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The impact of short message service text messages sent as appointment reminders to patients’ cell phones at outpatient clinics in São Paulo, Brazil
Abstract
Nonattendance for appointments remains a challenge to health care managers and providers. The objective of this article is to present the results of a study on the impact of appointment reminders sent as short message service text messages to patients' cell phones on nonattendance rates at outpatient clinics in São Paulo, Brazil.
Data were collected on scheduled appointments in four medical clinics using Clinic Manager or Clinic Web systems that can send automated messages to patients. Data on appointment attendance were collected from these systems.
More than 29,000 appointments were scheduled between July 1, 2007, and May 31, 2008, and for 7890 of them a text message reminder was sent to the patient's cell phone. The rates of nonattendance were compared between those who were sent and those who were not sent a text message as an appointment reminder.
The nonattendance reduction rates for appointments at the four outpatient clinics studied were 0.82% (p= .590), 3.55% (p= .009), 5.75% (p= .022), and 14.49% (p= < .001).
The study results indicate that sending appointment reminders as text messages to patients' cell phones is an effective strategy to reduce nonattendance rates. When patients attend their appointments, the facility providing care and the patients receiving uninterrupted care benefit.
... Using mobile phone text messages (SMS messages) as reminders has proven to be effective in a variety of settings and for different health problems (e.g., noncommunicable diseases and AIDS [13][14][15][16][17][18]). SMS messages are useful for reminding patients about medication adherence (e.g., antiretroviral therapy and asthma treatment [13][14][15]), and to improve preventive and outpatient clinic attendance rates in many LMIC [16][17][18][19]. ...
... Using mobile phone text messages (SMS messages) as reminders has proven to be effective in a variety of settings and for different health problems (e.g., noncommunicable diseases and AIDS [13][14][15][16][17][18]). SMS messages are useful for reminding patients about medication adherence (e.g., antiretroviral therapy and asthma treatment [13][14][15]), and to improve preventive and outpatient clinic attendance rates in many LMIC [16][17][18][19]. Similarly, mHealth tools targeted at providers, including CHWs, improve the quality of services they provide, most prominently through decision support and reminders [20][21][22][23]. ...
... SMS messages have advantages over other reminder systems, including that they can be sent to providers and patients and require less staff [13,18]. SMS messages can enhance the link between patients and health services and increase adherence in primary care and gynecology care settings via reminders, counseling, or by addressing patient apprehensions [13,[16][17][18]. ...
Background
Cervical cancer is one of the leading causes of cancer death among women worldwide, with more than 85% of cases occurring in low- and middle-income countries. Human papillomavirus (HPV) screening allows for self-collection with the potential to increase coverage, but still requires triage to identify which HPV+ women need diagnostic and treatment procedures. However, achieving high levels of triage adherence can be challenging, especially among socially vulnerable women. This paper describes the ATICA protocol (Application of Communication and Information Technologies to Self-Collection, for its initials in Spanish), aimed at evaluating the implementation strategy and the effectiveness of a multi-component mobile health (mHealth) intervention to increase adherence to triage among women with HPV+ self-collected tests.
Methods
We will use an effectiveness-implementation hybrid type I trial with a mixed-methods evaluation approach. A cluster randomized trial design including 200 community health workers (CHWs) will evaluate whether the mHealth intervention increases adherence to triage among HPV+ women who self-collected at home during a CHW visit within 120 days after a positive result. The intervention includes an initial mobile phone text message (SMS) alert and subsequent reminders sent to HPV+ women. For those who do not adhere to triage within 60 days of a positive HPV test, an email and SMS will be sent to the CHWs to promote contact with these women during home visits.
We will use the Consolidated Framework for Implementation Research (CFIR) as an organizing and analytic framework to evaluate the implementation of the intervention while also drawing on Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM). We will conduct a self-administered, semi-structured survey of CHWs, semi-structured interviews with local health authorities, and a survey of HPV+ women. Combining both qualitative and quantitative data will provide rich insights into local implementation challenges and successes.
Discussion
Findings from the implementation evaluation will be applicable to programs that use or are planning to incorporate HPV self-collection and/or mHealth interventions in different settings and countries. This innovative study will also serve as a model for using implementation science in the region.
Trial registration
ClinicalTrials.gov, NCT03478397. Registered on 20 March 2018.
Electronic supplementary material
The online version of this article (10.1186/s13063-019-3229-3) contains supplementary material, which is available to authorized users.
... The number of appointments that patients do not attend compared with the total number of scheduled appointments is the ''no-show rate.'' This term is synonymous with ''nonattendance rate,'' [1][2][3][4][5] ''missed appointment,'' [6][7][8] and ''failed appointment.'' 9,10 Research conducted on no-show rates has reported negative effects resulting therefrom. ...
... Patients who do not attend appointments or maintain a regular schedule can have a less desirable treatment outcome, 11 including reduced quality of care 12 and inconsistent continuity of care. 1 Irregular attendance can also be related to a higher rate of emergencies and less compliance with health-care providers' instructions. 13 Patients can be subjected to longer wait times if an office consequently overbooks their schedule and more patients attend than anticipated. ...
... Besides the negative financial impact of patient no-shows from the increased cost of care 2,14 and revenue loss, 2,10,15 office resources, such as additional staff time for rescheduling missed appointments, are often wasted. [1][2][3]10,[14][15][16][17] Patients commonly cite forgetting the appointment as a reason for no-show, 4,9,18 and a wide variety of reminder methods have been investigated to determine their effects on lowering the no-show rate, including paper mail, phone calls made by staff, automated phone calls, e-mails, and short message service (SMS) texts. ...
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.
... In another RCT design, the attendance rates were higher for those who received phone call reminders and mobile phone messaging respectively as compared to those who did not receive any reminders [17]. Sending appointment reminders as text messages could reduce nonattendance rates [7]. ...
... Overbooking can be used as a response to no-shows [7]. The use of overbooking can minimize the negative consequence of no-shows [25]. ...
Purpose
Outpatient appointment scheduling is a critical aspect of healthcare services; however, the unpredictable nature of patient behavior poses challenges. This study focuses on predicting patient behavior in cardiology appointment scheduling in an outpatient cardiology practice within the Mount Sinai Health System (MSHS) to optimize overbooking strategies.
Methods
By reviewing the literature and conducting exploratory data analysis, significant features influencing patient behavior were identified. An ensemble learning model for an imbalanced class was developed to accurately predict the likelihood of no-show appointments and enable strategic overbooking decisions.
Results
The findings demonstrate that an increased lead time is associated with a greater probability of appointment no-shows. Patient-initiated rescheduling and cancellations were identified as the primary reasons for appointment changes. Moreover, while average wait time increases with age, younger individuals tend to have longer appointments. A stacking ensemble model for imbalanced classes and three machine-learning approaches were evaluated. The stacking ensemble model outperformed traditional techniques with an impressive F1 score of 92.3% and an AUC of 91%.
Conclusion
The proposed model enables allocating appointments based on patient preferences and characteristics, optimizing resource use, and reducing the number of cancellations and no-shows.
... [4,7] Many solutions including Short Message System (SMS) and reminder call, [2,20] written missed appointment policy, [10] and overbooking [15] have been proposed to mitigate no-show and appointment cancellation. Studies have confirmed SMS and reminder phone calls' effectiveness in reducing missed appointment episodes, however, to varying degrees of success [20,21]. Overbooking is a strategy that often leads to an un-intended consequence of a prolonged wait time for compliant patients and lower than expected revenue for the clinic. ...
... I will be proposing a multi-prong approach, including SMS, enforcement of written policy, and education such as posters. 1. Automated Short messaging system (SMS): This has been efficient in reducing no-show and cancellation episodes in different medical specialties [21]. Downer et al. (2005) found a reduction in nonattendance rates with the use of SMS reminders that ranged from 3% to 27% depending on the specialty studied. 2 Geraghty et al. (2008) report an 11% reduction in nonattendance rates at an ear, nose, and throat hospital. ...
Background: No-Show and late canceled appointments significantly impact out-patient Physical therapist productivity, patient clinical outcomes, and the clinic's revenue-generating capacity. No-show and appointment cancelation cost the out-patient Physical Therapy practice in this case study $114,505.58CAD in 2017. This study seeks to understand, identify, and provide solutions unique to our local setting for the problem of no-shows and appointment cancellation.
Methods: This study uses the 2017 de-identified patient’s attendance records of an out-patient Physical Therapy clinic in Calgary, Canada. Patient data, including sex, age, scheduled appointment, no-show, and cancellation history, were examined. The data were analyzed using chi-square to determine any significant differences in attendance patterns among these groups.
Results: A total of 6,162 scheduled appointments were aggregated from the EHR. The overall no-show and cancelation was 20.6%. Male had a slightly higher rate of no-show/cancelation (20.8%) versus females (20.6%), which was not statistically significant (p = 0.734). In the adult age groups, no-show and cancelation rates were highest for 12-20y/o (31.4%), 21-30y/o (31.3%), and 41-50y/o (22.3%). These groups accounted for 50.6% of total revenue loss. There was a significant overall difference among the age groups (p < 0.0001) in no-show/cancelation. The top four reasons for no-show and cancellation include forgetting the appointment, family and personal emergency, lack of transportation, and a scheduling conflict with another equally important appointment.
Conclusion: Evidence indicates that no-show and appointment cancelation rates are high in Canadian health institutions leading to poor productivity, inefficiency, and revenue loss. This study seeks to provide an evidence-based intervention.
... (5) Além dessas, o envio de lembretes por Short Message Service SMS pode ser uma alternativa de baixo custo e com potencial para reduzir as faltas às consultas. (17) Os estudos que testaram lembretes enviados por SMS aos pacientes provaram ser uma estratégia fácil e eficaz na redução do absenteísmo. (18)(19)(20) No Brasil, Da Costa e outros (17) enviaram mensagens de texto SMS 24 horas antes das consultas para pacientes de quatro clínicas de atenção primária da cidade de São Paulo. ...
... (17) Os estudos que testaram lembretes enviados por SMS aos pacientes provaram ser uma estratégia fácil e eficaz na redução do absenteísmo. (18)(19)(20) No Brasil, Da Costa e outros (17) enviaram mensagens de texto SMS 24 horas antes das consultas para pacientes de quatro clínicas de atenção primária da cidade de São Paulo. Os autores observaram redução na taxa de absenteísmo no grupo intervenção, ou seja, que receberam as mensagens de texto. ...
The purpose of the study was to evaluate the impact of WhatsApp® text messaging reminders on the rate of non-attendance to pediatric specialty consultation. Randomized examination was conducted of a control group and an experimental group. Participants in the experimental group received a WhatsApp® reminder of the appointment date. All the appointments scheduled for the pediatric subspecialty were included, i.e. first-time appointments as well as those following. Data analysis was based on percentage estimation by the chi-square test. A total 998 participants were included in the analysis, most of whom were men (59%). The non-attendance rate was 24% in the experimental group and 25.5% in the control group, for a difference of 1.5% (p= 0.580). The non-attendance rate was 30% (p= 0.009), particularly high for appointments scheduled for Mondays. In general terms, studies using text messaging as reminders in different populations reduced the rate of non-attendance to consultation. However, our results suggest that sending WhatsApp® text messages as reminders of medical appointments is not an effective tool to reduce non-attendance to pediatric consultation.
... (5) Além dessas, o envio de lembretes por Short Message Service SMS pode ser uma alternativa de baixo custo e com potencial para reduzir as faltas às consultas. (17) Os estudos que testaram lembretes enviados por SMS aos pacientes provaram ser uma estratégia fácil e eficaz na redução do absenteísmo. (18)(19)(20) No Brasil, Da Costa e outros (17) enviaram mensagens de texto SMS 24 horas antes das consultas para pacientes de quatro clínicas de atenção primária da cidade de São Paulo. ...
... (17) Os estudos que testaram lembretes enviados por SMS aos pacientes provaram ser uma estratégia fácil e eficaz na redução do absenteísmo. (18)(19)(20) No Brasil, Da Costa e outros (17) enviaram mensagens de texto SMS 24 horas antes das consultas para pacientes de quatro clínicas de atenção primária da cidade de São Paulo. Os autores observaram redução na taxa de absenteísmo no grupo intervenção, ou seja, que receberam as mensagens de texto. ...
O objetivo deste estudo foi testar o impacto de um lembrete por mensagem de texto
eletrônica, via WhatsApp®, sobre a taxa de absenteísmo nas consultas de subespecialidades pediátricas. Este estudo aleatorizado foi composto por um grupo controle e um experimental. Os participantes do grupo experimental receberam um aviso por WhatsApp® lembrando a data da consulta. Foram incluídos no estudo todos os usuários agendados (primeira vez e retornos) para consultas de subespecialidades pediátricas. Para as análises foi calculado os percentuais e realizou-se o teste Qui-quadrado de associação. Um total de 998 participantes foram incluídos para análise. A maioria dos participantes era do sexo masculino (59 %). A taxa de absenteísmo no grupo experimental foi de 24 % e no grupo controle, 25,5 %, representando uma diferença de 1,5 % (p= 0,580). A taxa de absenteísmo era particularmente mais alta para consultas agendadas na segunda-feira, com 30 % (p=0,009). Globalmente, o uso de lembretes por mensagens de texto em estudos com diferentes populações reduz a taxa de absenteísmo. No entanto, nossas descobertas sugerem que o envio de mensagens de texto via WhatsApp® como lembretes de consulta não é uma ferramenta eficaz na redução do absenteísmo de subespecialidades pediátricas.
... 11 Although text message reminders have been successfully implemented in several LMICs to increase patient attendance to follow-up appointments, they have not been paired with an effective tool to track these patients and store their records. [12][13][14][15] The Out Patient (OP) Care smartphone app was developed by ONE BCG Pty Ltd from physicians and health care providers for oncology clinics in LMICs to remind patients of their appointments, track the progress and treatment decisions of oncology patients, and store medical records. ...
... Text message appointment reminders have already improved patient follow-up in clinics in several LMICs including China, Malaysia, Brazil, and India. [12][13][14][15] However, this successful service has not yet been paired with the mobile patient-tracking and record-keeping tools provided by OP Care to improve treatment adherence and follow-up specifically in LMICs. Continued use of mobile apps to solve health care problems in LMIC is supported by the success of other apps worldwide. ...
Background The majority of new cancer cases are expected to be diagnosed in low- and middle-income countries (LMICs) by 2025, and 65% of cancer deaths currently occur in LMICs. Treatment adherence, patient monitoring, and follow-up are essential to cancer care but are often not possible in these settings. Out Patient (OP) Care, a smartphone application (app) developed to fill this gap, texts appointment reminders to patients and electronically stores medical records confidentially.
Objectives This study aims to present the development of this app and evaluate its usability and feasibility as defined by provider and patient experiences in the context of a multidisciplinary cancer clinic in Gaborone, Botswana.
Methods OP Care was piloted at a multidisciplinary team gynecologic oncology clinic in Gaborone, Botswana. The app was developed through an iterative process with feedback from clinic staff and physicians. The usability was evaluated using a cross-sectional survey. All staff members in the gynecologic oncology clinic, which typically consists of one doctor and four nurses, as well as a portion of the staff in the (Princess Marina Hospital general) oncology ward used the app. All providers using the app were surveyed, along with all patients who attended the gynecologic oncology clinic during the 3-week survey period. Staff demographics, reactions, and opinions on usability, as well as patients' reactions to the appointment reminders were collected. Agreement to the ease-of-usability statements was recorded on a 1 (not at all) to 7 (extremely so) scale. Primary outcomes were the app's usability and the feasibility of text reminders from the patient's perspective.
Results Nine staff and 15 patients were surveyed. Staff included three doctors and six nurses and encompassed all of the staff in the gynecologic oncology clinic as well as a portion of the general oncology ward. All surveyed staff owned a smartphone and used a computer at home. Most (78%) staff did not feel that OP Care would increase their work burden and were willing to use the app if implemented permanently (median: 6; interquartile range [IQR]: 1). Seventeen out of the nineteen usability questions, such as “I feel comfortable using this system,” scored a median of 6, corresponding to “very much so.” Patients reported that the reminder text messages were helpful (median: 6; IQR: 1) and preferred the text reminders to be in Setswana (median: 7; IQR: 1).
Conclusion High usability scores indicate that the app can be scaled up to usage in this clinic and others. Although patients appreciate OP Care, the option for call and text reminders in Setswana is indicated.
... The mobile phone short message service (SMS) has been successfully used in medical practice to improve clinic attendance in various specialties including ophthalmology, and also to improve compliance with treatment in glaucoma and pediatric cataract. [8][9][10][11][12][13] Reminder text messages have also been used with success in increasing the uptake of cancer screening services. [14,15] They have been found to be as effective as telephone reminders in improving clinic attendance rates. ...
... Several studies have also overwhelmingly demonstrated the effectiveness of SMS reminders in lowering clinic nonattendance rates. [8][9][10][11] A small number of studies, however, reported no significant change in the clinic nonattendance rate from an SMS intervention. [20][21][22][23] In a study among people living with HIV in Haiti, sending an SMS reminder had no significant impact on clinic attendance rates. ...
PURPOSE:
The purpose of this study was to determine the role of a reminder short message service (SMS) on the uptake of glaucoma screening by first-degree relatives (FDRs) of patients with primary open-angle glaucoma (POAG) in North-central Nigeria following a telephone invitation for screening.
MATERIALS AND METHODS:
A randomized controlled trial was conducted in the eye clinic of a tertiary hospital in Jos, North-central Nigeria. Two hundred FDRs of patients with POAG were invited through phone for free glaucoma screening and randomly allocated into two groups. The intervention group received a reminder SMS, whereas the control group did not receive a reminder. Those who failed to turn up for screening were contacted through phone to determine the reasons for their nonattendance. Chi-square test and bivariate analysis were used to compare attendance rate between the two groups.
RESULTS:
Sending a reminder SMS following a telephone invitation had no effect on the uptake of glaucoma screening. The response rate was lower in the phone call plus reminder SMS group (43.0% vs. 53.0%) though the difference was not statistically significant (P = 0.157). Competing needs such as work and lack of transport fare were the most common reasons given for not attending the screening.
CONCLUSION:
A reminder text message is not an effective tool for increasing the uptake of glaucoma screening in at-risk individuals in North-central Nigeria. Existing barriers to health care in the country need to be addressed before mobile phone technology can be effectively used in increasing the utilization of any free eye screening service.
... The mobile phone short message service (SMS) has been successfully used in medical practice to improve clinic attendance in various specialties including ophthalmology, and also to improve compliance with treatment in glaucoma and pediatric cataract. [8][9][10][11][12][13] Reminder text messages have also been used with success in increasing the uptake of cancer screening services. [14,15] They have been found to be as effective as telephone reminders in improving clinic attendance rates. ...
... Several studies have also overwhelmingly demonstrated the effectiveness of SMS reminders in lowering clinic nonattendance rates. [8][9][10][11] A small number of studies, however, reported no significant change in the clinic nonattendance rate from an SMS intervention. [20][21][22][23] In a study among people living with HIV in Haiti, sending an SMS reminder had no significant impact on clinic attendance rates. ...
Purpose:
The purpose of this study was to determine the role of a reminder short message service (SMS) on the uptake of glaucoma screening by first-degree relatives (FDRs) of patients with primary open-angle glaucoma (POAG) in North-central Nigeria following a telephone invitation for screening.
Materials and methods:
A randomized controlled trial was conducted in the eye clinic of a tertiary hospital in Jos, North-central Nigeria. Two hundred FDRs of patients with POAG were invited through phone for free glaucoma screening and randomly allocated into two groups. The intervention group received a reminder SMS, whereas the control group did not receive a reminder. Those who failed to turn up for screening were contacted through phone to determine the reasons for their nonattendance. Chi-square test and bivariate analysis were used to compare attendance rate between the two groups.
Results:
Sending a reminder SMS following a telephone invitation had no effect on the uptake of glaucoma screening. The response rate was lower in the phone call plus reminder SMS group (43.0% vs. 53.0%) though the difference was not statistically significant (P = 0.157). Competing needs such as work and lack of transport fare were the most common reasons given for not attending the screening.
Conclusion:
A reminder text message is not an effective tool for increasing the uptake of glaucoma screening in at-risk individuals in North-central Nigeria. Existing barriers to health care in the country need to be addressed before mobile phone technology can be effectively used in increasing the utilization of any free eye screening service.
... The study of appointment reminders has occurred in a variety of settings, including primary care (Steiner et al., 2016), dental care (Perry, 2011), and psychotherapy clinics (Delgadillo et al., 2015). Appointment attendance reminders were found to either increase the rate of appointment attendance, increase the rate of appointments cancelled ahead of time, or decrease the rate of missed appointments in 48 of the 56 studies (86%) (Altuwaijri et al., 2012;Arora et al., 2015;Berenson et al., 2016;Bourne et al., 2011;Brannan et al., 2011;Branson et al., 2013;Chen et al., 2008;da Costa et al., 2010;Deng et al., 2015;Downer et al., 2005;Fairhurst and Sheikh, 2008;Farmer et al., 2014;Foley and O'Neill, 2009;Geraghty et al., 2008;Hofstetter et al., 2015aHofstetter et al., , 2015b all(reminder*) AND all("cellular phone*" OR "cell phone*" OR "mobile phone*" OR "sms*" OR "short text message*" OR "text message*" OR "short message service*") Kerrison et al., 2015;Koshy et al., 2008;Leong et al., 2006;Liew et al., 2009;Lin et al., 2012;Liu et al., 2017;Lund et al., 2012;Lund et al., 2014;McInnes et al., 2014;Milne, 2010;Muller et al., 2017;Murray et al., 2015;Narring et al., 2013;Nundy et al., 2013aNundy et al., , 2013bNyatsanza et al., 2016;Odeny et al., 2012;Perry, 2011;Pijnenborg et al., 2007;Prasad and Anand, 2012;Pratap et al., 2015;Rohman et al., 2015;Sims et al., 2012;Sly et al., 2014;Steiner et al., 2016;Taylor et al., 2012;Thomas et al., 2017;Ting et al., 2012;Tolonen et al., 2014;Trent et al., 2015;Van Ryswyk et al., 2015;Vidal et al., 2014;Wolff et al., 2016;Yang et al., 2016). ...
... The reminders helped increase appointment attendance (e.g., Guy et al., 2013) and before-appointment cancellations (an unexpected outcome; e.g., Steiner et al., 2016), as well as decrease missed appointments (e.g., Altuwaijri et al., 2012). By decreasing missed appointments and increasing advance cancellations, health care providers can save time and money, maintain uninterrupted care, and allow other patients to receive needed treatment (da Costa et al., 2010;Farmer et al., 2014;Rohman et al., 2015;Ting et al., 2012). SMS reminders also helped increase the rate of medication adherence (e.g., Montes et al., 2012), non-medication treatment adherence (e.g., Balato et al., 2013), and vaccination completion (e.g., Stockwell et al., 2014). ...
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.
... Wearables -Wearable technologies can be defined as sensorial devices capable of capture physiological patient's signals, such as body temperature, heart rate, blood pressure, etc., integrated in regular clothes [16]. Vital signs monitoring system is proposed in [17]. ...
... The first aspect to analyze is security and privacy due to the sensitive patient`s data. However, most related works fails to approach this topic [15,16,17,20,22,23,24,25]. There are some works using Secure Socket Layer (SSL), Elliptic Curve Cryptography (ECDH), and Java Authentication and Authorization Service (JAAS) to encrypt data, which is a good start. ...
... The peer reviews of m-Health interventions show that the applications are effectively improving postnatal care services. However, there is little evidence on how they work to support client education, behaviour change communication, SMS, and voice reminders (da Costa et al., 2010). The study did not analyse what range was education covered to mothers in support of PNC, also which guide has been used to refer the PNC services to mothers; again, no clear mobile platform has been mentioned regarding the technology fit for low-and medium-income countries' usage (Feroz et al., 2017). ...
Postnatal care (PNC) refers to the care given to the mother and the newborn from the time of delivery until six weeks of age. Despite attempts, postnatal care (PNC) delivery still falls short of meeting mothers’ and newborns’ needs. With approximately 90% of mobile phone users coming from underdeveloped nations, there is more room for improved maternal and neonatal health interventions. With the aid of mobile technologies, this study attempts to boost PNC adoption. Studies showed that the case study area, Tanzania, had little evidence of PNC intervention frameworks and mobile applications. First, it was determined which factors affected how well health systems handled postpartum care (PNC). Data were gathered from health facilities at every level in Mbeya, Tanzania. Following the examination of descriptive statistics, postpartum women had lower levels of satisfaction with the advice given to them by healthcare professionals regarding clinical attendance (mean = 2.81). After giving birth, postpartum mothers who remained in the medical centre longer had an 85% lower likelihood of being happy with the health system. Higher educated postpartum women had less favourable sentiments about PNC delivery. The findings pointed to the necessity of raising PNC awareness in order to enhance both health worker performance and the well-being of a mother and her newborn. These findings were used to create a framework that also included PNC performance indicators from the WHO and services that might help the mother and the health worker. Using JavaScript’s React native technology and the SQLite database engine, the Afya Mama mobile application was created. This study is of considerable importance to communities in Tanzania as a whole as it improves the uptake of PNC
... For example, in a randomized clinical trial of adults in Kenya living with HIV, patients who received text messaging support had significantly improved antiretroviral adherence and viral load suppression (VLS) [8]. Similarly, text message appointment reminders increased attendance rates at HIV clinics in Brazil [9] and provided personalized affirming or intervention messages for HIV medical care among individuals who used substances [10]. Studies have also shown that two-way text messaging programs are more effective for behavior change than single "push" messages [11]. ...
This study evaluated engagement, satisfaction, and efficacy of an automated and live two-way text messaging intervention that linked youth and young adults at high risk for poor HIV outcomes to their medical case managers, with the aims of increasing viral load suppression rates and improving medical visit attendance. Participants (N = 100) were an average age of 22–23 years old. Most were Black (93%) and men who have sex with men (82%). A total of 89,681 automated text messages were sent to participants; and 62% of participants engaged in monthly text-message exchanges with medical case managers. McNemar’s test results indicated that a significantly greater proportion of intervention participants were virally suppressed at 6 and 12 month follow-up than at enrollment. Adjusted odds ratio results showed a significant association between likelihood of achieving viral suppression at 6 and 12 months, and a greater number of participant responses to automated text messages. Future research should prospectively compare outcomes between usual care case management and usual care plus text-messaging to test for significant differences between groups.
... Similar results were obtained for personal phone calls in adolescents [39]. Text messages have been observed to produce similar outcomes to telephone calls, at a lower cost, in both adults [10,18] and pediatric patients [29]. ...
The Chilean public health system serves 74% of the country’s population, and 19% of medical appointments are missed on average because of no-shows. The national goal is 15%, which coincides with the average no-show rate reported in the private healthcare system. Our case study, Doctor Luis Calvo Mackenna Hospital, is a public high-complexity pediatric hospital and teaching center in Santiago, Chile. Historically, it has had high no-show rates, up to 29% in certain medical specialties. Using machine learning algorithms to predict no-shows of pediatric patients in terms of demographic, social, and historical variables. To propose and evaluate metrics to assess these models, accounting for the cost-effective impact of possible intervention strategies to reduce no-shows. We analyze the relationship between a no-show and demographic, social, and historical variables, between 2015 and 2018, through the following traditional machine learning algorithms: Random Forest, Logistic Regression, Support Vector Machines, AdaBoost and algorithms to alleviate the problem of class imbalance, such as RUS Boost, Balanced Random Forest, Balanced Bagging and Easy Ensemble. These class imbalances arise from the relatively low number of no-shows to the total number of appointments. Instead of the default thresholds used by each method, we computed alternative ones via the minimization of a weighted average of type I and II errors based on cost-effectiveness criteria. 20.4% of the 395,963 appointments considered presented no-shows, with ophthalmology showing the highest rate among specialties at 29.1%. Patients in the most deprived socioeconomic group according to their insurance type and commune of residence and those in their second infancy had the highest no-show rate. The history of non-attendance is strongly related to future no-shows. An 8-week experimental design measured a decrease in no-shows of 10.3 percentage points when using our reminder strategy compared to a control group. Among the variables analyzed, those related to patients’ historical behavior, the reservation delay from the creation of the appointment, and variables that can be associated with the most disadvantaged socioeconomic group, are the most relevant to predict a no-show. Moreover, the introduction of new cost-effective metrics significantly impacts the validity of our prediction models. Using a prototype to call patients with the highest risk of no-shows resulted in a noticeable decrease in the overall no-show rate.
... 14 We need innovative and scalable solutions to enhance provision of information, counseling, and support to HPVtested women that will allow a more efficient use of human resources and time and improve women's autonomy in accessing patient-centered information. mHealth interventions can enhance the relationship between patients and health providers [15][16][17] ; in particular, the use of mobile applications (apps) to communicate with patients and provide support has been shown to improve health outcomes for different health conditions. [18][19][20] Apps can be used even after the consultation ended and require less staff. ...
Purpose:
This study describes the 10 steps followed to produce the information architecture of a user-centered design (UCD) counseling mobile application, the first phase to develop an app. The app aims to reduce the psychosocial impact of the human papillomavirus test result and improve women's knowledge of human papilloma virus and cervical cancer.
Methods:
We used a UCD approach to produce the information architecture of the app (ie, how to organize contents into features). We analyzed field notes, meeting agendas, and documentation produced during each stage of the design process. We described the goals, methods, and outcomes of each step. We also discussed the critical challenges and the strategies to address them.
Results:
The steps are (1) knowledge, attitudes, and beliefs mapping: reanalysis of team's research findings from prior studies; (2) environmental scanning of apps available on the market; (3) stakeholders' point of view: The International Advisory Committee; (4) potential user's profile: building archetypes through the Persona method; (5) women's interviews: user's preferences and experiences; (6) effective features: scoping review to select app's features that address psychosocial impact; (7) the user journey: ideal interaction with the gynecological service and the counseling app; (8) women's focus groups: using Personas and Scenarios to discuss app's mock-up; (9) women's design sessions: prototype test and card-sorting techniques; and (10) team's design session: translating results into visual objects and features.
Conclusion:
We provide here detailed descriptions of the UCD process of an app for human papillomavirus-tested women for those venturing into the area of mHealth strategies work. Our experience can be used as a guide for future mHealth app development for a low- and middle-income setting.
... In addition, landline telephones are recognized in disuse, limiting their ability for recruitment. Limited research has examined mobile phonebased platforms for survey recruitment, especially in Brazil [2]. It remains unclear whether the method can recruit a representative sample of older adults [3,4]. ...
Background
Limited research has examined mobile phone-based platforms for survey recruitment, especially during the COVID-19 pandemic in Brazil. Our objective was to investigate the feasibility and representativeness of mobile phone-based advertisement during a preliminary study about COVID-19 vaccine hesitation in Brazil. Moreover, we evaluate whether the older population can be reached through mobile phone-based platforms of the survey.
Methods
We conducted a study in December 2021 based on a preliminary survey about the COVID-19 vaccine hesitation in Assis, Brazil, Sao Paulo state. From a list of the adult population hesitant about the second dose of the COVID-19 vaccine, we sent a mobile phone-based advertisement inviting the participants to answer the survey for one week. The respondent's data were collected in a Google form platform. The comparison between the target population and the respondents was made using the Chi-squared test and the Welch's test, using a P-value of 0.05 as significative.
Results
The response rate was 9.99% after one week. The mean age of the respondent group was 33.97 (SD 14.99) and 35.05 (SD 14.19) of the population, with a P-value of 0.192 and a Cohen's d coefficient of 0.0754, corresponding to a small effect size between groups. We demonstrate that the mobile phone-based survey is a feasible and representative strategy during the pandemics in Brazil.
Moreover, the older population respondent was representative.
Conclusion
We achieved a representative sample of respondents using the mobile phone-based survey in Brazil. Furthermore, it was representative of all sociodemographic and health characteristics assessed. Finally, these findings suggest that the method is a highly feasible and economical means of recruiting for survey research.
... Limited research has examined mobile phone-based platforms for survey recruitment, especially in Brazil. (2) Besides, it remains unclear whether the method can recruit a representative sample of older adults (3,4). Therefore, we aimed to investigate whether mobile phone-based text messages can be a feasible, timely, economical, and with minimal human resource commitment means of recruiting a representative sample of adults for a health research survey based on the hesitance for the COVID-19 vaccine in Brazil. ...
Background
Limited research has examined mobile phone-based platforms for survey recruitment, especially during the COVID-19 pandemic in Brazil. Our objective was to investigate the feasibility and representativeness of mobile phone-based advertisement during a preliminary study about COVID-19 vaccine hesitation in Brazil. Moreover, we evaluate whether the older population can be reached through mobile phone-based platforms of the survey.
Methods
We conducted a study in December 2021 based on a preliminary survey about the COVID-19 vaccine hesitation in Assis, Brazil, Sao Paulo state. From a list of the adult population hesitant for the second dose of the COVID-19 vaccine, we sent a mobile phone-based advertisement inviting the participants to answer the survey for one week. The respondent’s data were collected in a Google form platform. The comparison between the target population and the respondents was made using the Chi-squared test and the Welch’s test, using a P-value of .05 as significative.
Results
The response rate was 9.99% after one week. The mean age of the respondent group was 33.97 (SD 14.99) and 35.05 (SD 14.19) of the population, with a P-value of .192 and a Cohen’s d coefficient of 0.0754, corresponding to a small effect size between groups. We demonstrate that the mobile phone-based survey is a feasible and representative strategy during the pandemics in Brazil. Moreover, the older population respondent was representative.
Conclusion
We achieved a representative sample of respondents using the mobile phone-based survey in Brazil. Furthermore, it was representative in all sociodemographic and health characteristics assessed. Finally, these findings suggest the method is a highly feasible and economical means of recruiting for survey research.
... Smartphones can run sophisticated applications to record and analyze data and deliver educational messages to patients. Even in a pre-smartphone environment, simple text-based reminders delivered by mobile phones improved attendance at outpatient appointments and adherence to intervention plans [13][14][15][16][17]. By coupling the now near-ubiquitous smartphones with off the shelf smartwatch technologies, we can offer a sophisticated yet highly available alternative to existing, failing approaches to long-term maintenance. ...
Distance learning in response to the COVID-19 pandemic presented tremendous challenges for many families. Parents were expected to support children’s learning, often while also working from home. Students with Attention Deficit Hyperactivity Disorder (ADHD) are at particularly high risk for setbacks due to difficulties with organization and increased risk of not participating in scheduled online learning. This paper explores how smartwatch technology, including timing notifications, can support children with ADHD during distance learning due to COVID-19. We implemented a 6-week pilot study of a Digital Health Intervention (DHI) with ten families. The DHI included a smartwatch and a smartphone. Google calendars were synchronized across devices to guide children through daily schedules. After the sixth week, we conducted parent interviews to understand the use of smartwatches and the impact on children’s functioning, and we collected physiological data directly from the smartwatch. Our results demonstrated that children successfully adopted the use of the smartwatch, and parents believed the intervention was helpful, especially in supporting the development of organizational skills in their children. Overall, we illustrate how even simple DHIs, such as using smartwatches to promote daily organization and task completion, have the potential to support children and families, particularly during periods of distance learning. We include practical suggestions to help professionals teach children with ADHD to use smartwatches to improve organization and task completion, especially as it applies to supporting remote instruction.
... 22 This finding is also consistent to a study conducted in Brazil in which non-attendance was lower among patients who were sent SMS reminders to attend medical clinics. 23 mhealth (STM and VC) intervention was found to have improved uptake of RGM during the entire study period. mHealth interventions in health care has been reported previously by various researchers given the relatively emerging field of research and wide interest in mHealth interventions to improve uptake of services in Low-and Middle-Income Countries (LMIC). ...
This study aimed at finding out the effects of mobile health ( mhealth) technologies on uptake of Routine Growth Monitoring (RGM) among caregivers of children aged above 9 months in Kenya. This was a quasi-experimental study. The experiment groups received Short Text Message (STM) and Voice Call (VC). The analysis demonstrates that in month 1, caregivers who received STM were 6.875 times more likely to take their children for RGM compared to control (OR = 6.875; 95 CI: 3.591-13.164); caregivers who received VC were 6.750 times more likely to take their children for RGM compared to those in control arm (OR = 6.750; 95 CI: 3.522-12.938). Policy makers and implementers in the health will find these study findings useful in deciding whether or not to adopt STM or VC in improving uptake of RGM for children above 9 months.
... Its mission is to create a link between the sensors, smart phones and the health care team. A clear and gainful answer is given by Costa et al. [16] to assist for medical checks in the form of alarm or reminder. An auto-generated text message will deliver to the patient's phone. ...
... Por ejemplo, en el seguimiento a distancia de heridas para pacientes con poco acceso a atención médica, asistencia en el control del asma en adolecentes, recordatorios de citas médicas o estimación de los niveles de hemoglobina con la cámara del teléfono móvil, gran parte de ellos con buenos resultados. [15][16][17][18] Frente a eso, durante el año 2018, la OMS publicó una clasificación numérica para las tecnologías digitales y móviles, basada en su usuario primario objetivo. 19 La aplicación presentada en ese estudio es categorizada como 2.3, al ser de apoyo en las decisiones del proveedor de salud. ...
Resumen
Objetivo Evaluar la concordancia diagnóstica durante la evaluación inicial de pacientes con dolor de hombro entre: (1) Traumatólogos especialistas en hombro realizando una evaluación convencional y (2) un médico general utilizando una nueva aplicación móvil.
Materiales y Método Se diseñó una aplicación móvil para asistir a médicos generales a realizar una evaluación del dolor de hombro entregando una hipótesis diagnóstica. Se diseñó un estudio de concordancia diagnóstica. Se evaluó un grupo de 60 pacientes, quienes consultaron por primera vez con un especialista en hombro. Primero, todos fueron evaluados por un médico general utilizando la aplicación. Se registró la hipótesis diagnóstica entregada por la aplicación. Luego, el especialista realizó una evaluación con anamnesis y examen físico, registrando su hipótesis diagnóstica. Se realizó una prueba Kappa para determinar la concordancia entre ambos evaluadores.
Resultados La concordancia global entre los especialistas y la aplicación móvil utilizada por el médico general fue sustancial (k = 0,74; p < 0,001). La concordancia fue casi perfecta para el Pinzamiento subacromial, dolor cervical, lesión acromioclavicular, inestabilidad de hombro, y el pinzamiento interno.
Conclusión La concordancia diagnóstica durante la evaluación inicial de pacientes con dolor de hombro entre traumatólogos especialistas y un médico general utilizando una aplicación móvil fue sustancial.
Nivel de Evidencia Tipo III.
... West (2013) has rendered some support for this view and indicate that facilities from the mobile phone devices are important in the provision of affordable medical services that may otherwise be unavailable to geographically distanced poor population in many African countries. In particular, mobile phones facilitate access to reference material, assessment of medical records and efficiency in laboratory tests, better-tailored feedback because of enhanced self-monitoring and improved observation and treatment of patients with tuberculosis, reminding those affected by HIV and AIDS to take their medicines on schedule and more efficient management of clinical appointments (Bauer et al. 2010;Hoffman et al. 2010;Da Costa et al. 2010;Aker and Mbiti 2010). According to Kliner et al. (2013), rural communities are those that benefit most from the development externalities of healthtailored mobile phone applications. ...
This paper examines the joint effects of mobile phone technology, knowledge creation and diffusion on inclusive human development in 49 sub-Saharan African (SSA) countries. The empirical evidence is based on Tobit regressions for the period 2000–2012. The net effects of interactions between the mobile phone, knowledge creation and diffusion variables are positive indicating that the combined effects of these variables improve inclusive human development in SSA countries. Further analysis dividing the dataset into a number of fundamental characteristics based on economic, legal, religion and political stability associated with African economies show that mobile phone penetration and associated innovation in SSA improve inclusive human development irrespective of the country’s level of income, legal origins, religious orientation and the state of the nation. The pupil-teacher ratio exerts a negative influence on the outcome variable which is favourable for inclusive human development because higher ratios denote lower education quality since more pupils are accommodated by fewer teachers. The study contributes to innovation diffusion theory and economic development literature.
... For over 10 years, mobile phone technology has been used in the management of chronic disease with applications such as appointment reminders and short message service (SMS) prompts to take medication (78,79). Within asthma alone, webbased programmes have also been used to facilitate decisionmaking via self-help algorithms. ...
In order for inhaled corticosteroids to be delivered adequately to the airways they require patients to take them regularly using an effective technique. Patients often have a poor inhaler technique, and this has been shown to result in sub-optimal asthma control. It is important for all clinicians prescribing inhaled medication to be experienced in the correct technique, and take time to train children so that they have mastered corrected inhaler technique. Using Teach to Goal or teach back methodology is a simple and effective way to provide this in the clinic setting. More than one training session is typically needed before children can master correct inhaler technique. Adherence to inhaled therapy has been shown to be sub-optimal in pediatric populations, with studies showing an average rate of around 50%. Subjective methods of measuring adherence have been shown to be inaccurate and overestimate rates. The advent of new technology has allowed adherence rates to be measured electronically, and it has been shown that regular feedback of these data can be effective at improving asthma control. New mobile apps and smart technology aim to engage patients and families with their asthma care. Effective use of these apps in collaboration with health care professionals has a vast potential to improve adherence rates and inhaler technique, resulting in improved asthma control.
... Other studies show that missed appointments have a financial and operational cost, especially in health systems with strained capacity (Moore et al., 2001). A study in Sao Paulo, Brazil found that non-attendance rates were lower among patients who received SMS appointment reminders (Da Costa et al., 2010). As such, the idea of having an appointment reminder will enhance increased access to maternal and child health care by the women population in Kenya as demonstrated by these previous studies. ...
Kenya has an estimated maternal mortality ratio of 530 deaths per 100,000 live births, slightly lower than the average of 640 for sub-Saharan Africa. Each year, an estimated 7,900 Kenyan women die during or after pregnancy. More than half of births occur at home, primarily because of distance from and lack of means of transport to health facilities, as well as concerns about cost and beliefs that health facility deliveries are unnecessary. In 2011, 30 maternal and 440 neonatal deaths were recorded at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). Previous studies show that mobile health (mhealth) solutions are promising to enhance maternal and child health (MCH) outcomes, especially when integrated with mobile financial services for social protection and other measures. Moreover, studies have also shown that end user involvement whilst considering local settings, social and economic contexts could lead to successful implementation of mobile health projects. Ordinarily, the goal is to identify the current barriers and challenges to tailor the initiative to best serve the population’s needs given the local conditions. As such, the general objective of the current study was to evaluate health seeking behaviour, mobile communication perspectives and user perception on mobile health
technology for maternal and child health (MCH) services at the JOOTRH. The study investigated MCH client’s health-seeking behaviour, their use of mobile phones to seek for health and MCH staff use of mobile phones in healthcare providence. This study adopted a cross-sectional survey using purposive sampling to select the study participants. A total of 26 in-depth interviews corroborated by 13 focus group discussions were conducted with a sample of 130 clients. Furthermore, 6 key informant interviews were also conducted with MCH clinic staff members to assess use of mobile phones to provide health services, bringing the total number of respondents to 136. Primary data was collected from both the MCH clients and staff using open-ended semistructured interviews. Content analysis was used for the qualitative data to descriptively
summarize, code and thematically capture health-seeking behaviour for the clients and mobile health perceptions of both staff and clients. Findings suggest that clients health-seeking behaviour was influenced most by socioeconomic factors, especially, cost and education levels. Furthermore, women’s autonomy to make decisions to seek for health was low since the decision was dependent on those around them (spouse and household members). The mobile communication behavior and mhealth perspectives of MCH service users at the JOOTRH, Kisumu County, Kenya were narrowed down to making consultations and use of mobile money transfer services, although, they were confident on the potential of mhealth to leverage MCH services at the facility. The mobile communication behaviour and mhealth perspectives of MCH staff at the JOOTRH, Kisumu County, Kenya consisted of general communication and consultations away from the facility, with a continuum of care through patient follow up, although no clear formal guidelines had been formulated at the facility. The MCH clients and staff were very supportive of the idea of using mhealth to improve MCH service provision at the
facility and beyond. As such, these factors should be considered by policy makers when
designing future mhealth interventions as they may prove vital in bridging the gap towards better maternal and child healthcare utilization especially in facilities in low resource setting like Kisumu County. These should be supplemented with clear outlines of regulatory frameworks and regular monitoring and evaluation to measure effectiveness of such projects by implementers.
... Currently, patient reminder can be in the form of posted letters, telephone calls or electronic text messaging. All of them showed improvement in attendance rate in different clinical settings and populations (13)(14)(15)(16). Text messaging was found to be the most cost-effective method (17). ...
Background: Non-attendance of various non-physician-led multidisciplinary (NPLM) services causes wastage of health care resources. This study determined whether using mobile phone text message reminders by Short Message Service (SMS) in patients with type II diabetes attending a primary care clinic resulted in higher attendance rates of NPLM services when compared with those without SMS reminders.
Method: A single centre randomized-controlled trial included adult subjects with type II diabetes who could read Chinese or English, possessed an SMS-capable phone and booked at least NPLM service appointments in study site. The main outcomes were comparing attendance rates between the control group and the intervention group of various NPLM services including nurse complication screening, nurse individual counselling, multidisciplinary group education, dietitian counselling, physiotherapist service, retinopathy screening by optometrist and blood taking sessions
Results: 297 eligible subjects were approached, 15 were excluded and 11 refused to participate. 271 subjects were recruited (response rate 96%). Their mean (± standard deviation) age was 63.3±11.3. Their mean duration of DM was 6.9±5.3 years with mean HbA1c 7.37±1.32%. They were randomly assigned to intervention (N=135) or control (N=136) group. The Intervention groups received a standard SMS reminder included appointment name, date and time 24-72 hours prior to the scheduled appointment. The Control groups received no reminder. 733 appointments (intervention N=372, control N=361) were analysed. More subjects used smartphone (82.2%) than mobile phone without internet access (17.8%). All SMS were successfully delivered for the 372 appointments with no adverse event reported. The overall attendance rates were 92.7% in the intervention group and 83.1% in the control group (Odds ratio, OR 2.60, 95% confidence interval, CI 1.61-4.19, p<0.001). In subgroup analysis, SMS reminders were particularly useful in reminding nurse clinic (OR 3.06, 95% CI 1.22-7.66, p=0.017) and optometrist clinic (OR 2.73, 95% CI 1.07-7.01, p=0.037).
Conclusion: SMS reminder is a reliable method to increase overall attendance rates and health service utilization of NPLM DM services in outpatient setting.
... The growing field of mobile health in low-income regions has seen an increasing number of projects targeting patients, such as those with HIV and TB. Various studies have been conducted in this area and those studies depict how the use of mobile phones to healthcare services can be helpful to the patients in their treatments [7] [8]. ...
... Mechanisms by which health services are being improved entail access to medical record, laboratory test and reference material. It is in this respect that mobile applications are growingly being adapted for, inter alia: clinical appointments (Da Costa et al., 2010); enhanced observation and treatment of patients with tuberculosis (Hoffman et al., 2010) and better tailored feedbacks by means of enhanced self-monitoring (Bauer et al., 2010). The position that rural communities have been the greatest beneficiaries of health-related mobile applications by Kliner et al. (2013) has been confirmed by Kirui et al. (2013) within the spectrum of absolute pro-poor externalities from mobile phone/banking: 'We conclude that mobile phone-based money transfer services in rural areas help to resolve a market failure that farmers face; access to financial services' (p. ...
We assess the correlations between mobile banking and inclusive development (poverty and inequality) in 93 developing countries for the year 2011. Mobile banking entails: ‘mobile phones used to pay bills’ and ‘mobile phones used to receive/send money’, while the modifying policy indicator is the human development index (HDI). The data is decomposed into seven sub-panels based on two fundamental characteristics, namely: regions (Latin America, Asia and Pacific, Central and Eastern Europe, and Middle East and North Africa) and income levels (upper middle income, lower middle income and low income). Our results show that at certain thresholds of the HDI, mobile banking is positively linked to inclusive development. The following specific findings are established. First, the increased use of mobile phones to pay bills is negatively correlated with: (i) poverty in lower-middle-income countries (LMIC), upper-middle-income countries (UMIC) and Latin American countries (LA), respectively at HDI thresholds of 0.725, 0.727 and 0.778 and; (ii) inequality in UMIC and LA with HDI thresholds of respectively 0.646 and 0.761. Second, the increased use of mobile phones to send/receive money is negatively correlated with: (i) poverty in LMIC, UMIC and Central and Eastern European countries (CEE) with corresponding HDI thresholds of 0.631, 0.750 and 0.750 and (ii) inequality in UMIC, CEE and LA at HDI thresholds of 0.665, 0.736 and 0.726 respectively. The findings are discussed in the light of current policy challenges in the transition from Millennium Development Goals to Sustainable Development Goals. We have exploited the only macroeconomic data on mobile banking currently available.
... Some examples of absenteeism studies in Latin America also estimated variable rates: 11% in Costa Rica, 26 17% in Mexico, three studies from Argentina with nonattendance of 14% in Rosario, 27 22.7% in HIBA, 28 30% in the Mandirola study, 29 25.57% in Sao Paulo Brazil, 30 and between 8% and 20% in Chile's public system stratified by specialty and region. 31 These nonattendance rates present similar variability and heterogeneity between specialities, settings, and populations studied in concordance with other geographic areas estimations. ...
Objective
We aimed to estimate nonattendance to scheduled medical ambulatory appointments rates globally and by subgroups.
Design and participants
We designed a retrospective cohort of all adult outpatients over 18 years old who requested at least one scheduled ambulatory medical appointment from 1 January 2015 to 31 December 2016.
Setting
Hospital Italiano de Buenos Aires is a university general hospital in the Autonomous City of Buenos Aires, Argentina. It includes an integrated health care network that is formed by two high complexity hospitals and 22 primary care centers.
Results
The age median was 60.4 years, and 31.33% of the appointments were scheduled by men; 2 526 549 appointments fulfilled selection criteria, belonging to 348 420 patients. The global nonattendance rate was 27.84% (95% CI, 27.79‐27.9). The nonattendance rate to general practitioner appointments was 25.53% (95% CI, 25.42‐25.63); to clinical specialties, 27.78% (95% CI, 27.68‐27.87); and to surgical specialties, 29.31% (95% CI, 29.23‐29.4).
Conclusions
Because of the consistent variability of nonattendance in different settings, it is strongly recommended that local estimates are used in the design of effective interventions to improve adherence with outpatient healthcare scheduled appointments.
... In accordance with other studies, we found that sending appointment reminders as text messages to patients' cell phones was an effective strategy to reduce nonattendance rates, showing that forgetfulness is an important reason of not showing up in chronic disease care. 29 The success of the intervention is likely related to the improvement in the healthcare infrastructure, organizational changes required to implement the intervention, and its adoption by healthcare professionals at the affected PCCs. The results were positive to improve detection and referral by CHWs to primary care clinics of people with moderate to high CVD risk. ...
Background
Control of cardiovascular disease (CVD) risk factors is suboptimal in Argentina, despite the government's provision of free blood pressure and cholesterol‐lowering medications for people without private insurance. We assessed whether community health workers’ use of an integrated mHealth tool encourages patients to attend visits at primary care clinics to improve CVD risk management in 2 provinces of Argentina.
Methods and Results
We conducted a pragmatic cluster randomized trial, with primary care clinics randomly assigned to intervention or control. Eligible people were aged 40 to 79 years, lived in the catchment area of primary care clinics, possessed a mobile phone for personal use, had public health coverage, and a 10‐year CVD risk ≥10%. In the control arm, community health workers screened for CVD risk using a paper‐based tool and encouraged high‐risk people to present to the primary care clinics for care. In the intervention arm, community health workers used the mHealth tool to calculate CVD risk and confirm a scheduled physician appointment. Primary outcomes were the proportion of participants who attended a baseline visit and completed at least 1 follow‐up, respectively. We enrolled 755 people (376 interventions; 379 controls). Intervention participants were significantly more likely to complete baseline visits (49.4% versus 13.5%, P value 0.0008) and follow‐up visits (31.9% versus 7.7%; P value 0.0041). The use of chronic medication and current smoking were significant predictors of primary outcomes.
Conclusions
Use of mHealth tools identifies patients at high CVD risk in their home, increases the likelihood of participating in chronic CVD risk factor management, and strengthens referrals.
Clinical Trial Registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02913339.
... Como forma de otimizar a avaliação, a auto-matização de inquéritos alimentares na forma de questionários digitais está se mostrando como uma ferramenta promissora frente aos métodos tradicionais 10 . Fatores como o acesso agilizado, disponibilidade em tempo integral, rapidez no processamento, baixo custo e retorno facilitado, fazem com que instrumentos digitais tornem-se práticos para utilização em hospitais, clínicas e ambulatórios, principalmente se acessados por meio de dispositivos móveis 11 . Assim, considerando a alimentação um dos fatores que englobam o controle e a prevenção do DM, este estudo teve como objetivo avaliar os marcadores do consumo alimentar de pacientes diabéticos por meio de um aplicativo móvel. ...
Resumo Este trabalho objetiva avaliar os marcadores do consumo alimentar de pacientes diabéticos por meio de um aplicativo móvel. Estudo transversal, realizado com 100 adultos e idosos portadores de Diabetes Mellitus tipo 2, internados em um hospital do interior do estado do Rio Grande do Sul. Para a coleta de dados utilizou-se o aplicativo móvel Diabetes FoodControl. Na associação da adequação dos marcadores do consumo com as variáveis investigadas, utilizou-se o teste do qui-quadrado ao nível 5% de significância. Identificou-se alto percentual de indivíduos com excesso de peso e adiposidade abdominal, além de inadequado controle glicêmico. A frequência de consumo alimentar adequado foi mais prevalente para os grupos alimentares: frituras (82%), leite ou iogurte (71%), frutas frescas (70%), feijão e bebidas açucaradas (68%, cada), biscoitos doces e guloseimas (57%) e salada crua (56%). A adequação do consumo de marcadores não saudáveis foi mais frequente em diabéticos com renda inferior a quatro salários mínimos e entre os que não tinham hipertensão arterial sistêmica associada, respectivamente. A frequência de consumo dos marcadores pode ser considerada adequada em sua maioria, entretanto faz-se necessário acompanhamento nutricional, a fim de corrigir as alterações do estado nutricional e do controle glicêmico.
... For over a decade, mobile phones have been used as a tool for improving management of chronic illnesses including widespread health interventions of smoking cessation for respiratory diseases. Short message services (SMS) have been implemented for providing appointment reminders [1], improving medication adherence [2], and supporting asthma management [3]. Similarly, web-based eHealth interventions show improvement in chronic disease control [4] and patient empowerment [5]. ...
Adolescent asthma is still a major problem with poor adherence to treatment. Globally, adolescents are devoted users of smartphone technologies and app use in asthma self-management may improve adherence. The objective of this systematic review is to assess the feasibility and efficacy of mobile technology in improving asthma outcomes in adolescents. We conducted an extensive review of the peer-review literature of studies with populations consisting of children and adolescents under 18 years in seven bibliographic databases and Google Scholar. All study designs were considered. Quality assessment of included studies were independently assessed and reported. The search identified 291 articles; of the 16 eligible full-text papers, 8 met the review criteria, reporting two interventional, two qualitative and four observational studies. Samples ranged from 12 to 21 participants. Heterogeneity related to study design and the methods of the included studies prevented meta-analysis. Nevertheless, the intervention studies reported a positive effect of smartphone apps on asthma control, medication adherence and self-efficacy. Smartphone apps may be an effective asthma control tool especially among adolescents who are major users of smartphones; however, conclusions are limited by a lack of controlled trials and adequate sample sizes.
... Las aplicaciones prácticas de estos en la vida cotidiana incluyen: servicios de mensajería, recordatorio de citas (34) , monitorización de condiciones médicas crónicas (35) y el mejoramiento de la satisfacción con el tratamiento y el apoyo psicológico (36) . Además han demostrado su amplia aplicación para mejorar el diagnóstico, la eficiencia y como soporte para los programas de salud pública (37) . ...
Objetivo: Revisar las herramientas utilizadas en las investigaciones de e-salud en cuidados paliativos durante los últimos cinco años Método: se realizó una revisión bibliográfica en las bases de datos PubMed, Scopus y Bireme sobre el tema de cuidados paliativos, e-salud y costos en los últimos cinco años. Resultados: El uso de las tecnologías de la información es favorable para usuarios que reciben cuidados paliativos, ya que facilita su seguimiento y el manejo de sus síntomas, además de mejorar la comunicación entre profesionales y pacientes, disminuyendo en algunos casos los desplazamientos geográficos y reduciendo los costos asociados a la atención de estos pacientes. Conclusión: la e-salud implementada a través de diferentes herramientas de intervención ha demostrado ser valiosa para los pacientes con enfermedad avanzada en cuidados paliativos, ofreciendo potenciales beneficios educativos y de optimización de recursos y tiempo para pacientes, cuidadores, que les permite mejorar su contacto con profesionales de la salud.
... Channels through which health services are improved include: access to laboratory test, medical record and reference material. It is in this light that mobile applications are increasingly being adapted for: better tailored feedbacks owing to improved self-monitoring ( Bauer et al. 2010); enhanced treatment and observations of patients with tuberculosis (Hoffman et al. 2010) and clinical appointments (Da Costa et al. 2010). Communities in rural areas have been documented to be among the greatest beneficiaries of health-oriented mobile applications (Kliner et al. 2013), a position that is in line with the conclusions of Kirui et al. (2013) on the absolute pro-poor features of mobile phones/banking in these communities: 'We conclude that mobile phone-based money transfer services in rural areas help to resolve a market failure that farmers face; access to financial services' (141). ...
This study assesses human development thresholds at which mobile banking mitigates poverty and inequality in 93 developing countries for the year 2011. Mobile banking entails ‘mobile used to pay bills’ and ‘mobile used to receive/send money’, while the modifying policy indicator is the human development index (HDI). The empirical evidence is based on interactive quantile regressions. A summary of the findings shows that with increasing human development: (i) ‘mobiles used to pay bills’ contribute to reducing inequality in countries at the bottom and top ends of the inequality distribution, while (ii) ‘mobiles used to receive/send money’ have an appealing role in promoting inclusive development in all poverty distributions, with the exception of the top-end or 90th decile. The modifying thresholds of the HDI vary from 0.542 to 0.632 and 0.333 to 0.705 in inequality and poverty specifications, respectively. The relevance of the findings is discussed in light of the current transition from Millennium Development Goals to Sustainable Development Goals.
... Channels through which health services are improved include: access to laboratory test, medical record and reference material. It is in this light that mobile applications are increasingly being adapted for: better tailored feedbacks owing to improved self-monitoring ( Bauer et al. 2010); enhanced treatment and observations of patients with tuberculosis (Hoffman et al. 2010) and clinical appointments (Da Costa et al. 2010). Communities in rural areas have been documented to be among the greatest beneficiaries of health-oriented mobile applications (Kliner et al. 2013), a position that is in line with the conclusions of Kirui et al. (2013) on the absolute pro-poor features of mobile phones/banking in these communities: 'We conclude that mobile phone-based money transfer services in rural areas help to resolve a market failure that farmers face; access to financial services' (141). ...
This study assesses human development thresholds at which mobile banking mitigates poverty and inequality in 93 developing countries for the year 2011. Mobile banking entails: 'mobile used to pay bills' and 'mobile used to receive/send money', while the modifying policy indicator is the human development index (HDI). The empirical evidence is based on interactive quantile regressions. A summary of the findings shows that with increasing human development: (i) 'mobiles used to pay bills' contribute to reducing inequality in countries at the bottom and top ends of the inequality distribution, while (ii) 'mobiles used to receive/send money' have an appealing role in promoting inclusive development in all poverty distributions, with the exception of the top-end or 90 th decile. The modifying thresholds of the HDI vary from 0.542 to 0.632 and 0.333 to 0.705 in inequality and poverty specifications, respectively. The relevance of the findings is discussed in light of the current transition from Millennium Development Goals to Sustainable Development Goals.
... To be able to put this into practice, the new technologies can help us by following up on chronic pathologies, acute pathologies and by educating users as shown in a meta analysis [18]. They can also be used as reminders of visits / tests / treatments / clinical practice guidelines [19], for the electronic generation of medical prescriptions, to transmit the results of tests, and to remotely monitor patients [20], amongst other things. Informed consent is necessary to be able to send results to our patients. ...
The aim is to discover the effectiveness of starting up a communications centre for mass or personalised sending of mails or SMS with normal results of complementary tests in a Primary Healthcare Service. This is a pre-experimental before-and-after test of a single group. The study includes any person over 14 years of age with an open computerised medical record and doctor assigned, in any of the 21 primary healthcare units that have e-consent for sending normal results of complementary tests. The impact of the intervention on general practitioner appointments was monitored. A logistic regression model was made and it was observed that the probability of sending health data was 3.33 times higher in young women than in elderly CI 95% (3.13–3.54) and 2.50 times higher among users of low comorbidity CI 95% (2.39–2.62), and that these differences were statistically significant (p < 0.001). The number of face-to-face appointments fell by 3.31% amounting to a total of 18,708 appointments between the two periods of study. The establishment of a system for sending normal analysis results is directly proportional to the decrease in the number of face-to-face appointments on the schedules of the health professionals.
Objective: Missed patient appointments have a substantial negative impact on patient care, child health and well-being, and clinic functioning. This study aims to identify health system interface and child/family demographic characteristics as potential predictors of appointment attendance in a pediatric outpatient neuropsychology clinic. Method: Pediatric patients (N = 6,976 across 13,362 scheduled appointments) who attended versus missed scheduled appointments at a large, urban assessment clinic were compared on a broad array of factors extracted from the medical record, and the cumulative impact of significant risk factors was examined. Results: In the final multivariate logistic regression model, health system interface factors that significantly predicted more missed appointments included a higher percentage of previous missed appointments within the broader medical center, missing pre-visit intake paperwork, assessment/testing appointment type, and visit timing relative to the COVID-19 pandemic (i.e. more missed appointments prior to the pandemic). Demographic characteristics that significantly predicted more missed appointments in the final model included Medicaid (medical assistance) insurance and greater neighborhood disadvantage per the Area Deprivation Index (ADI). Waitlist length, referral source, season, format (telehealth vs. in-person), need for interpreter, language, and age were not predictive of appointment attendance. Taken together, 7.75% of patients with zero risk factors missed their appointment, while 22.30% of patients with five risk factors missed their appointment. Conclusions: Pediatric neuropsychology clinics have a unique array of factors that impact successful attendance, and identification of these factors can help inform policies, clinic procedures, and strategies to decrease barriers, and thus increase appointment attendance, in similar settings.
Objetivo: Analisar a associação entre o absenteísmo e o acesso às consultas especializadas dos diabéticos, no Sistema Único de Saúde (SUS) no Espírito Santo (ES).
Métodos: Estudo transversal realizado por meio de dados primários e secundários com 472 diabéticos ≥ 18 anos agendados em consulta com endocrinologista no Sistema de Centrais de Regulação do ES. As variáveis das dimensões do acesso - disponibilidade, viabilidade financeira e aceitabilidade – foram utilizadas para estimar a associação com o absenteísmo. Utilizou-se regressão logística para as análises bruta e ajustada.
Resultados: Encontrada associação do absenteísmo de diabéticos com as variáveis residir a menos de 10 km do prestador da consulta (OR: 1,81; IC95%: 1,16 – 2,82, p = 0,01), necessitar de transporte (OR: 4,89; IC95%: 2,54 – 9,42, p < 0,001) e ter gastos financeiros para comparecer à consulta (OR: 2,06; IC95%: 1,23 – 3,44; p = 0,01).
Conclusão: As principais barreiras de acesso aos serviços de saúde que contribuem para a alta prevalência de absenteísmo a consulta com endocrinologista podem ser entendidas como proxy da condição socioeconômica dos diabéticos e evidenciam estreita relação com os determinantes sociais de saúde.
Importance:
Electronic appointment reminder systems are increasingly used across health systems. However, their association with patients' waiting times for their appointments, a measure of timely access to care, has yet to be assessed.
Objective:
To assess the associations between the introduction of an electronic appointment reminder system and the number of days patients had to wait from appointment booking to appointment completion in patients in the Veterans Affairs Health System.
Design, setting, and participants:
Cohort study of patients who completed appointments from January 1, 2018, to October 13, 2018, inclusive in all 130 Veterans Affairs (VA) health centers in the US. The study population comprised a census of all patients who received care at any VA health center during the period of the study for outpatient, procedural, rehabilitation, or radiology services. Data were analyzed from May 15, 2021, to December 15, 2021.
Exposures:
Phased introduction of an electronic appointment reminder system (VEText) in 6 waves spread across the study period.
Main outcomes and measures:
The unit of observation in this study was a completed appointment made by any such patients. Observations were excluded if the appointment was booked before but completed after the exposure, or if data were duplicated, missing, or incomplete. For each completed appointment, the number of days between which the appointment was booked and when it was completed.
Results:
The number of observations after exclusion comprised 39.5 million completed appointments from 5.1 million patients (91.1% male) with a mean (SD) age of 62.57 (16.24) years. The adoption of VEText was associated with an estimated reduction in patient waiting time by a mean of 6.51 days (95% CI, 5.51-7.52 days). Adoption of VEText was also associated with an increase of 8.54 (95% CI, 7.65-9.44) days of additional waiting per incomplete booking.
Conclusions and relevance:
Results of this study suggest that appointment reminder systems may be associated with decreases in the mean number of days patients in the VA system have to wait for their appointments but can potentially lengthen waiting times for patients who miss their bookings. Further study is warranted to assess whether these findings may be generalizable to other populations.
The advances in eHealth have dramatically changed the face of healthcare delivery around the world, with Sub-Saharan Africa being no exception. It is essential to identify the prominent, emerging researchers, successful areas of research within the field of Health Informatics (H.I.) and Telemedicine (T.M.) to be duplicated where there is a need. This study gives a bibliometric overview of original research articles on medical informatics and telemedicine indexed in Scopus, PubMed, and Science Direct over the last 20 years in sub-Saharan Africa. Keywords related to health informatics and Telemedicine were used to retrieve relevant literature. We specifically analyzed the evolution, standard metrics, domains of MI and T.M. in sub-Saharan Africa (S.S.A.) and Brazil, Russia, India, China, and South Africa (BRIC) nations. Our results identified mhealth as the main field of research in telemedicine that has seen significant growth in both BRIC and S.S.A nations and is poised to be the focus of research activity in the near future. Research production in mhealth and telemedicine showed a considerable increase from 1999–2018. The production was dominated by articles from South Africa in Africa and China from the BRIC nations. Most prolific authors have resources and are leaders of health informatics projects. The production came from 26 sub-Saharan African countries, denoting this field's devotion in different areas around sub-Sahara. Research in mhealth needs to be encouraged, mostly in the fight against infectious and non-infectious diseases in sub-Saharan Africa, where technology can improve health services and decrease disease burden.
Resumo A existência de barreiras nos serviços de demanda agendada resulta no elevado índice de absenteísmo. O objetivo deste manuscrito é apresentar as principais características do Sistema de Agendamento Online da estratégia e-SUS APS no Brasil. O Sistema de Agendamento Online desenvolvido pelo Laboratório Bridge da Universidade Federal de Santa Catarina, o qual também desenvolve o sistema de Prontuário Eletrônico do Cidadão (PEC e-SUS APS), e permite o agendamento de consultas através do aplicativo Conecte SUS Cidadão. O PEC e-SUS APS possui, entre outros, o módulo de agenda do profissional onde são realizadas as marcações e cancelamentos de consultas, permitindo a visualização de seus horários e disponibilidades. Embora o uso de sistemas de agendamento online seja capaz de fornecer benefícios, infelizmente eles têm sido pouco explorados na APS. Os principais motivos estão relacionados com a falta de informação e capacitação dos profissionais sobre o sistema e os impactos nos serviços prestados pelos estabelecimentos de saúde da APS. A fim de garantir a maior adoção e utilização do Sistema de Agendamento Online, é necessário ampliar a divulgação do sistema de modo a instituí-lo na rotina dos serviços como um instrumento facilitador do acesso à APS.
Studies have linked the large percentage of maternal and neonatal mortality that occur in postnatal period to low uptake of postnatal care (PNC) services. Mobile health (mHealth) intervention through message reminders has resulted in significant increase in antenatal care utilisation in previous studies. However, its use in PNC services' uptake has not been adequately investigated in Nigeria. This study aimed to evaluate the effect of a mobile health intervention on PNC attendance among mothers in selected primary healthcare facilities in Osun State, Nigeria. A quasi-experimental research design was utilised. Participants were allocated to Intervention Group and Control Group. One hundred and ninety pregnant mothers were recruited in each group. A mobile health intervention software was developed and used to send educational and reminder messages to mothers in the intervention group from the 35th week of pregnancy to six weeks after delivery. Uptake of PNC services was assessed at birth, 3 days, 10 days and 42 days after delivery. Data were analysed using descriptive statistics, chi-square and logistic regression models. About one-third (30.9%) of respondents in the intervention group had four postnatal care visits while only 3.7% in the control group had four visits (p < 0.001). After controlling for the effect of confounding variables, group membership remained a significant predictor of PNC uptake. (AOR: 10.869, 95% CI: 4.479-26.374). Mobile health intervention significantly improved utilisation of the recommended four postnatal care visits.
This paper examines the joint effects of mobile phone technology, knowledge creation and diffusion on inclusive human development in 49 sub-Saharan African (SSA) countries. The empirical evidence is based on Tobit regressions for the period 2000-2012. The net effects of interactions between the mobile phone, knowledge creation and diffusion variables are positive indicating that the combined effects of these variables improve inclusive human development in SSA countries. Further analysis dividing the dataset into a number of fundamental characteristics based on economic, legal, religion and political stability associated with African economies show that mobile phone penetration and associated innovation in SSA improve inclusive human development irrespective of the country's level of income, legal origins, religious orientation and the state of the nation. The pupil-teacher ratio exerts a negative influence on the outcome variable which is favourable for inclusive human development because higher ratios denote lower education quality since more pupils are accommodated by fewer teachers. The study contributes to innovation diffusion theory and economic development literature.
Communication-based interventions have been linked to improved health and social outcomes among underserved populations. Migrant women in sex work face serious health and social inequities, including risks of HIV and other sexually transmitted infections (STIs) and violence. Given gaps in evidence about health communication among migrant sex workers and the potential for communication-based interventions to promote health and safety, this qualitative study investigates experiences with accessing and sharing information regarding HIV/STI prevention, sexual and reproductive health, and physical safety among migrant sex workers at the Mexico-Guatemala border. Findings suggest that participatory peer-based, workplace, and m-health communication interventions could facilitate access to HIV/STI prevention, and to sexual and reproductive health/safety resources for migrant women involved in sex work, while strengthening peer support networks and social cohesion. To have long-lasting results, such interventions must be complemented by broader structural changes, including sex work and migration law reforms, increased community mobilization, and improved working conditions.
Purpose
The purpose of this paper is to respond to some challenges in the transition to sustainable development goals by examining the correlations between mobile and inclusive development (quality of growth, poverty and inequality) in 93 developing countries for the year 2011.
Design/methodology/approach
Mobile money service entails: “mobile used to pay bills” and “mobile used to receive/send money.” Interactive ordinary least squares are employed.
Findings
The following findings are established. First, increasing use of the mobile phones to pay bills is positively linked to “quality of growth” in lower-middle-income countries and negatively correlated with inequality in Latin American countries. Second, growing use of mobile phones to send/receive money is negatively associated with poverty in Asia and Pacific and Central and Eastern Europe.
Originality/value
Macroeconomic data on mobile money service are scarce. No study to the best of our knowledge has used this macroeconomic mobile money service data before.
Brazil's comprehensive HIV treatment program does not specifically address ART adherence challenges for adolescents-a group accounting for the largest number of incident HIV infections in Brazil. We conducted three focus groups with 24 adolescents (age 15-24) living with HIV in Rio de Janeiro, separately for cisgender men who have sex with men, heterosexual-identified cisgender men and women, and transgender women of any sexual orientation, and key informant interviews (n = 7) with infectious disease specialists and HIV/AIDS service organization staff. Content analysis identified socioecological barriers and facilitators to adherence, including individual (e.g., low knowledge, side effects, and substance use), interpersonal (e.g., stigma from partners and health care providers) and structural (e.g., transportation and medication access) barriers. Overlapping and unique barriers emerged by sexual/gender identity. A community-informed, theory-driven ART adherence intervention for adolescents that is organized around identity and leverages social networks has the potential to improve HIV treatment and health outcomes for Brazilian adolescents.
Objectives:
Compliance with recommended follow-up from the pediatric emergency department (PED) has been shown to be poor. This study evaluated whether a text message reminder to the caregivers after discharge from the PED improved compliance with recommended primary care follow-up.
Methods:
This was a blinded randomized control trial conducted at a level 1 pediatric trauma center. The intervention was a text message sent to the caregiver within 24 hours of discharge from the PED reminding them to follow up with their primary care doctor. Patients were eligible if the caregiver had text message capability on their cellular phones, they were currently established patients of the organization's Pediatric Faculty Practice, they were discharged home from the PED, and they were referred for follow-up within 1 week of discharge by the pediatric emergency physician. After informed consent, pediatric patients were randomized to either an intervention group (text message appointment reminder) or a control group (standard scheduling with no reminder). The patient, treating physician, and primary care outpatient center were blinded to the group assignment. Enrollment occurred 24 hours per day and 7 days per week.
Results:
There were 123 patients enrolled in the study, 62 patients randomized to the control group (standard scheduling) and 61 randomized to the intervention group (text message appointment reminder). Of the patients, 58% were male and 42% were female, with the average age of the patients being 2.2 years (SD, 2.8). The majority of patients were seen in the PED on a weekday, with 24% presenting on a weekend. Only 28% of patients completed the recommended follow-up, and the average time from PED discharge to follow-up was 6 days (SD, 4.2; range, 0-17 days). There was no significant difference in follow-up in the standard treatment group (19/62, 31%) versus the text message intervention group (16/61, 26%) (P = 0.69; rate ratio, 0.94; 95% confidence interval, 0.75-1.18). When we assessed other variables, we found that parents of younger children were more likely to follow up as recommended by the pediatric ED physician. Of those who were compliant with follow-up, we found a mean age of 1.3 years (SD, 2.0; range, 0.8-9.1) versus 2.6 years (SD, 3.0; range, 0.08-15.3) for those who were not compliant with follow-up (P = 0.02).
Conclusions:
In this randomized controlled study, a text message reminder to caregivers did not improve compliance for PED patients. However, caregivers of younger children were more likely to complete follow-up as recommended by the PED physician compared with caregivers of older children.
Background
The median age of single homeless adults is approximately 50 years. Older homeless adults have poor social support and experience a high prevalence of chronic disease, depression, and substance use disorders. Access to mobile phones and the internet could help lower the barriers to social support, social services, and medical care; however, little is known about access to and use of these by older homeless adults.
Objective
This study aimed to describe the access to and use of mobile phones, computers, and internet among a cohort of 350 homeless adults over the age of 50 years.
Methods
We recruited 350 participants who were homeless and older than 50 years in Oakland, California. We interviewed participants at 6-month intervals about their health status, residential history, social support, substance use, depressive symptomology, and activities of daily living (ADLs) using validated tools. We performed clinical assessments of cognitive function. During the 6-month follow-up interview, study staff administered questions about internet and mobile technology use. We assessed participants’ comfort with and use of multiple functions associated with these technologies.
Results
Of the 343 participants alive at the 6-month follow-up, 87.5% (300/343) completed the mobile phone and internet questionnaire. The median age of participants was 57.5 years (interquartile range 54-61). Of these, 74.7% (224/300) were male, and 81.0% (243/300) were black. Approximately one-fourth (24.3%, 73/300) of the participants had cognitive impairment and slightly over one-third (33.6%, 100/300) had impairments in executive function. Most (72.3%, 217/300) participants currently owned or had access to a mobile phone. Of those, most had feature phones, rather than smartphones (89, 32.1%), and did not hold annual contracts (261, 94.2%). Just over half (164, 55%) had ever accessed the internet. Participants used phones and internet to communicate with medical personnel (179, 64.6%), search for housing and employment (85, 30.7%), and to contact their families (228, 82.3%). Those who regained housing were significantly more likely to have mobile phone access (adjusted odds ratio [AOR] 3.81, 95% CI 1.77-8.21). Those with ADL (AOR 0.53, 95% CI 0.31-0.92) and executive function impairment (AOR 0.49; 95% CI 0.28-0.86) were significantly less likely to have mobile phones. Moderate to high risk amphetamine use was associated with reduced access to mobile phones (AOR 0.27, 95% CI 0.10-0.72).
Conclusions
Older homeless adults could benefit from portable internet and phone access. However, participants had a lower prevalence of smartphone and internet access than adults aged over 65 years in the general public or low-income adults. Participants faced barriers to mobile phone and internet use, including financial barriers and functional and cognitive impairments. Expanding access to these basic technologies could result in improved outcomes.
Background
Non-attendance to clinic appointments is associated with poorer treatment outcomes. There is a dearth of information about missed first clinic appointments among patients with schizophrenia in Nigeria.
Aims
To determine the prevalence, correlates and reasons for missed first appointment among out-patients with schizophrenia at the Federal Neuro-Psychiatric Hospital, Benin City, Nigeria.
Method
A cross-sectional descriptive study among 275 out-patients with schizophrenia, using the Mini International Neuro-Psychiatric Interview and the Brief Psychiatric Rating Scale.
Results
The prevalence of missed first appointment was 31%. Higher BPRS score was associated with missing the appointment. The main reasons for missed appointments were: forgetting the appointment date and patient's refusal to come to the clinic.
Conclusions
Missed first out-patient clinic appointment is common among patients with schizophrenia at the study site, forgetting appointment dates being a common reason. Among other recommendations, methods of reminding patients and caregivers of appointment dates at the study location may need to be explored.
Declaration of interest
None.
Patients miss about 20% of scheduled appointments for mental health treatment, almost twice the rate in other medical specialties. Up to 50% of patients who miss appointments drop out of scheduled care. Many who miss appointments because of slips and lapses later rearrange their appointments without adverse consequences. Those that do not are at risk of further deterioration, relapse and hospital readmission. Predictors of non-attendance are complex and linked with the predictors of missed medication. Service barriers and administrative errors are common but are often overlooked in the absence of feedback from patients. Of prime importance are the therapeutic alliance and degree of 'helpfulness' of the clinician but again these are rarely measured routinely. Useful markers of engagement include patient-rated trust, satisfaction and degree of perceived participation in treatment decisions. Much can be done to improve attendance in most services. Simple measures such as offering prompt, convenient appointments, offering reminders and augmenting with telephone contact have a reasonable evidence base. Scales to assess therapeutic alliance are now available. Complex interventions need to be evaluated carefully in order that the overall benefits outweigh costs. We suggest that clinicians consider accessibility, discharge policies and patient feedback when examining local rates of non-attendance.
Outpatient non-attendance is a common source of inefficiency in a health service, wasting time and resources and potentially lengthening waiting lists.
A prospective audit of plastic surgery outpatient clinics was conducted during the six months from January to June 1997, to determine the clinical and demographic profile of non-attenders. Of 6095 appointments 16% were not kept. Using the demographic information, we changed our follow-up guidelines to reflect risk factors for multiple non-attendances, and a self-referral clinic was introduced to replace routine follow-up for high risk non-attenders. After these changes, a second audit in the same six months of 1998 revealed a non-attendance rate of 11%—i.e. 30% lower than before.
Many follow-up appointments are sent inappropriately to patients who do not want further attention. This study, indicating how risk factor analysis can identify a group of patients who are unlikely to attend again after one missed appointment, may be a useful model for the reduction of outpatient non-attendance in other specialties.
Patients who schedule clinic appointments and fail to keep them have a negative impact on the workflow of a clinic in many ways. This study was conducted to identify the reasons patients in an urban family practice setting give for not keeping scheduled appointments.
Semistructured interviews were conducted with 34 adult patients coming to the clinic for outpatient care. Interviews were audiotaped and transcribed verbatim. A multidisciplinary team used an immersion-crystallization organizing style to analyze the content of the qualitative interviews individually and in team meetings.
Participants identified 3 types of issues related to missing appointments without notifying the clinic staff: emotions, perceived disrespect, and not understanding the scheduling system. Although they discussed logistical issues of appointment keeping, participants did not identify these issues as key reasons for nonattendance. Appointment making among these participants was driven by immediate symptoms and a desire for self-care. At the same time, many of these participants experienced anticipatory fear and anxiety about both procedures and bad news. Participants did not feel obligated to keep a scheduled appointment in part because they felt disrespected by the health care system. The effect of this feeling was compounded by participants' lack of understanding of the scheduling system.
The results of this study suggest that reducing no-show rates among patients who sometimes attend might be addressed by reviewing waiting times and participants' perspectives of personal respect.
Objective:
To evaluate the effect of appointment reminders sent as short message service (SMS) text messages to patients' mobile telephones on attendance at outpatient clinics.
Design:
Cohort study with historical control.
Setting:
Royal Children's Hospital, Melbourne, Victoria.
Patients:
Patients who gave a mobile telephone contact number and were scheduled to attend any of five outpatient clinics (dermatology, gastroenterology, general medicine, paediatric dentistry and plastic surgery) in September (trial group) or August (control group), 2004.
Main outcome measures:
Failure to attend (FTA) rate compared between the group sent a reminder and those who were not.
Results:
2151 patients were scheduled to attend a clinic in September; 1382 of these (64.2%) gave a mobile telephone contact number and were sent an SMS reminder (trial group). Corresponding numbers in the control group were 2276 scheduled to attend and 1482 (65.1%) who gave a mobile telephone number. The FTA rate for individual clinics was 12%-16% for the trial group, and 19%-39% for the control group. Overall FTA rate was significantly lower in the trial group than in the control group (14.2% v 23.4%; P < 0.001).
Conclusions:
The observed reduction in failure to attend rate was in line with that found using traditional reminder methods. The ease with which large numbers of messages can be customised and sent by SMS text messaging, along with its availability and comparatively low cost, suggest it may be a suitable means of improving patient attendance.
This study examined whether patients discharged from inpatient psychiatric care would have lower rehospitalization rates if they kept an outpatient follow-up appointment after discharge.
Complete data were collected in 1998 on 3,113 psychiatric admissions in eight Southeastern states; 542 were readmissions. Patients' health care was managed by United Behavioral Health of Georgia (UBH-GA), which encouraged inpatient facilities to ensure that an outpatient appointment was scheduled for all discharged patients. UBH-GA contacted outpatient providers to determine whether patients kept at least one appointment. Rehospitalization rates were calculated for 90, 180, 270, and 365 days after discharge to examine effects over time of keeping an initial appointment.
Of the 542 patients who were rehospitalized, 136 kept at least one outpatient appointment after discharge from their initial admission; 406 did not. For patients who did not keep an appointment, rehospitalization rates increased over time, ranging from 15 percent to 29 percent. For patients who kept an outpatient appointment, the rehospitalization rate remained the same over time, about 10 percent. The 270- and 365-day rehospitalization rates and the aggregated annual rates were significantly higher (p>.01) for patients who did not keep an appointment.
Patients who did not have an outpatient appointment after discharge were two times more likely to be rehospitalized in the same year than patients who kept at least one outpatient appointment. Aggregated annual rates indicated that patients who kept appointments had a one in ten chance of being rehospitalized, whereas those who did not had a one in four chance.
Non-attendance in general practice has received increasing attention over the past few years. Its relationship with access to health care has been recognized and is of particular relevance in light of the access targets set out in the NHS Plan.
The literature was searched for articles relating to non-attendance. Titles and abstracts were examined, and relevant articles obtained. Bibliographies were examined for further references. Articles that described interventions for reducing non-attendance that were comparative studies and that examined general appointments, as opposed to appointments for screening purposes for example, were of particular interest.
The epidemiology of non-attendance has been well described, but there is little work on the reasons for non-attendance. Evidence for effective interventions to improve attendance in primary care is lacking, and this may prove to be an area of research interest in the future. As well as specific interventions to reduce non-attendance, new approaches to health care access are required in order to tackle this issue.
The purpose of this study was to investigate the effect of a nurse short message service by cellular phone and the Internet on glycosylated hemoglobin (HbA1c) levels and adherence to diabetes control recommendations. The patients with diabetes were asked to input their blood glucose levels every day by cellular phone or the Internet. Optimal recommendations were sent weekly to each patient by short message service. After 12 weeks, the patients had a mean decrease of 1.1% in HbA1c level and an increase in diabetic medication taking, 30 minutes of physical exercise, and foot care adherence.
To evaluate the operational and financial efficacy of sending short message service (SMS) text message reminders to the mobile telephones of patients with scheduled outpatient clinic appointments.
Cohort study with historical control.
Royal Children's Hospital, Melbourne, Victoria.
Patients who gave a mobile telephone contact number and were scheduled to attend an outpatient clinic at the Royal Children's Hospital, Melbourne in October, November and December 2004 (trial group) or in October, November and December 2003 (historical control group).
Failure-to-attend (FTA) rate compared between the trial group, whose members were sent a reminder, and the historical control group, whose members were not sent a reminder. Financial benefits versus cost of sending reminders.
22,658 patients with a mobile telephone contact number scheduled to attend an outpatient clinic appointment in October, November and December 2004 were sent an SMS reminder; 20,448 (90.2%) of these patients attended their appointment. The control group included 22,452 patients with a mobile telephone contact number scheduled to attend an appointment, with 18,073 (80.5%) patients attending. The FTA rate was significantly lower in the trial group than in the historical control group (9.8% v 19.5%; P < 0.001). The cost of sending the SMS reminders was small compared with the increase in patient revenue and associated benefits generated as a result of improved attendance.
The observed reduction in FTA rate was in line with that found using traditional reminder methods and a prior pilot study using SMS. The FTA reduction coupled with the increase in patient revenue suggests that reminding patients using SMS is a very cost effective approach for improving patient attendance.
Non-attendance at out-patient clinics is a seemingly intractable problem, estimated to cost 65 pounds sterling (97 euros) per incident. This results in under-utilisation of resources and prolonged waiting lists. In an effort to reduce out-patient clinic non-attendance, our ENT department, in conjunction with the information and communication technology department, instigated the use of a mobile telephone short message service ('text') reminder, to be sent out to each patient three days prior to their out-patient clinic appointment.
To audit non-attendance rates at ENT out-patient clinics following the introduction of a text reminder system.
Retrospective review.
Non-attendance at our institution's ENT out-patient clinics was audited, following introduction of a text message reminder system in August 2003. Rates of non-attendance were compared for the text message reminder group and a historical control group.
Before the introduction of the text message reminder system, the mean rate of non-attendance was 33.6 per cent. Following the introduction of the system, the mean rate of non-attendance reduced to 22 per cent.
Sending text message reminders is a simple and cost-effective way to improve non-attendance at ENT out-patient clinics.
To determine whether proactive telephone support improves adherence to antiretroviral therapy (ART) and clinical outcomes when compared to standard care.
A multisite, randomized controlled trial (RCT) was conducted with 109 ART-naive subjects coenrolled in AIDS Clinical Trials Group (ACTG) 384. Subjects received standard clinic-based patient education (SC) or SC plus structured proactive telephone calls. The customized calls were conducted from a central site over 16 weeks by trained registered nurses. Outcome measures (collected over 64 weeks) included an ACTG adherence questionnaire and 384 study endpoints.
For the primary endpoint, self-reported adherence, a significantly better overall treatment effect was observed in the telephone group (P = 0.023). In a post hoc analysis, composite adherence scores, taken as the first 2 factor scores from a principal components analysis, also found significant intervention benefit (P = 0.023 and 0.019 respectively). For the 384 primary study endpoint, time to regimen failure, the Kaplan-Meier survival curve for the telephone group remained above the SC group at weeks 20 to 64; a Cox proportional hazard model that controlled for baseline RNA stratification, CD4, gender, age, race/ethnicity, and randomized ART treatment arm suggested the telephone group tended to have a lower risk for failure (hazard ratio = 0.68; 95% confidence interval: 0.38 to 1.23).
Findings indicate that customized, proactive telephone calls have good potential to improve long-term adherence behavior and clinical outcomes.
Why don't patients attend their appointments? Maintaining engagement with psychiatric services Patient mobile telephone "text" reminder: a novel way to reduce non-attendance at the ENT out-patient clinic
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A.J. Mitchell, T. Selmes, Why don't patients attend their appointments? Maintaining engagement with psychiatric services, Adv. Psychiatr. Treat. 13 (2007) 423–434. [2] M. Geraghty, F. Glynn, M. Amin, J. Kinsella, Patient mobile telephone "text" reminder: a novel way to reduce non-attendance at the ENT out-patient clinic, J. Laryngol. Otol. 122 (2008) 296–298.
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Brasil já tem 127,74 mi de celulares ativos
- Reuters
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D. Sigulem, O.L. Cardoso, S.S.F.X. Gimenez, A. Cebukin, M.S.
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Métodos quantitativos em medicina
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- N R S Ortega
E. Massad, R.X. Menezes, P.S.P. Silveira, N.R.S. Ortega,
Métodos quantitativos em medicina, Manole, São Paulo,
2004.
Clinic Manager system
- Sigulem