Impact of appointment reminders via Short Message Service in a District Hospital

Impact of appointment reminders Impact of appointment reminders via Short Message Service in a via Short Message Service in a

District HospitalDistrict Hospital

Introdução à Medicina’s Annual Assignment

2006/2007

Final Presentation

Class 4 - FMUP

:: Annual Assignment | Introdução à Medicina 2006-2007 | Class4

Impact of appointment reminders via Short Message Service in a District Hospital

2

Presentation Structure

Objective

Introduction

Methods

Results and Discussion

References

Acknowledgments

Authors



3

This study aims to measure the changes in outpatient’s non-attendance rate according

to the sending or not of an appointment reminder via Short Message Service in a

District Hospital.

Objective



4

Introduction

Problem: failure to attend outpatients appointments.

[Hashim, 2001]

Reasons for non-attendance:

- Forgetfulness (which is the most important for our work);

- Long distance from home to health services and trip cost;

- Inconvenient time of appointment (incompatible with work

schedule).

[McClure, 1996]



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Consequences of non-attendance:

Missed opportunities for diagnosis and treatment; Reduced opportunities for hospital revenue; Extended time patients have to wait for an appointment booking.

[Downer, 2005]

Emerging technology of Short Message Service is starting to be

used to remind patients about their appointments...

Introduction



6

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

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

Introduction



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Hardware used by the hospital to send appointment reminders through the technology of SMS (Pictures taken in S. Sebastião Hospital)

Introduction



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Conclusions of previous studies conducted in Portugal

related to Hospital S. Sebastião

improving patients attendance, reflected by:

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

general appointments;

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

recovering of about 900 appointments per month;

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

Introduction



9

Participants and Methods

Population: All patients of S. Sebastião Hospital, who

have mobile phone number registered at the system.

Sample’s selection: The set of the Hospital’s patients

who have appointments in the days we perform the study.

Study design: Experimental and transversal study



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SMS sent by the hospital:Outpatients visits

“Hospital São Sebastião. O utente NOME tem consulta de ESPECIALIDADE

em DATA as HORA. Compareça 20 min. antes.”

Exams

“Hospital São Sebastião. O utente NOME tem exame de ESPECIALIDADE em

DATA as HORA. Compareça 20 min. antes.”

Hospitalizations

“Hospital São Sebastião. O utente NOME tem internamento de

ESPECIALIDADE em DATA.”




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Flowchart:

Selection of Participants


Start

Has an appointment?

Yes

No

End

List of patients who have an appointment

State = “Not sent”

State = “Not sent”?

Save

No SMS sendingYes

Save

State = “Sent”

Next episode

State = “Not sent”

Yes

Within the study criteria?

No

All SMS sent

List of patients who have mobile phone

number registered at the system

Has mobile phone number registered at

the sistem? Yes

No



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Methods:

Selection of the days for the study (6 working days) Messages sent from 8th to 15th March for the appointments on

days 12th to 19th March.

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

The messages are sent two working days before the appointment.

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




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Data Analysis (using SPSS program):

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




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2. We are studying if the attendance rate varies according to

some of the following variables:

• Gender

• Age Groups

• Date of the appointment

• Hour of the appointment

• Previous contact with the system

• Type of Episode

• Mobile telephone network

• Speciality




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

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




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Flowchart: description of methods


Start

Experimental study

Population: all the hospital’s patients

Sample: patients who have an

appointment in the days of the study

Algorithm aplication (flag)

Attendance and non-attendance rates gathering,

within the reminded and not remimded groups

Statistical analysis

End

SMS sending or not according to

flag

Define query



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Non-Attendance p

Age (Years Old)

Under 15 16,3

<0,0516 to 25 14,0

26 to 55 10,4

More than 55 9,9

GenderFemale 10,8

>0,05Male 12,3

Table 1 - Attendances (%) according to each variable individually

Considering the age of the patients, we verify that the non-attendance rate decreases along with age.

There isn’t any relation between gender and non-attendance.




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Non-Atendance p

Previous contact with the system

Yes 9,0>0,05

No 11,6

Type of Episode

Analysis 23,2

<0,05Outpatient 10,1

Exams 15,3

Inpation 18,0

Table 1 – Cont.


• There isn’t any relation between the previous contact with the system and the non-attendance

• Hospitalizations is the episode with the highest non-attendance rate, followed by exams, analyses and outpatients



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Non-attendance p

Day of the week

Monday 10,6

Tuesday 12,1

Wednesday 15,0 <0,05

Thursday 11,9

Friday 6,8

Table 1 – Cont.

• This table shows that on Wednesday people tend to fail appointments more than on any other day and on Friday

the non-attendance rate is the lowest.



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Non-attendance p

Time of the Day

Morning 11,4>0,05

Afternoon 10,9

Mobile Telephone Network

Vodafone 10,9

>0,05Optimus 12,9

TMN 11,3

Table 1 – Cont.


•There aren’t any relation between the non-attendance and time of the day and also mobile telephone network



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Table 1 – Cont.

Non-attendance p

Specialty

Medical 11,2

<0,05Medical-surgical 11,3

Surgical 5,0

Other 23,9

• it can be seen a relation between non-attendance and specialty. Surgical is the one with lowest non-attendance



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Table 2 – Attendances (%) according to the sending or not of SMS.

Attendance Non-Attendance p

Reminded 90,4 9,6<0,05

Non-reminded 86,9 13,1

Rate difference: 3,5%

Rate ratio: 26,7%.


Number of episodes = 3899

Missings = 537



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• it was conducted Logistics regressions for the variable attendance including in

each regression the variable in study, the variable state of SMS sending and

the interaction between the two variables to investigate the influence of the

different variables on the impact of the sending of a SMS appointment

reminder. This regressions, with a p>0,05, showed that there was no relation

between the variables studied and the impact of the SMS appointment

reminder, what means that there is no benefit to SMS relatively to the groups of

the variable in study.




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Comparison of data collected

Reference

Type of

sample

selection

Type of

reminder

Durability of

the study

Time between the

reminder and the

appointment

Dimension

of the sample

(number of

individuals)

Non-

attendance

rate in non-

reminded

group

Difference

of the non-

attendance

rate after

reminder

Ritchie PD

(2000)

Randomized Phone call Not

mentioned

1 to 3 days 400 45,6% 16,3%.

Hardy KJ

(2001)

Non-

randomized

Information

pack and

telephone

call

Not

mentioned

2 weeks

(information pack)

1 week (phone

call)

325 15% 10,4 %

O’Brien G

(1998)

Randomized Phone call 11 months 1 day 703 55,9% 11,5%

Sawyer SM

(2002)

Randomized Phone call Not

mentioned

1 day 171 20% 12%



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Comparison of data collected

Reference Type of

sample

selection

Type of

reminder

Durability

of the

study

Time between

the reminder

and the

appointment

Dimension

of the sample

(number of

individuals)

Non-attendance

rate in non-

reminded group

Difference of

the non-

attendance rate

after reminder

Haynes JM

(2006)

Non-

randomized

Phone

call

7 months Not mentioned 515 11,7% 7,7%

Downer SR

(2006)

Non-

randomized

SMS 3 months Not mentioned 45110 19,5% 9.7%

Downer SR

(2005)

Non-

randomized

SMS 1 month 3 working days 2864 23,4% 9.2%

Hashim MJ

(2001)

Randomized Phone

call

Not

mentioned

1 day 903 26% 7%

Leong KC

(2006)Randomized

phone

call and

SMS

3 months 1-2 days 993 51,9% SMS – 10,9%

Telephone call –

11,5%

Costa J

(2007)

Randomized SMS 6 working

days

2 days 3899 13,1% 3,5%



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Discussion

The results show a decrease in the non-attendance rate with the sending of a SMS appointment reminder, which is consistent with the effectiveness of the sending of SMS or other appointment reminders in previous studies [1,2,3,4,7]. Although the non-attendance rate difference of this study was lower than the ones obtained with the studies referred, the non-attendance rate without the sending of an appointment reminder was also lower, so it was already expected a lower reduction. Comparatively with other studies referred, this has the advantage of being randomized and having a big sample.

Considering all this, and seeing that the difference isn´t as striking as it was expected, the hospital could adopt other methods in order to obtain a greater reduction in the non-attendance rate.



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References

References in order of appearance:

Hashim MJ, Franks P, Fiscella K. Effectiveness of Telephone Reminders in Improving

Rate of Appointments Kept at an Outpatient Clinic: A Randomized Controlled Trial. J

Am Board Fam Pract. 2001 May-Jun;14(3):193-6.

McClure RJ, Newell SJ, Edwards S. Patient characteristics affecting attendance at

general outpatient clinics. Abstract. 1996 Feb;74(2):121-5.

Downer SR, Meara JG, Da Costa AC. Use of SMS text messaging to improve

outpatient attendance. Med J Aust. 2005 Oct 3;183(7): Haynes 366-8.



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References

• Downer SR, Meara JG, Da Costa AC. Use of SMS text messaging to improve

outpatient attendance. Med J Aust. 2005 Oct 3;183(7):366-8.

• Haynes JM, Sweeney EL. The Effect of Telephone Appointment-Reminder Calls on

Outpatient Absenteeism in a Pulmonary Function Laboratory. Respir Care. 2006

Jan;51(1):36-9.

• Hashim MJ, Franks P, Fiscella K. Effectiveness of Telephone Reminders in Improving

Rate of Appointments Kept at an Outpatient Clinic: A Randomized Controlled Trial. J

Am Board Fam Pract. 2001 May-Jun;14(3):193-6.

• Hardy KJ, O'Brian SV, Furlong NJ. Information given to patients before appointments

and its effect on non-attendance rate. Abstract. 2001 Dec 1;323(7324):1298-300.



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References

• McClure RJ, Newell SJ, Edwards S. Patient characteristics affecting attendance

at general outpatient clinics. Abstract. 1996 Feb;74(2):121-5.

• Neal RD, Hussain-Gambles M, Allgar VL, Lawlor DA, Dempsey O. Reasons for

and consequences of missed appointments in general practice in the UK:

questionnaire survey and prospective review of medical records. Abstract. 2005

Nov 7;6:47.

• Downer SR. Meara JG. Da Costa AC. Sethuraman K. SMS text messaging

improves outpatient attendance. Aust Health Rev.2006 Aug;30(3):389-96.

• http://download.microsoft.com/download/

6/4/1/64122b0868594d95b0241544e37afab5/Case_Study_

%20Hospital_Sao_Sebastiao.doc

• Contratos programa com hospitais --Rcorreia 15:15, 14 Novembro 2006 (WET)



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References

•Tecnologia "made in" S. Sebastião Hospital 22:30, 5 Dezembro 2006

•“Gestão de consultas por SMS no Hospital Santa Maria”-

http://www.telecom.pt/InternetResource/PTSite/PT/DestaquesHP/smsconsultas.ht

m

• Portugal Telecom - consulted on April 3rd 2006



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Acknowledgments

Dr. Ricardo CorreiaProf. Dr. Altamiro da Costa PereiraDr. Alberto FreitasDr. Armando PintoDrª. Filipa Almeida

S. Sebastião Hospital, in particular Engº. Rui Gomes



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Authors

Class 4, Introdução à Medicina 2006-2007, Faculdade de Medicina UP

Cardoso, L.; Costa, A.; Costa, J.; Cunha, A.; Dias, C.; Lima, M.; Pacheco, P.; Silva, D.; Silva, I.; Sousa, D.; Tinoco, M.; Valente, L.; Viana, S.; Correia, R.

Contact:

[email protected]

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Impact of appointment reminders via Short Message Service in a District Hospital