Introdução à Medicina’s Annual Assignment 2006/2007

1. Introdução à Medicina’s Annual Assignment 2006/2007 Impact of appointment reminders via Short Message Service in a Secondary Hospital

2. Objective This study aims to measure the changes in outpatient’s attendance and non-attendance rates according to the sending or not of an appointment reminder via Short Message Service in a Secondary Hospital.

3. Introduction • Problem:failure to attend outpatients appointments. [Hashim, 2001] • Reasons for non-attendance: • Forgetfulness (which is the most important for our work) ; • Long distance from home to health services and trip cost; • Inconvenient time of appointment (incompatible with work schedule). [McClure, 1996]

4. Consequences of non-attendance: • Missed opportunities for diagnosis and treatment; • Reduced opportunities for hospital revenue; • Extended time patients have to wait for an appointment booking. [Downer, 2005] Emerging technology of Short Message Service is starting to be used to remind patients about their appointments...

5. Portugal:this method is starting to be used in some hospitals such as Santa Maria and the one of our study S. Sebastião. [http://www.telecom.pt/InternetResource/PTSite/PT/DestaquesHP/smsconsultas.htm] • Advantages of this method: • it is cheap; • it is computorized; no need for many human resources; • easy to apply.

6. Pictures taken in S. Sebastião Hospital to show the hardware used to send the text messages.

7. Conclusions of previous studies conducted in Portugal related to Hospital S. Sebastião • improving patients attendance, reflected by: • general reduction in the no-attendance rate of 14% in general appointments; • most extreme case of Paediatrics with a reduction of 50%; • recovering of about 900 appointments per month; • account for nearly 15.000 euros per month. • (information given by administrative services of Hospital S. Sebastião)

8. Participants and Methods • Study design:Experimental study – Intervention Study • Population:All patients of S. Sebastião Hospital, who have cellular phone number registered at the system. • Sample’s selection:The sample consists of the set of the Hospital’s patients who have appointments in the days we are performing the study.

9. Flowchart: Selection of Participants

10. Methods: • Selection of the days for the study (5 working days) • Messages sent from 8th to 15th March for the appointments on days 12th to 19th March. • The hospital sends appointment reminders randomly and alternately to the participants of the sample. • The messages are sent two working days before the appointment. • Finally the results of those who attended the appointment and those who did not, in both groups, reminded and non-reminded are collected.

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

12. 2. We are studying if the attendance rate varies according to some of the following variables: • Gender • Age Groups • Date of the appointment (Day of the week) • Hour of the appointment (Morning, Afternoon) • Number of messages previously sent • Episode (Outpatients visits, Sessions, Exams, Analysis, • Hospitalizations)

13. Chi-square test for each of the variables mentioned before and contingency tables. • That will allow us to conclude if there is any relationship between the sending of text messages as appointment reminders and the patients’ attendance.

14. Flowchart: description of methods

15. Results General table NOTE:The missing data are the results we haven’t yet received due to the fact that we had to present this work on the 21st March, thus they collected the data before some appointments had happened so we don’t have the attendances rates of those appointments.

16. Difference of the non-attendance rate after reminder: 14,5 – 11,9 = 2,6%

17. Episode: Outpatients visits

18. Episode: Exams

19. Episode: Analysis

20. Comparison of data collected

21. Comparison of data collected (cont.)

22. Comparison of data collected (cont.) *We chose to mention only one of the authors. **We rated this item with “positive” or “negative”. We consider a positive outcome when the sending of reminders improved the attendance; a negative outcome means that with this procedure we notice a lower attendance rate or no change between attendance in reminded group or not-reminded.

23. References (in order of appearance) • Hashim MJ, Franks P, Fiscella K. Effectiveness of Telephone Reminders in Improving Rate of Appointments Kept at an Outpatient Clinic: A Randomized Controlled Trial. J Am Board Fam Pract. 2001 May-Jun;14(3):193-6. • McClure RJ, Newell SJ, Edwards S. Patient characteristics affecting attendance at general outpatient clinics. Abstract. 1996 Feb;74(2):121-5. • Downer SR, Meara JG, Da Costa AC. Use of SMS text messaging to improve outpatient attendance. Med J Aust. 2005 Oct 3;183(7): Haynes 366-8.

24. Hardy KJ, O'Brian SV, Furlong NJ. Information given to patients before appointments and its effect on non-attendance rate. Abstract. 2001 Dec 1;323(7324):1298-300. • Haynes JM, Sweeney EL. The Effect of Telephone Appointment-Reminder Calls on Outpatient Absenteeism in a Pulmonary Function Laboratory. Respir Care. 2006 Jan;51(1):36-9. • Neal RD, Hussain-Gambles M, Allgar VL, Lawlor DA, Dempsey O. Reasons for and consequences of missed appointments in general practice in the UK: questionnaire survey and prospective review of medical records. Abstract. 2005 Nov 7;6:47.

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