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

1. Impact of appointment reminders via Short Message Service in a District Hospital Introdução à Medicina’s Annual Assignment 2006/2007 Final Presentation Class 4 - FMUP

2. Presentation Structure ObjectiveIntroductionMethodsResults and DiscussionReferencesAcknowledgmentsAuthors

3. Objective 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.

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]

5. Introduction • 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...

6. Introduction • 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.

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

8. 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

10. Participants and Methods • 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.”

11. Participants and Methods Flowchart: Selection of Participants

12. Participants and Methods • 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.

13. Participants and Methods • Data Analysis (using SPSS program): • Statistical analysis, comparing the percentage of attendances and non-attendances in reminded and non-reminded groups;

14. Participants and Methods • 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

15. Participants and Methods • Chi-square test for each of the variables mentioned before and contingency tables. • 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.

16. Participants and Methods Flowchart: description of methods

17. Results and Discussion 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.

18. Results and Discussion 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

19. Results and Discussion 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.

20. Results and Discussion Table 1 – Cont. • There aren’t any relation between the non-attendance and time of the day and also mobile telephone network

21. Results and Discussion • Table 1 – Cont. • it can be seen a relation between non-attendance and specialty. Surgical is the one with lowest non-attendance

22. Results and Discussion Table 2 – Attendances (%) according to the sending or not of SMS. Number of episodes = 3899 Missings = 537 Rate difference: 3,5% Rate ratio: 26,7%.

23. Results and Discussion Results and Discussion • 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.

24. Comparison of data collected

25. Comparison of data collected

26. 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.

27. 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.

28. 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.

29. 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)

30. 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.htm • Portugal Telecom - consulted on April 3rd 2006

31. Acknowledgments Dr. Ricardo Correia Prof. Dr. Altamiro da Costa Pereira Dr. Alberto Freitas Dr. Armando Pinto Drª. Filipa Almeida S. Sebastião Hospital, in particular Engº. Rui Gomes

32. 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: turma4.2006fmup@gmail.com