systems on CT (computed tomography) and MRI (magnetic resonance imaging) missed care opportunities. METHODS This was an IRB (institutional review board) exempt prospective interventional quality improvement study. The proportion of missed care opportunities (appointment made, no imaging performed) related to scheduled CT and MRI examinations were evaluated over 2 months (Month 1: reminder phone calls by staff 48-96 hours prior and mailed letter 1-2 weeks prior; Month 2: no manual call or letter, automated text message 24 hours prior, automated phone call 72 hours prior, automated patient portal message 7 days prior). The proportion of missed care opportunities was calculated in aggregate and by modality. Process control p-charts were generated. An a priori power analysis was performed. Chi-squared tests were performed. p-value < 0.017 was considered significant after Bonferroni correction. RESULTS Missed care opportunities occurred for 2.82% (292/10348; 95% CI: 2.51-3.16) of all CT and MRI appointments using traditional communication and 2.44% (262/10719; 95% CI: 2.16-2.75) using automated communication (p = 0.09). Automated messaging did not significantly change the proportion of missed care opportunities for CT (traditional: 2.62% [95% CI: 2.23-3.06] vs. automated: 2.06% [95% CI: 1.70-2.48], p = 0.05) or MRI (traditional: 3.1% [95% CI: 2.60-3.66] vs. automated: 2.83% [95% CI: 2.40-3.30], p = 0.43). Process control p-charts showed dominance of common cause variation. CONCLUSION Automated messaging did not meaningfully change the overall proportion of missed care opportunities compared to traditional human-initiated phone calls. Automated communications may reduce cost and improve efficiency without adversely affecting access to care.
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Anthony CA, Rojas E, Glass N, Keffala V, Noiseux N, Elkins J, Brown TS, Bedard NA. A Psycholgical Intervention Delivered by Automated Mobile Phone Messaging Stabilized Hip and Knee Function During the COVID-19 Pandemic: A Randomized Controlled Trial. J Arthroplasty 2022; 37:431-437.e3. [PMID: 34906660 PMCID: PMC8665663 DOI: 10.1016/j.arth.2021.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We conducted a randomized controlled trial to evaluate the effectiveness of acceptance and commitment therapy (ACT) delivered via a mobile phone messaging robot to patients who had their total hip arthroplasty or total knee arthroplasty procedures postponed due to the COVID-19 pandemic. METHODS Ninety patients scheduled for total hip arthroplasty or total knee arthroplasty who experienced surgical delay due to the COVID-19 pandemic were randomized to the ACT group, receiving 14 days of twice daily automated mobile phone messages, or the control group, who received no messages. Minimal clinically important differences (MCIDs) in preintervention and postintervention patient-reported outcome measures were utilized to evaluate the intervention. RESULTS Thirty-eight percent of ACT group participants improved and achieved MCID on the Patient-Reported Outcome Measure Information System Physical Health compared to 17.5% in the control group (P = .038; number needed to treat [NNT] 5). For the joint-specific Hip Disability and Osteoarthritis Outcome Score Joint Replacement and Knee Disability and Osteoarthritis Outcome Score Joint Replacement (KOOS JR), 24% of the ACT group achieved MCID compared to 2.5% in the control group (P = .004; NNT 5). An improvement in the KOOS JR was found in 29% of the ACT group compared to 4.2% in the control group (P = .028; NNT 5). Fourteen percent of the ACT group participants experienced a clinical important decline in the KOOS JR compared to 41.7% in the control group (P = .027; NNT 4). CONCLUSION A psychological intervention delivered via a text messaging robot improved physical function and prevented decline in patient-reported outcome measures in patients who experienced an unexpected surgical delay during the COVID-19 pandemic. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- Chris A. Anthony
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA,Address correspondence to: Chris A. Anthony, MD, Department of Orthopaedics, University of Pennsylvania, 800 Spruce Street, 1st Floor Cathcart Building, Philadelphia, PA
| | - Edward Rojas
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Natalie Glass
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Valerie Keffala
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Nicholas Noiseux
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Jacob Elkins
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Timothy S. Brown
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Nicholas A. Bedard
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
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Yakovchenko V, McInnes DK, Petrakis BA, Gillespie C, Lipschitz JM, McCullough MB, Richardson L, Vetter B, Hogan TP. Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework. JMIR Mhealth Uhealth 2021; 9:e31037. [PMID: 34779779 PMCID: PMC8663696 DOI: 10.2196/31037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/23/2021] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. Conclusions VHA’s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. Trial Registration ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349
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Affiliation(s)
- Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Chris Gillespie
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Jessica M Lipschitz
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Megan B McCullough
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Department of Public Health, University of Massachusetts, Lowell, MA, United States
| | - Lorilei Richardson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Brian Vetter
- Office of Connected Care, Veterans Health Administration, Washington, DC, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Supporting breast cancer survivors via text messages: reach, acceptability, and utility of EMPOWER-SMS. J Cancer Surviv 2021; 16:1165-1175. [PMID: 34505206 PMCID: PMC8428506 DOI: 10.1007/s11764-021-01106-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/26/2021] [Indexed: 01/17/2023]
Abstract
Purpose This study aims to evaluate the reach, usefulness, acceptability, and factors influencing engagement with a lifestyle-focused text message intervention to support women’s mental and physical health after breast cancer treatment. Methods This study uses a mixed-methods process evaluation nested in the EMPOWER-SMS randomised controlled trial (n = 160; intervention n = 80, wait-list control n = 80). Data sources included screening logs, text message delivery software analytics, intervention feedback survey, and focus groups (n = 16), which were summarised thematically based on the framework approach. Results A total of 387 women met the inclusion criteria (meanage ± SD = 59.3 ± 11.6 years). Participants who declined (n = 227) were significantly older than those who enrolled (n = 160; 62.2 ± 11.1 vs 55.1 ± 11.1 years, respectively, p < 0.001). Most intervention participants (64/80; 80%) completed the end-of-study survey, reporting the messages were easy to understand (64/64; 100%), useful (58/64; 91%), and motivating (43/64; 67%). The focus groups (n = 16) revealed five factors influencing engagement: (i) feelings of support/continued care, (ii) convenience/flexibility of message delivery, (iii) weblinks, (iv) information from a credible source, and (v) options to save or share messages. Conclusion A lifestyle-focused text message program was acceptable and useful for women after breast cancer treatment. However, text messaging may be a barrier for women aged over 68 years. Suggestions for program improvements included delivering the program to patients with other cancers, during all stages of treatment, and including more weblinks in text messages. Implications for Cancer Survivors Text message programs offer a low-cost way to deliver post-treatment health support to breast cancer survivors in a non-invasive way. Text messages can improve patient–health professional communication and were found to be acceptable and useful.
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13
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Alawadhi A, Palin V, van Staa T. Prevalence and factors associated with missed hospital appointments: a retrospective review of multiple clinics at Royal Hospital, Sultanate of Oman. BMJ Open 2021; 11:e046596. [PMID: 34408035 PMCID: PMC8375741 DOI: 10.1136/bmjopen-2020-046596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Missed hospital appointments pose a major challenge for healthcare systems. There is a lack of information about drivers of missed hospital appointments in non-Western countries and extent of variability between different types of clinics. The aim was to evaluate the rate and predictors of missed hospital appointments and variability in drivers between multiple outpatient clinics. SETTING Outpatient clinics in the Royal hospital (tertiary referral hospital in Oman) between 2014 and 2018. PARTICIPANTS All patients with a scheduled outpatient clinic appointment (N=7 69 118). STUDY DESIGN Retrospective cross-sectional analysis. PRIMARY AND SECONDARY OUTCOME MEASURES A missed appointment was defined as a patient who did not show up for the scheduled hospital appointment without notifying or asking for the appointment to be cancelled or rescheduled. The outcomes were the rate and predictors of missed hospital appointments overall and variations by clinic. Conditional logistic regression compared patients who attended and those who missed their appointment. RESULTS The overall rate of missed hospital appointments was 22.3%, which varied between clinics (14.0% for Oncology and 30.3% for Urology). Important predictors were age, sex, service costs, patient's residence distance from hospital, waiting time and appointment day and season. Substantive variability between clinics in ORs for a missed appointment was present for predictors such as service costs and waiting time. Patients aged 81-90 in the Diabetes and Endocrine clinic had an adjusted OR of 0.53 for missed appointments (95% CI 0.37 to 0.74) while those in Obstetrics and Gynaecology had OR of 1.70 (95% CI 1.11 to 2.59). Adjusted ORs for longer waiting times (>120 days) were 2.22 (95% CI 2.10 to 2.34) in Urology but 1.26 (95% CI 1.18 to 1.36) in Oncology. CONCLUSION Predictors of a missed appointment varied between clinics in their effects. Interventions to reduce the rate of missed appointments should consider these factors and be tailored to clinic.
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Affiliation(s)
- Ahmed Alawadhi
- Health Informatics, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Victoria Palin
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tjeerd van Staa
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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14
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MacPherson MM, Cranston KD, Locke SR, Bourne JE, Jung ME. Using the behavior change wheel to develop text messages to promote diet and physical activity adherence following a diabetes prevention program. Transl Behav Med 2021; 11:1585-1595. [PMID: 34008852 PMCID: PMC8604265 DOI: 10.1093/tbm/ibab058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Improving diet and physical activity (PA) can reduce the risk of developing type 2 diabetes (T2D); however, long-term diet and PA adherence is poor. To impact population-level T2D risk, scalable interventions facilitating behavior change adherence are needed. Text messaging interventions supplementing behavior change interventions can positively influence health behaviors including diet and PA. The Behavior Change Wheel (BCW) provides structure to intervention design and has been used extensively in health behavior change interventions. Describe the development process of a bank of text messages targeting dietary and PA adherence following a diabetes prevention program using the BCW. The BCW was used to select the target behavior, barriers and facilitators to engaging in the behavior, and associated behavior change techniques (BCTs). Messages were written to map onto BCTs and were subsequently coded for BCT fidelity. The target behaviors were adherence to diet and PA recommendations. A total of 16 barriers/facilitators and 28 BCTs were selected for inclusion in the messages. One hundred and twenty-four messages were written based on selected BCTs. Following the fidelity check a total of 43 unique BCTs were present in the final bank of messages. This study demonstrates the application of the BCW to guide the development of a bank of text messages for individuals with prediabetes. Results underscore the potential utility of having independent coders for an unbiased expert evaluation of what active components are in use. Future research is needed to demonstrate the feasibility and effectiveness of resulting bank of messages.
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Affiliation(s)
- Megan M MacPherson
- School of Health and Exercise Sciences, Faculty of Health and Social
Development, University of British Columbia,
Kelowna, Canada
| | - Kaela D Cranston
- School of Health and Exercise Sciences, Faculty of Health and Social
Development, University of British Columbia,
Kelowna, Canada
| | - Sean R Locke
- Kinesiology, Faculty of Applied Health Sciences, Brock
University, St. Catharines, Ontario,
Canada
| | - Jessica E Bourne
- Centre for Exercise, Nutrition and Health Sciences, School of Policy
Studies, University of Bristol, Bristol,
UK
| | - Mary E Jung
- School of Health and Exercise Sciences, Faculty of Health and Social
Development, University of British Columbia,
Kelowna, Canada
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15
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Eze P, Lawani LO, Acharya Y. Short message service (SMS) reminders for childhood immunisation in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2021-005035. [PMID: 34290051 PMCID: PMC8296799 DOI: 10.1136/bmjgh-2021-005035] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/29/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Childhood vaccine delivery services in the low- and middle-income countries (LMIC) are struggling to reach every child with lifesaving vaccines. Short message service (SMS) reminders have demonstrated positive impact on a number of attrition-prone healthcare delivery services. We aimed to evaluate the effectiveness of SMS reminders in improving immunisation coverage and timeliness in LMICs. Methods PubMed, Embase, Scopus, Cochrane CENTRAL, CINAHL, CNKI, PsycINFO and Web of Science including grey literatures and Google Scholar were systematically searched for randomised controlled trials (RCTs) and non-RCTs that evaluated the effect of SMS reminders on childhood immunisation and timeliness in LMICs. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 assessment tool for RCTs and Cochrane Risk of Bias in Non-randomised Studies of Interventions tool for non-RCTs. Meta-analysis was conducted using random-effects models to generate pooled estimates of risk ratio (RR). Results 18 studies, 13 RCTs and 5 non-RCTs involving 32 712 infants (17 135 in intervention groups and 15 577 in control groups) from 11 LMICs met inclusion criteria. Pooled estimates showed that SMS reminders significantly improved childhood immunisation coverage (RR=1.16; 95% CI: 1.10 to 1.21; I2=90.4%). Meta-analysis of 12 included studies involving 25 257 infants showed that SMS reminders significantly improved timely receipt of childhood vaccines (RR=1.21; 95% CI: 1.12 to 1.30; I2=87.3%). Subgroup analysis showed that SMS reminders are significantly more effective in raising childhood immunisation coverage in lower middle-income and low-income countries than in upper middle-income countries (p<0.001) and sending more than two SMS reminders significantly improves timely receipt of childhood vaccines than one or two SMS reminders (p=0.040). Conclusion Current evidence from LMICs, although with significant heterogeneity, suggests that SMS reminders can contribute to achieving high and timely childhood immunisation coverage. PROSPERO registration number CRD42021225843.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Lucky Osaheni Lawani
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yubraj Acharya
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, USA
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16
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Zhong L, Noud BP, Pruitt H, Marcrum SC, Picou EM. Effects of text supplementation on speech intelligibility for listeners with normal and impaired hearing: a systematic review with implications for telecommunication. Int J Audiol 2021; 61:1-11. [PMID: 34154488 DOI: 10.1080/14992027.2021.1937346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Telecommunication can be difficult in the presence of noise or hearing loss. The purpose of this study was to systematically review evidence regarding the effects of text supplementation (e.g. captions, subtitles) of auditory or auditory-visual signals on speech intelligibility for listeners with normal or impaired hearing. DESIGN Three databases were searched. Articles were evaluated for inclusion based on the Population Intervention Comparison Outcome framework. The Effective Public Health Practice Project instrument was used to evaluate the quality of the identified articles. STUDY SAMPLE After duplicates were removed, the titles and abstracts of 2019 articles were screened. Forty-six full texts were reviewed; ten met inclusion criteria. RESULTS The quality of all ten articles was moderate or strong. The articles demonstrated that text added to auditory (or auditory-visual) signals improved speech intelligibility and that the benefits were largest when auditory signal integrity was low, accuracy of the text was high, and the auditory signal and text were synchronous. Age and hearing loss did not affect benefits from the addition of text. CONCLUSIONS Although only based on ten studies, these data support the use of text as a supplement during telecommunication, such as while watching television or during telehealth appointments.
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Affiliation(s)
- Ling Zhong
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brianne P Noud
- Department of Audiology, Center for Hearing and Speech, St. Louis, MO, USA
| | - Harriet Pruitt
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Speech-Language Pathology, Advanced Therapy Solutions, Clarksville, TN, USA
| | - Steven C Marcrum
- Department of Otolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Erin M Picou
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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17
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Mekonnen ZA, Gelaye KA, Were M, Tilahun B. Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia. JMIR Mhealth Uhealth 2021; 9:e27603. [PMID: 34128813 PMCID: PMC8277338 DOI: 10.2196/27603] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message-based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. OBJECTIVE This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. METHODS A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. RESULTS A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants. CONCLUSIONS Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. TRIAL REGISTRATION Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Martin Were
- Department of Biomedical Informatics, Vanderbilt Medical Center, Nashville, TN, United States
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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18
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Garrison-Desany HM, Wilson E, Munos M, Sawadogo-Lewis T, Maïga A, Ako O, Mkuwa S, Hobbs AJ, Morgan R. The role of gender power relations on women's health outcomes: evidence from a maternal health coverage survey in Simiyu region, Tanzania. BMC Public Health 2021; 21:909. [PMID: 33980197 PMCID: PMC8117490 DOI: 10.1186/s12889-021-10972-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/26/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Gender is a crucial consideration of human rights that impacts many priority maternal health outcomes. However, gender is often only reported in relation to sex-disaggregated data in health coverage surveys. Few coverage surveys to date have integrated a more expansive set of gender-related questions and indicators, especially in low- to middle-income countries that have high levels of reported gender inequality. Using various gender-sensitive indicators, we investigated the role of gender power relations within households on women's health outcomes in Simiyu region, Tanzania. METHODS We assessed 34 questions around gender dynamics reported by men and women against 18 women's health outcomes. We created directed acyclic graphs (DAGs) to theorize the relationship between indicators, outcomes, and sociodemographic covariates. We grouped gender variables into four categories using an established gender framework: (1) women's decision-making, (2) household labor-sharing, (3) women's resource access, and (4) norms/beliefs. Gender indicators that were most proximate to the health outcomes in the DAG were tested using multivariate logistic regression, adjusting for sociodemographic factors. RESULTS The overall percent agreement of gender-related indicators within couples was 68.6%. The lowest couple concordance was a woman's autonomy to decide to see family/friends without permission from her husband/partner (40.1%). A number of relationships between gender-related indicators and health outcomes emerged: questions from the decision-making domain were found to play a large role in women's health outcomes, and condoms and contraceptive outcomes had the most robust relationship with gender indicators. Women who reported being able to make their own health decisions were 1.57 times (95% CI: 1.12, 2.20) more likely to use condoms. Women who reported that they decide how many children they had also reported high contraception use (OR: 1.79, 95% CI: 1.34, 2.39). Seeking care at the health facility was also associated with women's autonomy for making major household purchases (OR: 1.35, 95% CI: 1.13, 1.62). CONCLUSIONS The association between decision-making and other gender domains with women's health outcomes highlights the need for heightened attention to gender dimensions of intervention coverage in maternal health. Future studies should integrate and analyze gender-sensitive questions within coverage surveys.
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Affiliation(s)
- Henri M Garrison-Desany
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA.
| | - Emily Wilson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Melinda Munos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Talata Sawadogo-Lewis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Abdoulaye Maïga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Onome Ako
- Amref Health Africa Canada, 489 College Street, Toronto, ON, M6G 1A5, Canada
| | - Serafina Mkuwa
- Amref Health African Tanzania, Ali Hassan Mwinyi Road, Dar es Salaam, Tanzania
| | - Amy J Hobbs
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
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19
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Pervin J, Sarker BK, Nu UT, Khatun F, Rahman AMQ, Venkateswaran M, Rahman A, Frøen JF, Friberg IK. Developing targeted client communication messages to pregnant women in Bangladesh: a qualitative study. BMC Public Health 2021; 21:759. [PMID: 33879108 PMCID: PMC8056650 DOI: 10.1186/s12889-021-10811-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Timely and appropriate evidence-based practices during antenatal care improve maternal and neonatal health. There is a lack of information on how pregnant women and families perceive antenatal care in Bangladesh. The aim of our study was to develop targeted client communication via text messages for increasing antenatal care utilization, as part of an implementation of an electronic registry for maternal and child health. Methods Using a phenomenological approach, we conducted this qualitative study from May to June 2017 in two sub-districts of Chandpur district, Bangladesh. We selected study participants by purposive sampling. A total of 24 in-depth interviews were conducted with pregnant women (n = 10), lactating women (n = 5), husbands (n = 5), and mothers-in-law (n = 4). The Health Belief Model (HBM) was used to guide the data collection. Thematic analysis was carried out manually according to the HBM constructs. We used behavior change techniques to inform the development of targeted client communication based on the thematic results. Results Almost no respondents mentioned antenatal care as a preventive form of care, and only perceived it as necessary if any complications developed during pregnancy. Knowledge of the content of antenatal care (ANC) and pregnancy complications was low. Women reported a variety of reasons for not attending ANC, including the lack of information on the timing of ANC; lack of decision-making power; long-distance to access care; being busy with household chores, and not being satisfied with the treatment by health care providers. Study participants recommended phone calls as their preferred communication strategy when asked to choose between the phone call and text message, but saw text messages as a feasible option. Based on the findings, we developed a library of 43 automatically customizable text messages to increase ANC utilization. Conclusions Pregnant women and family members had limited knowledge about antenatal care and pregnancy complications. Effective health information through text messages could increase awareness of antenatal care among the pregnant women in Bangladesh. This study presents an example of designing targeted client communication to increase antenatal care utilization within formal scientific frameworks, including a taxonomy of behavior change techniques. Trial registration ISRCTN69491836. Registered on December 06, 2018. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10811-y.
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Affiliation(s)
- Jesmin Pervin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. .,University of Bergen, Bergen, Norway.
| | - Bidhan Krishna Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - U Tin Nu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fatema Khatun
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Norwegian Institute of Public Health, Oslo, Norway
| | - A M Quaiyum Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahima Venkateswaran
- University of Bergen, Bergen, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Anisur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - J Frederik Frøen
- University of Bergen, Bergen, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Ingrid K Friberg
- Norwegian Institute of Public Health, Oslo, Norway.,Tacoma-Pierce County Health Department, Tacoma, WA, USA
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20
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Lam TYT, Hui AJ, Sia F, Wong MY, Lee CCP, Chung KW, Lau JYW, Wu PI, Sung JJY. Short Message Service reminders reduce outpatient colonoscopy nonattendance rate: A randomized controlled study. J Gastroenterol Hepatol 2021; 36:1044-1050. [PMID: 32803820 DOI: 10.1111/jgh.15218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/22/2020] [Accepted: 08/11/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM Nonattendance of outpatient colonoscopy leads to inefficient use of health-care resources. We aimed to study the effectiveness of using Short Message Service (SMS) reminder prior in patients scheduled for outpatient colonoscopy on their nonattendance rate. METHODS Patients who scheduled for an outpatient colonoscopy and had access of SMS were recruited from three clinics in Hong Kong. Patients were randomized to SMS group and standard care (SC) group. All patients were given a written appointment slip on the booking date. In addition, patients in the SMS group received an SMS reminder 7-10 days before their colonoscopy appointment. Patients' demographics, attendance, colonoscopy completion, and bowel preparation quality were recorded. Logistic regression was performed to identify predictors of nonattendance. RESULTS From November 2013 to October 2019, a total of 2225 eligible patients were recruited. A total of 1079 patients were allocated to the SMS group and 1146 to the SC group. The nonattendance rate of patients in the SMS group was significantly lower than that in the SC group (8.9% vs 11.9%, P = 0.022). There were no significant differences in their baseline characteristics and colonoscopy completion rate and bowel preparation quality. A trend towards a higher rate of adequate bowel preparation was observed in the SMS group when compared with the SC group (69.9% vs 65.8%, P = 0.053). Independent predictors for nonattendance included younger age, underprivilege, and existing diabetes. CONCLUSIONS An SMS reminder for outpatient colonoscopy is effective in reducing the nonattendance rate and may potentially improve the bowel preparation quality.
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Affiliation(s)
- Thomas Y T Lam
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Aric J Hui
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Felix Sia
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Mei Y Wong
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | | | - Ka W Chung
- Wong Siu Ching Family Medicine Centre, Hong Kong
| | - James Y W Lau
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | - Peter I Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.,Department of Gastroenterology and Hepatology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
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21
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Randomized controlled study using text messages to help connect new medicaid beneficiaries to primary care. NPJ Digit Med 2021; 4:26. [PMID: 33589706 PMCID: PMC7884833 DOI: 10.1038/s41746-021-00389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/05/2021] [Indexed: 11/08/2022] Open
Abstract
Accessing primary care is often difficult for newly insured Medicaid beneficiaries. Tailored text messages may help patients navigate the health system and initiate care with a primary care physician. We conducted a randomized controlled trial of tailored text messages with newly enrolled Medicaid managed care beneficiaries. Text messages included education about the importance of primary care, reminders to obtain an appointment, and resources to help schedule an appointment. Within 120 days of enrollment, we examined completion of at least one primary care visit and use of the emergency department. Within 1 year of enrollment, we examined diagnosis of a chronic disease, receipt of preventive care, and use of the emergency department. 8432 beneficiaries (4201 texting group; 4231 control group) were randomized; mean age was 37 years and 24% were White. In the texting group, 31% engaged with text messages. In the texting vs control group after 120 days, there were no differences in having one or more primary care visits (44.9% vs. 45.2%; difference, −0.27%; p = 0.802) or emergency department use (16.2% vs. 16.0%; difference, 0.23%; p = 0.771). After 1 year, there were no differences in diagnosis of a chronic disease (29.0% vs. 27.8%; difference, 1.2%; p = 0.213) or appropriate preventive care (for example, diabetes screening: 14.1% vs. 13.4%; difference, 0.69%; p = 0.357), but emergency department use (32.7% vs. 30.2%; difference, 2.5%; p = 0.014) was greater in the texting group. Tailored text messages were ineffective in helping new Medicaid beneficiaries visit primary care within 120 days.
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22
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Postal L, Celuppi IC, Lima GDS, Felisberto M, Lacerda TC, Wazlawick RS, Dalmarco EM. PEC e-SUS APS online appointment scheduling system: a tool to facilitate access to Primary Care in Brazil. CIENCIA & SAUDE COLETIVA 2021; 26:2023-2034. [PMID: 34231716 DOI: 10.1590/1413-81232021266.38072020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/25/2021] [Indexed: 11/22/2022] Open
Abstract
Barriers faced by health services providing scheduled care result in high no-show rates. This article describes the main characteristics of an online appointment scheduling system incorporated into the citizens' electronic health record system (PEC e-SUS APS). Developed by the Bridge Laboratory, Federal University of Santa Catarina, which also developed the PEC e-SUS APS, the system allows patients to schedule appointments using the national patient communications hub, Conecte SUS Cidadão. The PEC e-SUS APS includes a professional's agenda module that allows patients to view available time slots and book and cancel appointments. Unfortunately, despite the benefits of online scheduling systems, their potential has been poorly exploited in Brazil. The main reasons for this include lack of information and training of health professionals on how to use the system and its potential benefits for Primary Health Care (PHC) services. Wider dissemination is needed to improve the adoption of the system and promote the routine use of this tool in health services in order to facilitate access to primary health care.
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Affiliation(s)
- Lucas Postal
- Laboratório Bridge, Centro Tecnológico. R. Lauro Linhares 2055, Trindade. 88036-003 Florianópolis SC Brasil.
| | - Ianka Cristina Celuppi
- Laboratório Bridge, Centro Tecnológico. R. Lauro Linhares 2055, Trindade. 88036-003 Florianópolis SC Brasil. .,Departamento de Enfermagem, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina (UFSC). Florianópolis SC Brasil
| | - Geovana Dos Santos Lima
- Laboratório Bridge, Centro Tecnológico. R. Lauro Linhares 2055, Trindade. 88036-003 Florianópolis SC Brasil. .,Departamento de Enfermagem, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina (UFSC). Florianópolis SC Brasil
| | - Mariano Felisberto
- Laboratório Bridge, Centro Tecnológico. R. Lauro Linhares 2055, Trindade. 88036-003 Florianópolis SC Brasil. .,Programa de Pós-Graduação em Farmácia, Centro de Ciências da Saúde, UFSC. Florianópolis SC Brasil
| | - Thaísa Cardoso Lacerda
- Laboratório Bridge, Centro Tecnológico. R. Lauro Linhares 2055, Trindade. 88036-003 Florianópolis SC Brasil.
| | - Raul Sidnei Wazlawick
- Laboratório Bridge, Centro Tecnológico. R. Lauro Linhares 2055, Trindade. 88036-003 Florianópolis SC Brasil. .,Departamento de Informática e Estatística, Centro Tecnológico, UFSC. Florianópolis SC Brasil
| | - Eduardo Monguilhott Dalmarco
- Laboratório Bridge, Centro Tecnológico. R. Lauro Linhares 2055, Trindade. 88036-003 Florianópolis SC Brasil. .,Departamento de Análises Clínicas, Centro de Ciências da Saúde, UFSC. Florianópolis SC Brasil
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McLaughlin MJ, Modrcin AC, Hickman TP, Hoffman M. Determining the impact of a clinic coordinator on patient access and clinic efficiency in a pediatric multidisciplinary spina bifida clinic using medical informatics. J Pediatr Rehabil Med 2021; 14:661-666. [PMID: 34806629 DOI: 10.3233/prm-200790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The objective of this study was to analyze the effects on patient access by decreasing missed appointments after hiring a clinic coordinator using medical informatics. METHODS A single-center retrospective analysis of the rates of missed appointments before and after hiring a clinic coordinator in a multidisciplinary spinal differences clinic were analyzed using a commercially available business software system (SAP® Business Objects). The total number of clinic visits was collected for each month to determine the access available for patients. RESULTS The median number of missed appointments per clinic by month before employing the clinic coordinator was higher than in the two years following implementation (p < 0.0005). No differences were seen in the number of available appointment slots per month indicating no new clinics were needed to improve patient access (p = 0.551). Projected billing amounts prior to hiring the clinic coordinator indicated that $91,520 was lost in the 2 years prior to hiring this coordinator compared to $30,160 lost during the 2 years following the creation of this position (p = 0.0009). CONCLUSION Hiring a clinic coordinator decreased the rate of missed appointments and was a cost-efficient intervention to improve patient access and provide effective patient care in a multidisciplinary setting.
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Affiliation(s)
- Matthew J McLaughlin
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pediatrics, Children's Mercy - Kansas City, Kansas City, MO, USA
| | - Ann C Modrcin
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pediatrics, Children's Mercy - Kansas City, Kansas City, MO, USA
| | - Timothy P Hickman
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Mark Hoffman
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pediatrics, Children's Mercy - Kansas City, Kansas City, MO, USA
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Reducing missed appointments in general practice: evaluation of a quality improvement programme in East London. Br J Gen Pract 2020; 71:e31-e38. [PMID: 33257461 PMCID: PMC7716879 DOI: 10.3399/bjgp20x713909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/23/2020] [Indexed: 01/07/2023] Open
Abstract
Background Missed appointments are common in primary care, contributing to reduced clinical capacity. NHS England has estimated that there are 7.2 million missed general practice appointments annually, at a cost of £216 million. Reducing these numbers is important for an efficient primary care sector. Aim To evaluate the impact of a system-wide quality improvement (QI) programme on the rates of missed GP appointments, and to identify effective practice interventions. Design and setting Practices within a clinical commissioning group (CCG) in East London, with an ethnically diverse and socially deprived population. Method Study practices engaged in a generic QI programme, which included sharing data on appointment systems and Did Not Attend (DNA) rates. Fourteen out of 25 practices implemented DNA reduction projects, supported by practice-based coaching. Appointment data were collected from practice electronic health records. Evaluation included comparisons of DNA rates pre- and post-intervention using interrupted times series analysis. Results In total, 25 out of 32 practices engaged with the programme. The mean DNA rate at baseline was 7% (range 2–12%); 2 years later the generic intervention DNA rates were 5.2%. This equates to a reduction of 4030 missed appointments. The most effective practice intervention was to reduce the forward booking time to 1 day. The practice that made this change reduced its mean DNA rate from 7.8% to 3.9%. Conclusion Forward booking time in days is the best predictor of practice DNA rates. Sharing appointment data produced a significant reduction in missed appointments, and behaviour change interventions with patients had a modest additional impact; in contrast, introducing structural change to the appointment system effectively reduced DNA rates. To reduce non-attendance, it appears that the appointment system needs to change, not the patient.
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Kodama T, Tamura Y, Komori T, Kataoka M, Igura K, Hashimoto T. A Pilot Randomized Controlled Trial of a Text Message Intervention to Promote Help Seeking for Psychiatric Outpatients. Comput Inform Nurs 2020; 39:154-161. [PMID: 32732643 DOI: 10.1097/cin.0000000000000636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mental illness often affects and is affected by other diseases, such as cardiovascular disease, cancer, and AIDS/HIV infection, and people living with mental illness require additional common services and resource mobilization efforts. Therefore, we developed a mobile phone intervention and conducted a randomized controlled trial with 45 psychiatric outpatients with mental illnesses. Data from 39 individuals (intervention group: 20, control group: 19; mean [SD] age, 44.64 [14.12] years) were included in the analyses. The intervention involved the promotion of help-seeking behaviors by sending text messages, including information about social welfare services, for 3 months. After the intervention period, no significant differences were found in the proportion of help-seeking behaviors between the intervention and control groups. However, concerning the reason for not using social services, the proportion of participants who answered "I do not know how to use it" in the intervention group was significantly lower compared to the control group. More than 80% of participants in the intervention group reported that the text messaging service was helpful and useful, and they wanted more messages and information. This was the first randomized controlled trial to promote psychiatric patients' help-seeking behavior using text messaging. Moreover, the text messaging intervention was found to be cost-effective.
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Affiliation(s)
- Toyohiko Kodama
- Author Affiliations: School of Health Sciences, University of Occupational and Environmental Health (Dr Kodama); Mie University Graduate School of Medicine (Drs Tamura, Komori, Kataoka); School of Nursing, Gifu Kyoritsu University (Dr Igura); and Kobe University Graduate School of Health Sciences, (Dr Hashimoto), Japan
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Anthony N, Molokwu J, Alozie O, Magallanes D. Implementation of a Text Message to Improve Adherence to Clinic and Social Service Appointments. J Int Assoc Provid AIDS Care 2020; 18:2325958219870166. [PMID: 31456465 PMCID: PMC6900568 DOI: 10.1177/2325958219870166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Attendance to clinic appointments and compliance with treatment plans are essential
components of HIV/AIDS care. Compliance is especially important in young and minority
individuals living with HIV/AIDS. We assessed the effectiveness of a text-based reminder
system compared with usual care in improving the attendance to clinic and social work
appointments at a Ryan White-funded clinic based in an academic institution. Methods: Convenience sample looking at 2 periods, 6 months before initiation of text messages
and 6 months after initiation of text messages. Results: Following a 6-month postintervention period, we found a statistically significant
reduction in our no-show rates (individuals failing to keep scheduled appointments) of
24.8% versus 17.7%, P value .05. Conclusion: Using an inexpensive online text messaging system, we were able to significantly
decrease no-show rates in a primarily younger, low-income, and uninsured population.
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Affiliation(s)
- Nishal Anthony
- 1 Resident Physician Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Jennifer Molokwu
- 2 Department of Family and Community Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Ogechika Alozie
- 3 Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.,4 Department of Clinical Informatics, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Diego Magallanes
- 5 South Plans Community Action Partnership, Project CHAMPS, Lubbock, TX, USA
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Berliner Senderey A, Kornitzer T, Lawrence G, Zysman H, Hallak Y, Ariely D, Balicer R. It's how you say it: Systematic A/B testing of digital messaging cut hospital no-show rates. PLoS One 2020; 15:e0234817. [PMID: 32574181 PMCID: PMC7310733 DOI: 10.1371/journal.pone.0234817] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022] Open
Abstract
Failure to attend hospital appointments has a detrimental impact on care quality. Documented efforts to address this challenge have only modestly decreased no-show rates. Behavioral economics theory has suggested that more effective messages may lead to increased responsiveness. In complex, real-world settings, it has proven difficult to predict the optimal message composition. In this study, we aimed to systematically compare the effects of several pre-appointment message formats on no-show rates. We randomly assigned members from Clalit Health Services (CHS), the largest payer-provider healthcare organization in Israel, who had scheduled outpatient clinic appointments in 14 CHS hospitals, to one of nine groups. Each individual received a pre-appointment SMS text reminder five days before the appointment, which differed by group. No-show and advanced cancellation rates were compared between the eight alternative messages, with the previously used generic message serving as the control. There were 161,587 CHS members who received pre-appointment reminder messages who were included in this study. Five message frames significantly differed from the control group. Members who received a reminder designed to evoke emotional guilt had a no-show rates of 14.2%, compared with 21.1% in the control group (odds ratio [OR]: 0.69, 95% confidence interval [CI]: 0.67, 0.76), and an advanced cancellation rate of 26.3% compared with 17.2% in the control group (OR: 1.2, 95% CI: 1.19, 1.21). Four additional reminder formats demonstrated significantly improved impact on no-show rates, compared to the control, though not as effective as the best performing message format. Carefully selecting the narrative of pre-appointment SMS reminders can lead to a marked decrease in no-show rates. The process of a/b testing, selecting, and adopting optimal messages is a practical example of implementing the learning healthcare system paradigm, which could prevent up to one-third of the 352,000 annually unattended appointments in Israel.
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Affiliation(s)
- Adi Berliner Senderey
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
- The Faculty of Industrial Engineering and Management, Technion–Israel Institute of Technology, Haifa, Israel
- * E-mail:
| | | | - Gabriella Lawrence
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
- Braun School of Public Health, Hebrew University–Hadassah Medical Center, Jerusalem, Israel
| | | | - Yael Hallak
- Fuqua School of Business, Duke University, Durham, North Carolina, United States of America
| | - Dan Ariely
- Kayma Labs, kayma, Tel Aviv, Israel
- Fuqua School of Business, Duke University, Durham, North Carolina, United States of America
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
- Public Health Department, Ben Gurion University of the Negev, Be’er Sheva, Israel
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Ruggeri K, Folke T, Benzerga A, Verra S, Büttner C, Steinbeck V, Yee S, Chaiyachati K. Nudging New York: adaptive models and the limits of behavioral interventions to reduce no-shows and health inequalities. BMC Health Serv Res 2020; 20:363. [PMID: 32336283 PMCID: PMC7184714 DOI: 10.1186/s12913-020-05097-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background Missed healthcare appointments (no-shows) are costly and operationally inefficient for health systems. No-show rates are particularly high for vulnerable populations, even though these populations often require additional care. Few studies on no-show behavior or potential interventions exist specifically for Federally Qualified Health Centers (FQHCs), which care for over 24 million disadvantaged individuals in the United States. The purpose of this study is to identify predictors of no-show behavior and to analyze the effects of a reminder intervention in urban FQHCs in order to design effective policy solutions to a protracted issue in healthcare. Methods This is a retrospective observational study using electronic medical record data from 11 facilities belonging to a New York City-based FQHC network between June 2017 to April 2018. This data includes 53,149 visits for 41,495 unique patients. Seven hierarchical generalized linear models and generalized additive models were used to predict no-shows, and multiple regression models evaluated the effectiveness of a reminder. All analyses were conducted in R. Results The strongest predictor of no-show rates in FQHCs is whether or not patients are assigned to empaneled providers (z = − 91.45, p < 10− 10), followed by lead time for appointments (z = 23.87, p < 10− 10). These effects were fairly stable across facilities. The reminder had minimal effects on no-show rates overall (No show rate before: 41.6%, after: 42.1%). For individuals with appointments before and after the reminder, there was a small decrease in no-shows of 2%. Conclusions The limited effects of the reminder intervention suggest the need for more personalized behavioral interventions to reduce no-shows. We recommend that these begin with increasing the use of empaneled providers for preventive care appointments and reducing the lag time between setting the appointment and the actual date of the appointment, at least for individuals with a high rate of no-show. By complementing these with low-intensity, low-cost behavioral interventions, we would expect greater impacts for improved access to care, contributing to the well-being of vulnerable populations.
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Affiliation(s)
- Kai Ruggeri
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA.
| | - Tomas Folke
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA
| | - Amel Benzerga
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA
| | - Sanne Verra
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA
| | - Clara Büttner
- Faculty of Health, Medicine and Life Science, Maastricht University, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands
| | - Viktoria Steinbeck
- Faculty of Health, Medicine and Life Science, Maastricht University, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands
| | - Susan Yee
- Community Healthcare Network, New York City, 60 Madison Ave., New York, NY, 10010, USA
| | - Krisda Chaiyachati
- Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Blockley Hall Room 1313, Philadelphia, PA, 19104, USA
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Thorpe R, Masser BM, Nguyen L, Gemelli CN, Davison TE. Bringing new plasma donors back: testing the efficacy of telephone and e‐mail communications with first‐time donors. Transfusion 2020; 60:1463-1469. [DOI: 10.1111/trf.15787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Rachel Thorpe
- Australian Red Cross Blood Service Donor Research Team Melbourne Victoria Australia
| | - Barbara M. Masser
- School of PsychologyUniversity of Queensland Brisbane Queensland Australia
| | - Lilly Nguyen
- Australian Red Cross Blood Service Donor Research Team Melbourne Victoria Australia
| | - Carley N. Gemelli
- Australian Red Cross Blood Service Donor Research Team Melbourne Victoria Australia
| | - Tanya E. Davison
- Australian Red Cross Blood Service Donor Research Team Melbourne Victoria Australia
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Ahmad MU, Zhang A, Mhaskar R. A predictive model for decreasing clinical no-show rates in a primary care setting. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1698864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M. Usman Ahmad
- Medical Education, University of South Florida (USF) Morsani College of Medicine (MCOM), Tampa, FL, USA
| | - Angie Zhang
- Medical Education, University of South Florida (USF) Morsani College of Medicine (MCOM), Tampa, FL, USA
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31
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Romocki LS, Des Marais A, Cofie L, Anderson C, Curington T, Smith JS. Use of Short Messaging Service to Improve Follow-Up for Abnormal Pap Test Results in Minority and Medically Underserved Women in North Carolina: Questionnaire on Attitudes and Acceptability. JMIR Form Res 2019; 3:e12675. [PMID: 31389334 PMCID: PMC6701163 DOI: 10.2196/12675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 02/06/2023] Open
Abstract
Background An estimated one in eight cervical cancer cases are due to a lack of follow-up care for abnormal Pap test results. Low rates of completion of follow-up care particularly affect low-income minority women. The burden of cervical cancer could be reduced through interventions that improve timely colposcopy follow-up and treatment of abnormal screening results. Mobile communications via text messaging present a low-cost opportunity to increase rates of clinic return among women referred to follow-up after obtaining abnormal screening results. Objective Our aims were to determine the acceptability and feasibility of using text messaging to increase completion of follow-up care following abnormal cervical cancer screening (Pap test) results and to examine factors that may affect the acceptability and use of text messaging to increase communications between health care providers (HCP) and low-income minority women. Methods The study participants were 15 low-income women who had undergone a Pap test within the preceding 12 months. Semistructured interviews, including open- and closed-ended questions from a validated questionnaire, were conducted by phone or in person. Responses to closed-ended survey items were tabulated, and descriptive statistics were generated using Microsoft Excel. Responses to the open-ended questions were coded and analyzed using NVivo 11 qualitative analysis software. Results Nearly all participants (14/15, 93%) were comfortable receiving a text message from an HCP stating that their Pap test results were available (<40 years: 100%; ≥40 years: 86%). Over half (8/15; 53%) of the participants were comfortable receiving a text message stating that their Pap test results were abnormal, although many preferred to receive such information via a phone call (6/15; 40%). Most participants (9/15; 60%) believed that receiving a text reminder would make them more likely to attend their appointment. The preferred method for receiving a reminder appeared to vary by age, with older women preferring telephone reminders over text messaging reminders. Analysis of open-ended questions suggested that text messaging appeals to some women due to its wide use and convenience for communicating with HCPs. However, women cited concerns about the confidentiality of messages and barriers to understanding the messages, including the physical capacity to read and accurately interpret the content of the messaging. Conclusions Most participants indicated a willingness to receive text messages from their HCPs about cervical cancer screening results and believed that text messages were the best way to remind them of appointments for follow-up care. Potential concerns could be addressed by excluding explicit references to the nature of the appointment in the text message in order to avoid disclosure of sensitive health information to unauthorized individuals. Although text messaging seems promising to improve adherence to timely follow-up, personal preferences should be considered by allowing patients to opt-out of text communications.
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Affiliation(s)
- LaHoma Smith Romocki
- Department of Public Health Education, North Carolina Central University, Durham, NC, United States
| | - Andrea Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Leslie Cofie
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States
| | - Chelsea Anderson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Jennifer Susan Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Saxe-Custack A, Kerver JM, Mphwanthe G, Weatherspoon L. Participant experiences in a paraprofessional-led weight management program for children and families. SAGE Open Med 2019; 7:2050312119863920. [PMID: 31321034 PMCID: PMC6628540 DOI: 10.1177/2050312119863920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Pediatric obesity is a serious and widespread medical condition that is
increasing in the United States. Unfortunately, family-based programming to
address the disorder fails to successfully reach and engage many children,
particularly in low-income communities. To provide more affordable,
accessible, and scalable programming options, researchers partnered with
pediatricians and the Cooperative Extension Service (Extension) in a
Midwestern state to develop a collaborative intervention. Partnering
pediatricians referred children and families to a weight management program
delivered by a trained Extension paraprofessional. The current study
describes family experiences with the program. Methods: Researchers conducted a focus group or family interview with 13 program
completers to elicit program perceptions, experiences with
paraprofessionals, and motivators to continue. The focus group and family
interviews were audio recorded and transcribed verbatim for textual
analysis. Using thematic analysis, researchers examined patterns across
transcripts and formulated emerging themes. Results: Key themes that emerged included (1) nutrition guidance, (2) interaction, (3)
child influence, and (4) family engagement. Families viewed
paraprofessionals as compassionate and competent educators who were
instrumental in helping families modify health-related behaviors. Conclusions: Results of the current study are important to efforts focused on addressing
childhood obesity, particularly in underserved communities where access to
healthcare services is limited.
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Affiliation(s)
- Amy Saxe-Custack
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA.,Pediatric Public Health Initiative, Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Jean M Kerver
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, Traverse City, MI, USA
| | - Getrude Mphwanthe
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
| | - Lorraine Weatherspoon
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
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Gellasch P. The Developmental Screening Behaviors, Skills, Facilitators, and Constraints of Family Nurse Practitioners in Primary Care: A Qualitative Descriptive Study. J Pediatr Health Care 2019; 33:466-477. [PMID: 30878265 DOI: 10.1016/j.pedhc.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Researchers have found that many primary care providers are not following developmental screening recommendations. Few studies exist on the screening behaviors of advanced practice nurses. METHODS A qualitative descriptive study explored the screening behaviors, skills, and environmental facilitators/constraints of 24 family nurse practitioners (FNPs) who cared for pediatric patients from birth to 5 years of age in primary care settings. An inductive approach to content analysis was used to interpret the data. RESULTS Five main themes emerged: (a) Developmental Screening Behaviors During Well-Child Visits, (b) Developmental Screening Behaviors When a Concern Was Raised, (c) Need for Additional Developmental Screening Skills, (d) Factors That Support Developmental Screening, and (e) Factors That Limit Developmental Screening. Sixteen subthemes supported the main themes. DISCUSSION Most FNPs were not using standardized tools. Behaviors mainly consisted of actions that were informal. FNPs were not familiar with current recommendations, and they had difficulty describing most instruments.
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Bracken K, Keech A, Hague W, Kirby A, Robledo KP, Allan C, Conway A, Daniel M, Gebski V, Grossmann M, Handelsman DJ, Inder W, Jenkins A, McLachlan R, Stuckey B, Yeap BB, Wittert G. Telephone call reminders did not increase screening uptake more than SMS reminders: a recruitment study within a trial. J Clin Epidemiol 2019; 112:45-52. [PMID: 31051248 DOI: 10.1016/j.jclinepi.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to compare the response rates and costs of phone call vs. short message service (SMS) screening reminders to prospective randomized controlled trial (RCT) participants. STUDY DESIGN AND SETTING This study was a randomized evaluation within a large Australian diabetes prevention RCT. Participants were men aged 50-74 years, overweight or obese, without a previous type 2 diabetes diagnosis. Those eligible on a prescreening questionnaire who did not attend a further screening assessment within 4 weeks were randomized to receive an SMS or phone call reminder (N = 709). The primary outcome was attendance for further screening assessment within 8 weeks of prescreening. RESULTS Attendance was 18% (62/354) in the SMS reminder group, and 23% (80/355) in the phone reminder group, with no statistically significant difference in response according to reminder type (relative risk = 1.29, 95% confidence interval [CI]: 0.96-1.73, P = 0.09). The lower confidence limits for response to SMS (95% CI: 14-22%) and phone reminders (95% CI: 18-27%) did not include the 8-week attendance rate before this evaluation, 12%. Phone reminders cost substantially more than SMS reminders (AU$6.21 vs. AU$0.53 per reminder). CONCLUSION SMS reminders were as adequate a method as phone reminders to boost RCT screening uptake and were considerably more affordable.
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Affiliation(s)
- Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Kirby
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Carolyn Allan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Ann Conway
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Mark Daniel
- Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Mathis Grossmann
- Department of Medicine, The Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - David J Handelsman
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Warrick Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Bronwyn Stuckey
- Keogh Institute of Medical Research and Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital and Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Taylor SL, Meyer JM, Munoz-Abraham AS, Chatoorgoon K. Standardized text messages improve 30-day patient follow-up for ACS pediatric NSQIP cases. Pediatr Surg Int 2019; 35:523-527. [PMID: 30712083 DOI: 10.1007/s00383-019-04436-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Thirty-day follow-up is a critical and challenging component of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). We hypothesized the simplicity and immediacy of text messaging would increase response rates while reducing workload. METHODS For 6 months, text messages were the primary form of contact for first and second follow-up attempts. If no response, a phone call was made. Results of this protocol were compared to the previous 6 months when phone calls were the primary method. RESULTS The text message (TM) group had 298 cases and phone call (PC) group had 354. The first contact was successful in 63.8% of the TM group compared to 47.5% of the PC group. The second contact was successful in 15.4% (TM) and 16.9% (PC). In the third attempt, 3.0% answered the call in the TM group versus 9.3% in the PC group. Some families remained unreachable: 17.8% in TM group and 26.3% in PC group (p = 0.01). When totaled, time spent to obtain caregivers' responses was over five times higher in the PC group (910 min) than the TM group (173 min) (p = 0.005). CONCLUSION Patient follow-up using text messaging has improved our follow-up rate while decreasing workload.
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Affiliation(s)
- Stephanie L Taylor
- Division of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University, 1465 S Grand Blvd, St. Louis, MO, 63104-6454, USA.,Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Jenna M Meyer
- Division of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University, 1465 S Grand Blvd, St. Louis, MO, 63104-6454, USA.,Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Armando Salim Munoz-Abraham
- Division of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University, 1465 S Grand Blvd, St. Louis, MO, 63104-6454, USA.,Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Kaveer Chatoorgoon
- Division of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University, 1465 S Grand Blvd, St. Louis, MO, 63104-6454, USA. .,Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.
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Texting Test Results Reduces the Time to Treatment for Sexually Transmitted Infections. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 25:165-170. [DOI: 10.1097/phh.0000000000000795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zebina M, Melot B, Binachon B, Ouissa R, Lamaury I, Hoen B. Impact of an SMS reminder service on outpatient clinic attendance rates by patients with HIV followed-up at Pointe-à-Pitre University Hospital. Patient Prefer Adherence 2019; 13:215-221. [PMID: 30774317 PMCID: PMC6354684 DOI: 10.2147/ppa.s182186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE By the end of 2014, 23% of people living with HIV (PWHIV) who had had a scheduled appointment at our outpatient clinic had not attended. We implemented an SMS reminder service and assessed its impact on medical consultation-attendance rate. METHODS The intervention was directed at all PWHIV with a scheduled appointment between March and April 2015 at our infectious diseases department. Two days before the scheduled visit, an appointment reminder SMS was sent to every other patient at random. On the visit day, a questionnaire was used to determine patient perceptions regarding the SMS. RESULTS A total of 224 patients (126 males, 98 females, mean age 52 years, 94% taking anti-retroviral therapy) were selected to take part in the study. The medical consultation-attendance rate was 76% in the SMS reminder read group (87 patients) and 72% in the SMS reminder not sent or not read group (137 patients, P=0.6). Among the 66 SMS reminder read patients who attended their consultation and answered the questionnaire, 51% reported that the SMS had contributed to their attendance. CONCLUSION Sending an SMS reminder had no significant impact on clinic attendance rates. This may have been due in part to the sociocultural characteristics of our patients. Further research should investigate other tools to improve attendance rates.
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Affiliation(s)
- Marine Zebina
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
| | - Bénédicte Melot
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
| | - Blandine Binachon
- INSERM, Center for Clinical Investigation, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Rachida Ouissa
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
| | - Isabelle Lamaury
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
| | - Bruno Hoen
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
- INSERM, Center for Clinical Investigation, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France
- EA 4537, Faculty of Medicine Hyacinthe Bastaraud, University of the French West Indies and French Guiana, Pointe-à-Pitre, France
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Triemstra JD, Lowery L. Prevalence, Predictors, and the Financial Impact of Missed Appointments in an Academic Adolescent Clinic. Cureus 2018; 10:e3613. [PMID: 30680269 PMCID: PMC6340409 DOI: 10.7759/cureus.3613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Missed appointments have been shown to have significant economic consequences on clinics and health systems. Furthermore, adolescents have been shown to miss appointments more frequently than other pediatric patients. Information regarding predictive factors for which patients will miss appointments has been researched for adolescents, but scheduling-related risk factors and the financial impact of missed appointments in an adolescent clinic are lacking. Therefore, we sought to identify the financial impact and schedule-related risk factors of missed appointments in an academic adolescent clinic. Methods A retrospective chart review of financial and scheduling information of each missed appointment was conducted at the Adolescent and Young Adult Medicine Clinic at Helen DeVos Children’s Hospital (HDVCH) in Grand Rapids, Michigan between November 2016 and October 2017. Information obtained was the day of the week, time of appointment, lead days till appointment, level of provider, historical weather data, appointment type (new patient, established physical, established visit, or injection only) and insurance type for each patient. Results We report a 21.2% missed appointment rate. Monday had a significantly higher fraction of missed appointments than other days of the week (p < 0.001). An increase in nonattendance was also seen with an increase in the lead days until appointment (p = 0.026). Weather (p = 0.507), time of day (p = 0.665) and type of provider (p = 0.361) were not found to be significant. We estimated an annual billing and reimbursement loss from missed appointments of $170,100 and $51,289, respectively. Conclusion These results highlight that revenue lost from missed appointments is significant and directly affects the ability to improve patient access and care. Future efforts to decrease missed appointments should target schedule-related risk factors in addition to patient reminder systems.
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Affiliation(s)
- Justin D Triemstra
- Pediatrics, Spectrum Health, Michigan State University, Grand Rapids, USA
| | - Lisa Lowery
- Pediatrics, Spectrum Health, Michigan State University, Grand Rapids, USA
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Shuen JA, Wilson MP, Kreshak A, Mullinax S, Brennan J, Castillo EM, Hinkle C, Vilke GM. Telephoned, Texted, or Typed Out: A Randomized Trial of Physician-Patient Communication After Emergency Department Discharge. J Emerg Med 2018; 55:573-581. [PMID: 30181075 DOI: 10.1016/j.jemermed.2018.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/06/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Novel means of emergency department (ED) post-discharge communication-telephone callbacks and text messages-are increasingly being utilized to facilitate patient-oriented outcomes, such as ED revisits, patient adherence, and satisfaction. OBJECTIVE The primary measure of interest is the rate of ED revisits in the week after discharge. The secondary measures of interests are rate of primary medical doctor (PMD) or specialist physician contact in the week after discharge and patient satisfaction. METHODS Pilot randomized controlled trial with three groups: usual discharge; usual care + phone call 48 h after discharge asking if patients wanted to speak with a physician; or usual care + text message 48 h after discharge asking if patients wanted to speak with a physician. All participants received a 1-week assessment of patient satisfaction. ED revisit and contact with PMD or specialist physician within 7 days of discharge were obtained from electronic medical record and analyzed using χ2 test. RESULTS Two hundred and fifty-one patients were enrolled and randomized (66 control, 103 phone, 82 text). Although the three groups did not show a statistically significant difference, the phone and text groups had similar and lower proportions of patients revisiting the ED (>50% reduction) and calling or visiting their PMD or specialist physician (approximately 30% reduction) than the control group (χ2 = 4.57, degrees of freedom [df] = 2, p = 0.10; χ2 = 1.36, df = 2, p = 0.51). There was no difference in patient satisfaction (χ2 = 2.88, df = 2, p = 0.24). CONCLUSIONS Patients who are contacted for ED follow-up by phone and text, though perhaps not more satisfied, may tend to revisit the ED and contact their PMD or specialty physician less often than patients receiving standard written discharge instructions. However, this pilot study is underpowered, so larger randomized studies are needed to confirm.
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Affiliation(s)
- Jessica A Shuen
- Emergency Trauma Department, Hackensack University Medical Center, Hackensack, New Jersey
| | - Michael P Wilson
- Division of Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Allyson Kreshak
- Department of Emergency Medicine, UC San Diego Health System, University of California at San Diego, San Diego, California
| | - Samuel Mullinax
- Division of Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jesse Brennan
- Department of Emergency Medicine, UC San Diego Health System, University of California at San Diego, San Diego, California
| | - Edward M Castillo
- Department of Emergency Medicine, UC San Diego Health System, University of California at San Diego, San Diego, California
| | - Corinne Hinkle
- Department of Emergency Medicine, UC San Diego Health System, University of California at San Diego, San Diego, California
| | - Gary M Vilke
- Department of Emergency Medicine, UC San Diego Health System, University of California at San Diego, San Diego, California
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Mohammed H, Rizk MZ, Wafaie K, Ulhaq A, Almuzian M. Reminders improve oral hygiene and adherence to appointments in orthodontic patients: a systematic review and meta-analysis. Eur J Orthod 2018; 41:204-213. [DOI: 10.1093/ejo/cjy045] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Hisham Mohammed
- Edinburgh Dental Institute, University of Edinburgh, Scotland
- Glasgow Orthodontic Academy, Scotland
| | | | - Khaled Wafaie
- School of Dentistry, University of Dundee, Scotland, UK
| | - Aman Ulhaq
- Edinburgh Dental Institute, University of Edinburgh, Scotland
| | - Mohammed Almuzian
- Edinburgh Dental Institute, University of Edinburgh, Scotland
- Glasgow Orthodontic Academy, Scotland
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Australia
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Schwebel FJ, Larimer ME. Using text message reminders in health care services: A narrative literature review. Internet Interv 2018; 13:82-104. [PMID: 30206523 PMCID: PMC6112101 DOI: 10.1016/j.invent.2018.06.002] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Despite the extensive use of mHealth behavior change interventions, questions remain about the use of technology-based reminders in delivering health care services. Text messaging, or short message service (SMS), is one reminder method that has been extensively researched. Most SMS-reminder research is distributed across a range of health care outcomes. The aim of this article is to systematically review the aggregate impact of these reminders on overall health care outcomes. METHODS A systematic literature review was conducted and yielded 2316 articles. Studies were included if they used SMS reminders to support patient health care outcomes. Study methodology was aligned with the PRISMA guidelines for systematic reviews. RESULTS Following screening, 162 articles met inclusion criteria. Of these studies, 93 investigated medical compliance reminders and 56 investigated appointment reminders. The review found that nearly all the SMS-reminder studies helped improve patient medical compliance and appointment reminders. Additionally, researchers reported numerous benefits from using SMS reminders, including ease of use, relative inexpensiveness, and rapid and automated message delivery. Minimal risks were reported and most participants found the reminders to be acceptable. DISCUSSION Text messages appear to be an effective reminder mechanism to promote improved patient appointment and medical compliance. Reminders should continue to be evaluated and improved to determine the most effective timing and frequency of messages for improving outcomes.
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Affiliation(s)
- Frank J. Schwebel
- University of Washington, Department of Psychology, 119A Guthrie Hall Box 351525, Seattle, WA 98195-1525, United States of America,Corresponding author.
| | - Mary E. Larimer
- University of Washington, Department of Psychology, 119A Guthrie Hall Box 351525, Seattle, WA 98195-1525, United States of America,University of Washington, Department of Psychiatry and Behavioral Sciences, 1100 NE 45th, Suite 300, Office 312, Box 354944, Seattle, WA 98105, United States of America
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Wallace DJ, Ray KN, Degan A, Kurland K, Angus DC, Malinow A. Transportation characteristics associated with non-arrivals to paediatric clinic appointments: a retrospective analysis of 51 580 scheduled visits. BMJ Qual Saf 2018; 27:437-444. [PMID: 29175854 PMCID: PMC8063503 DOI: 10.1136/bmjqs-2017-007168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prior work has not studied the effects of transportation accessibility and patient factors on clinic non-arrival. OBJECTIVES Our objectives were: (1) to evaluate transportation characteristics and patient factors associated with clinic non-arrival, (2) to evaluate the comparability of bus and car drive time estimates, and (3) to evaluate the combined effects of transportation accessibility and income on scheduled appointment non-arrival. METHODS We queried electronic administrative records at an urban general pediatrics clinic. We compared patient and transportation characteristics between arrivals and non-arrivals for scheduled appointments using multivariable modeling. RESULTS There were 15 346 (29.8%) clinic non-arrivals. In separate car and bus multivariable models that controlled for patient and transit characteristics, we identified significant interactions between income and drive time, and clinic non-arrival. Patients in the lowest quartile of income who were also in the longest quartile of travel time by bus had an increased OR of clinic non-arrival compared with patients in the lowest quartile of income and shortest quartile of travel time by bus (1.55; P<0.01). Similarly, patients in the lowest quartile of income who were also in the longest quartile of travel time by car had an increased OR of clinic non-arrival compared with patients in the lowest quartile of income and shortest quartile of travel time by car (1.21, respectively; P<0.01). CONCLUSIONS Clinic non-arrival is associated with the interaction of longer travel time and lower income.
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Affiliation(s)
- David J Wallace
- Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kristin N Ray
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Abbye Degan
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kristen Kurland
- School of Architecture, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Derek C Angus
- Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ana Malinow
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Wegrzyniak LM, Hedderly D, Chaudry K, Bollu P. Measuring the effectiveness of patient-chosen reminder methods in a private orthodontic practice. Angle Orthod 2018; 88:314-318. [PMID: 29376734 PMCID: PMC8288327 DOI: 10.2319/090517-597.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/01/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of patient-chosen appointment reminder methods (phone call, e-mail, or SMS text) in reducing no-show rates. MATERIALS AND METHODS This was a retrospective case study that determined the correlation between patient-chosen appointment reminder methods and no-show rates in a private orthodontic practice. This study was conducted in a single office location of a multioffice private orthodontic practice using data gathered in 2015. The subjects were patients who self-selected the appointment reminder method (phone call, e-mail, or SMS text). Patient appointment data were collected over a 6-month period. Patient attendance was analyzed with descriptive statistics to determine any significant differences among patient-chosen reminder methods. RESULTS There was a total of 1193 appointments with an average no-show rate of 2.43% across the three reminder methods. No statistically significant differences ( P = .569) were observed in the no-show rates between the three methods: phone call (3.49%), e-mail (2.68%), and SMS text (1.90%). CONCLUSIONS The electronic appointment reminder methods (SMS text and e-mail) had lower no-show rates compared with the phone call method, with SMS text having the lowest no-show rate of 1.90%. However, since no significant differences were observed between the three patient-chosen reminder methods, providers may want to allow patients to choose their reminder method to decrease no-shows.
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Saeed S, Somani N, Sharif F, Kazi AM. Evaluating the Effectiveness of Text Messaging and Phone Call Reminders to Minimize No Show at Pediatric Outpatient Clinics in Pakistan: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2018; 7:e91. [PMID: 29636321 PMCID: PMC5915671 DOI: 10.2196/resprot.9294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Missing health care appointments without canceling in advance results in a no show, a vacant appointment slot that cannot be offered to others. No show can be reduced by reminding patients about their appointment in advance. In this regard, mobile health (mHealth) strategy is to use text messaging (short message service, SMS), which is available on all cellular phones, including cheap low-end handsets. Nonattendance for appointments in health care results in wasted resources and disturbs the planned work schedules. OBJECTIVES The purpose of this study is to evaluate the efficacy of the current text messaging (SMS) and call-based reminder system and further explore how to improve the attendance at the pediatric outpatient clinics. The primary objectives are to (1) determine the efficacy of the current clinic appointment reminder service at pediatric outpatient clinics at Aga Khan University Hospital, (2) assess the mobile phone access and usage among caregivers visiting pediatrics consultant clinics, and (3) explore the perception and barriers of parents regarding the current clinic appointment reminder service at the pediatric outpatient clinics at Aga Khan University Hospital. METHODS The study uses a mixed-method design that consists of 3 components: (1) retrospective study (component A) which aims to determine the efficacy of text messaging (SMS) and phone call-based reminder service on patient's clinic attendance during January to June 2017 (N=58,517); (2) quantitative (component B) in which a baseline survey will be conducted to assess the mobile phone access and usage among parents/caregivers of children visiting pediatrics consultant clinics (n=300); and (3) qualitative (component C) includes in-depth interviews and focus group discussion with parents/caregivers of children visiting the pediatric consultancy clinic and with health care providers and administrative staff. Main constructs will be to explore perceptions and barriers related to existing clinic appointment reminder service. Ethics approval has been obtained from the Ethical Review Committee, Aga Khan University, Pakistan (4770-Ped-ERC-17). RESULTS Results will be disseminated to pediatric quality public health and mHealth communities through scientific meetings and through publications, nationally and internationally. CONCLUSIONS This study will provide insight regarding efficacy of using mHealth-based reminder services for patient's appointments in low- and middle-income countries setup. The finding of this study will be used to recommend further enhanced mHealth-based solutions to improve patient appointments and decrease no show.
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Affiliation(s)
- Sana Saeed
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Noureen Somani
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fatima Sharif
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Abdul Momin Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Mazaheri Habibi MR, Abadi FM, Tabesh H, Vakili-Arki H, Abu-Hanna A, Eslami S. Evaluation of patient satisfaction of the status of appointment scheduling systems in outpatient clinics: Identifying patients' needs. J Adv Pharm Technol Res 2018; 9:51-55. [PMID: 30131937 PMCID: PMC6078003 DOI: 10.4103/japtr.japtr_134_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Appointment scheduling systems are potentially useful tools for enhancing the patient satisfaction. This study was conducted to inspect patient's needs and satisfaction of the current status of appointment scheduling systems in outpatient clinics. This cross-sectional study was conducted in 10 outpatient clinics with different specializations. The outpatient clinics were selected based on the stratified randomization method. Data were collected using a questionnaire from December 2016 to March 2017. The questionnaire reliability was measured with the participation of 15 patients using the test-retest method. The content validity was also evaluated by 13 experts. A total of 319 patients completed the survey. The mean score of overall patient satisfaction and the patient satisfaction of the clinic environment were 6.73 ± 0.16 and 8.30 ± 0.12, respectively. The average waiting time was 64.2 ± 3.45 min. The service time took on an average 9.85 ± 0.37 min. The patient satisfaction of the clinic environment (P = 0.023), length of waiting time (P = 0.001), and duration of service time (P = 0.005) had a statistically significant association with overall patient satisfaction. Based on the results, the need for improving overall patient satisfaction score was felt. The patient satisfaction of waiting time, service time, and clinic environment had the greatest influence on overall patient satisfaction. Furthermore, it is recommended that a web-based appointment scheduling system should be implemented.
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Affiliation(s)
- Mohammad Reza Mazaheri Habibi
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hasan Vakili-Arki
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Kumar GS, Kashyap A, Raghav S, Bhardwaj R, Singh A, Guram G. Role of Text Message Reminder on Oral Hygiene Maintenance of Orthodontic Patients. J Contemp Dent Pract 2018; 19:98-101. [PMID: 29358543 DOI: 10.5005/jp-journals-10024-2219] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Fixed orthodontic treatment is frequently associated with increased plaque accumulation leading to gingivitis and white spot lesions (WSLs). AIM This study evaluated the role of text message reminder on oral hygiene of orthodontic patients. MATERIALS AND METHODS A total of 60 patients under fixed orthodontic treatment were randomly divided into two equal groups as control group and study (text message) group. Text message group received reminders about oral hygiene, while the control group did not receive any messages. Oral hygiene of both the groups was evaluated at baseline, 2, and 3 months using plaque indices (PIs) along with WSL status. Data were statistically analyzed using Statistical Package for the Social Sciences (SPSS) statistical software, version 19, with chi-square test and t-test. RESULTS At the baseline, plaque score was higher in the study group over control group (p > 0.038), whereas it was decreased after 3 months in the test group (p > 0.001). For WSL, there was no significant difference at baseline, but it was significantly lower in study group (p > 0.003). CONCLUSION Oral hygiene status improved with text message reminder.
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Affiliation(s)
- G Sujay Kumar
- Department of Orthodontics, Sharavathi Dental College and Hospital, Shimoga, Karnataka, India, e-mail:
| | - Arpita Kashyap
- Private Practitioner, Crystal Smile Care, Department of Orthodontics, Guwahati, Assam, India
| | - Shweta Raghav
- Department of Orthodontics and Dentofacial Orthopedics College of Dental Sciences, Indore, Madhya Pradesh, India
| | - Rishibha Bhardwaj
- Department of Orthodontics, I.T.S. Dental College, Muradnagar Uttar Pradesh, India
| | - Arunesh Singh
- Department of Orthodontics, Rama Dental College, Hospital & Research Centre, Kanpur, Uttar Pradesh, India
| | - Guneet Guram
- Department of Orthodontics, Adesh Institute of Dental Sciences & Research, Bathinda, Punjab, India
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Bashshur RL, Howell JD, Krupinski EA, Harms KM, Bashshur N, Doarn CR. The Empirical Foundations of Telemedicine Interventions in Primary Care. Telemed J E Health 2017; 22:342-75. [PMID: 27128779 DOI: 10.1089/tmj.2016.0045] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION This article presents the scientific evidence for the merits of telemedicine interventions in primary care. Although there is no uniform and consistent definition of primary care, most agree that it occupies a central role in the healthcare system as first contact for patients seeking care, as well as gatekeeper and coordinator of care. It enables and supports patient-centered care, the medical home, managed care, accountable care, and population health. Increasing concerns about sustainability and the anticipated shortages of primary care physicians have sparked interest in exploring the potential of telemedicine in addressing many of the challenges facing primary care in the United States and the world. MATERIALS AND METHODS The findings are based on a systematic review of scientific studies published from 2005 through 2015. The initial search yielded 2,308 articles, with 86 meeting the inclusion criteria. Evidence is organized and evaluated according to feasibility/acceptance, intermediate outcomes, health outcomes, and cost. RESULTS The majority of studies support the feasibility/acceptance of telemedicine for use in primary care, although it varies significantly by demographic variables, such as gender, age, and socioeconomic status, and telemedicine has often been found more acceptable by patients than healthcare providers. Outcomes data are limited but overall suggest that telemedicine interventions are generally at least as effective as traditional care. Cost analyses vary, but telemedicine in primary care is increasingly demonstrated to be cost-effective. CONCLUSIONS Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment. Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost, but patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.
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Affiliation(s)
- Rashid L Bashshur
- 1 University of Michigan Health System, University of Michigan , Ann Arbor, Michigan
| | - Joel D Howell
- 2 Department of Internal Medicine, University of Michigan , Ann Arbor, Michigan.,3 Department of History and Health Management and Policy, University of Michigan , Ann Arbor, Michigan
| | | | - Kathryn M Harms
- 5 Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Noura Bashshur
- 1 University of Michigan Health System, University of Michigan , Ann Arbor, Michigan
| | - Charles R Doarn
- 6 Department of Family and Community Medicine, University of Cincinnati , Cincinnati, Ohio
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Andreae MH, Nair S, Gabry JS, Goodrich B, Hall C, Shaparin N. A pragmatic trial to improve adherence with scheduled appointments in an inner-city pain clinic by human phone calls in the patient's preferred language. J Clin Anesth 2017; 42:77-83. [PMID: 28841451 DOI: 10.1016/j.jclinane.2017.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE We investigated if human reminder phone calls in the patient's preferred language increase adherence with scheduled appointments in an inner-city chronic pain clinic. We hypothesized that language and cultural incongruence is the underlying mechanism to explain poor attendance at clinic appointments in underserved Hispanic populations. DESIGN Pragmatic randomized controlled clinical trial SETTING: Innercity academic chronic pain clinic with a diverse, predominantly African-American and Hispanic population PATIENTS: All (n=963) adult patients with a scheduled first appointment between October 2014 and October 2015 at the Montefiore Pain Center in the Bronx, New York were enrolled. INTERVENTIONS Patients were randomized to receive a human reminder call in their preferred language before their appointment, or no contact. MEASUREMENTS We recorded patients' demographic characteristics and as primary outcome attendance as scheduled, failure to attend and/or cancellation calls. We fit Bayesian and classical multinomial logistic regression models to test if the intervention improved adherence with scheduled appointments. MAIN RESULTS Among the 953 predominantly African American and Hispanic/Latino patients, 475 patients were randomly selected to receive a language-congruent, human reminder call, while 478 were assigned to receive no prior contact, (after we excluded 10 patients, scheduled for repeat appointments). In the experimental group, 275 patients adhered to their scheduled appointment, while 84 cancelled and 116 failed to attend. In the control group, 249 patients adhered to their scheduled appointment, 31 cancelled and 198 failed to attend. Human phone reminders in the preferred language increased adherence (RR 1.89, CI95% [1.42, 1.42], (p<0.01). The intervention seemed particularly effective in Hispanic patients, supporting our hypothesis of cultural congruence as possible underlying mechanism. CONCLUSIONS Human reminder phone calls prior in the patient's preferred language increased adherence with scheduled appointments. The intervention facilitated access to much needed care in an ethnically diverse, resource poor population, presumably by overcoming language barriers.
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Affiliation(s)
- Michael H Andreae
- Department of Anesthesiology, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, Hershey PA 17033, United States.
| | - Singh Nair
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467 Bronx, NY, United States
| | - Jonah S Gabry
- Institute for Social and Economic Research and Policy (ISERP), Columbia University of the City of New York, International Affairs Building, 420 West 118th St, New York, NY 10027, United States
| | - Ben Goodrich
- Department of Political Science, Columbia University in the City of New York, International Affairs Building, 420 West 118th Street, New York, NY 10027, United States
| | - Charles Hall
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States
| | - Naum Shaparin
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467 Bronx, NY, United States
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Singh G, Manjunatha N, Rao S, Shashidhara HN, Moirangthem S, Madegowda RK, Binukumar B, Varghese M. Use of Mobile Phone Technology to Improve follow-up at a Community Mental Health Clinic: A Randomized Control Trial. Indian J Psychol Med 2017; 39:276-280. [PMID: 28615760 PMCID: PMC5461836 DOI: 10.4103/0253-7176.207325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mobile phone technology is being used worldwide to improve follow-ups in health care. AIM Aim of the study is to evaluate whether the use of mobile technology will improve or not the follow-up of Indian patients from a community mental health center. MATERIALS AND METHODS Patients or caregivers having mobile phones and consenting for study were enrolled, and sociodemographic and clinical details of patients were taken. Participants were randomized into two groups (short message service [SMS] vs. non-SMS group). At first intervention level, a SMS was sent to SMS group (not in non-SMS group) 1 day before their appointment. At second-level intervention (voice call level), patients from both groups who missed their first appointment were given a voice call requesting them to come for follow-up, and the reasons for first missed appointments (MA) were also elicited. The effect of these two intervention levels (first SMS for SMS group and next voice calls for both groups) on follow-up was evaluated. RESULTS A total of 214 patients were enrolled in the study. At first SMS intervention level of SMS group (n = 106), 62.26% of participants reached appointment-on-time (RA), while in the non-SMS/as usual group (n = 108), 45.37% of patients RA. The difference of these groups is statistically significant. At second-level intervention (voice call), 66 of 88 (another 15 were unable to contact) were came for follow-up consultation within 2 days of MA. Distance and diagnosis of alcohol dependence were significantly associated with MA. Social reasons were most common reasons for first MA. CONCLUSION The use of mobile phone technology in an outpatient community psychiatric clinic improved follow-up significantly.
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Affiliation(s)
- Gaurav Singh
- Department of Psychiatry, K.D. Medical College Hospital and Research Center, Mathura, Uttar Pradesh, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sabina Rao
- Sakra Hospital, Bengaluru, Karnataka, India
| | - H N Shashidhara
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rajendra K Madegowda
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - B Binukumar
- Biostatistics, National Institute of Mental Health and Neurosciences, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Lee S, Schorr E, Chi CL, Treat-Jacobson D, Mathiason MA, Lindquist R. Peer Group and Text Message-Based Weight-Loss and Management Intervention for African American Women. West J Nurs Res 2017; 40:1203-1219. [PMID: 28335711 DOI: 10.1177/0193945917697225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
About 80% of African American (AA) women are overweight or obese. Accessible and effective weight management programs targeting weight loss, weight maintenance and the prevention of weight regain are needed to improve health of AA women. A feasibility study was conducted to examine the feasibility, acceptability, and potential efficacy of a 16-week intervention protocol for weight loss and management that combined daily text messages and biweekly peer group sessions. Modest but statistically significant reductions were detected in weight and body mass index from baseline to 16 weeks. At baseline, 36% of participants were in action and maintenance stages in measures of the stages of change for weight loss and management; this percent increased to 82% at 16 weeks. Findings of this feasibility study provide preliminary evidence of an educational intervention that could motivate women and lead to successful behavior change, and successful weight loss and management for AA women.
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Affiliation(s)
- Sohye Lee
- 1 University of Minnesota, Minneapolis, MN, USA
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