Reminder systems to improve patient adherence to tuberculosis clinic appointments for diagnosis and treatment

Abstract

BackgroundPeople with active tuberculosis (TB) require six months of treatment. Some people find it difficult to complete treatment, and there are several approaches to help ensure completion. One such system relies on reminders, where the health system prompts patients to attend for appointments on time, or re-engages people who have missed or defaulted on a scheduled appointment.ObjectivesTo assess the effects of reminder systems on improving attendance at TB diagnosis, prophylaxis, and treatment clinic appointments, and their effects on TB treatment outcomes.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register, Cochrane Effective Practice andOrganization of Care Group Specialized Register, CENTRAL,MEDLINE, EMBASE, LILACS, CINAHL, SCI-EXPANDED, SSCI, m RCT, and the Indian Journal of Tuberculosis without language restriction up to 29 August 2014. We also checked reference lists and contacted researchers working in the field.Selection criteriaRandomized controlled trials (RCTs), including cluster RCTs and quasi-RCTs, and controlled before-and-after studies comparing reminder systems with no reminders or an alternative reminder system for people with scheduled appointments for TB diagnosis, prophylaxis, or treatment.Data collection and analysisTwo review authors independently extracted data and assessed the risk of bias in the included trials. We compared the effects of interventions by using risk ratios (RR) and presented RRs with 95% confidence intervals (CIs). Also we assessed the quality of evidence using the GRADE approach.Main resultsNine trials, including 4654 participants, met our inclusion criteria. Five trials evaluated appointment reminders for people on treatment for active TB, two for people on prophylaxis for latent TB, and four for people undergoing TB screening using skin tests.We classified the interventions into 'pre-appointment' reminders (telephone calls or letters prior to a scheduled appointment) or'default' reminders (telephone calls, letters, or home visits to people who had missed an appointment).For people being treated for active TB, clinic attendance and TB treatment completion were higher in people receiving pre-appointment reminder phone-calls (clinic attendance: 66% versus 50%; RR 1.32, 95% CI 1.10 to 1.59, one trial (USA), 615 participants, low quality evidence; TB treatment completion: 100% versus 88%; RR 1.14, 95% CI 1.02 to 1.27, one trial (Thailand), 92 participants, low quality evidence). Clinic attendance and TB treatment completion were also higher with default reminders (letters or home visits) (clinic attendance: 52% versus 10%; RR 5.04, 95% CI 1.61 to 15.78, one trial (India), 52 participants, low quality evidence; treatment completion: RR 1.17, 95% CI 1.11 to 1.24, two trials (Iraq and India), 680 participants, moderate quality evidence).For people on TB prophylaxis, clinic attendance was higher with a policy of pre-appointment phone-calls (63% versus 48%; RR 1.30, 95% CI 1.07 to 1.59, one trial (USA), 536 participants); and attendance at ...

Text messaging research participants as a follow-up strategy to decrease emergency department study attrition

“…12 These ED-specific findings are consistent with previous studies demonstrating improved follow-up adherence in other health care settings when text messaging was used. 6 This study is not without limitations. The main limitation of this study is that it is a nested cohort analysis within a small RCT conducted at a single academic centre.…”

“…3 This method of communication has been effective in the health care setting to provide appointment reminders, facilitate self-management of chronic illnesses, and encourage medication adherence. [4][5][6] Several reviews of the literature have illustrated wide application and potential for mobile phones to increase access to health care; enhance the efficiency of service delivery; improve diagnosis, treatment, and rehabilitation; and support public health. [4][5][6] Despite the widespread application of text messaging to facilitate health care delivery, there is a paucity in the literature supporting the use of text messaging to facilitate clinical research, specifically to assist in research participant follow-up.…”

“…[4][5][6] Several reviews of the literature have illustrated wide application and potential for mobile phones to increase access to health care; enhance the efficiency of service delivery; improve diagnosis, treatment, and rehabilitation; and support public health. [4][5][6] Despite the widespread application of text messaging to facilitate health care delivery, there is a paucity in the literature supporting the use of text messaging to facilitate clinical research, specifically to assist in research participant follow-up. 7 Incomplete or missing outcome data from patients lost to follow-up or patients who withdraw from study participation present a major threat to the internal and external validity of a clinical trial.…”

Impact of mobile message reminders on tuberculosis treatment outcomes in Pakistan

“…One potential intervention would be to combine SMS reminders with off-site support as the Lester et al (2010) trial did for HIV patients in Kenya. SMS reminders could also be used to remind patients of clinic appointments, as various forms of reminders (telephone calls, home visits, letters) for clinic appointments have been found to be beneficial in studies with TB patients (Liu et al 2014). …”

Transdisciplinary working to shape systematic reviews and interpret the findings: commentary

“…The proposed solution of 'directly observed therapy' (DOT), a practice that involves healthcare practitioners observing patients taking their treatment, is not well supported by systematic review evidence regarding distinct approaches to implementation of directly observed therapy [9], including incentives and enablers [10], or reminders [11]. Whilst these reviews, drawing on randomised controlled trials, provided some useful inputs to specific technical recommendations being made by the World Health Organization at the time, in broader policy terms they offer disappointing findings to national policy makers frustrated by the "real world" where: conflicts disrupting health systems; practitioners favouring patients they considered most deprived and therefore most deserving; and patients finding the timing of the treatment and incentive (a midday meal) inconvenient [10].…”