November, 2016 - SUPPORT Summary of a systematic review | print this article |

Does the use of mobile phone messaging reminders increase attendance at healthcare appointments?

Failure to attend healthcare appointments impacts on patient health and health system costs. Sending patients appointment reminders using mobile phone text messages (Short Message Service (SMS) and Multimedia Message Service (MMS)) could improve attendance compared to no reminders, or other types of reminders, such as postal or phone call reminders.

The broad penetration of mobile phones in several low-income countries makes this intervention particularly promising.

Key messages

  • Mobile phone text message reminders compared with no reminders probably lead to an increase in attendance at healthcare appointments
  • Mobile phone text message reminders probably lead to little or no difference in attendance at healthcare appointments compared to phone call reminders. However, the cost per text message per attendance may be lower compared to the cost of mobile phone call reminders
  • Mobile phone text message reminders plus postal reminders may lead to improved attendance at healthcare appointments compared to postal reminders alone

 

Background

Different communication methods can be used to remind patients about healthcare appointments, including face-to-face reminders, postal messages, calls to landlines, calls to mobile phones, messages via web-based electronic health records, emails and mobile phone text messages (SMS/MMS).

Mobile phones have penetrated rapidly in many low-income countries, and this growth is expected to continue. The use of mobile phone reminders to increase healthcare appointment attendance rates and for a range of other healthcare purposes, is therefore of particular interest.

 



About the systematic review underlying this summary

Review objectives:To assess the effects of mobile phone messaging reminders on attendance rates at healthcare appointments
Type of What the review authors searched for What the review authors found
Study designs & interventions Randomised trials evaluating the use of reminders for healthcare appointments sent from a healthcare provider to a patient using SMS or MMS compared with no intervention, or other modes of communication.
Eight randomised trials involving a total of 6,615 people evaluated a text messaging intervention compared to usual practice (in 7 studies, the usual practice was no reminders). The messages were sent 24 to 72 hours before the appointment, and included the participant's name and appointment details. Two studies included instructions (i.e. to call a specified number if the patient was unable to attend), and two emphasised the importance of attending the appointment. Three studies used a web-based platform to send the messages, one used a modem linked to electronic medical records, and three did not describe the platform used. In one study, messages were sent either manually or through an automated delivery system
Participants Any type of participants regardless of age, gender and ethnicity; patients with any type and stage of disease.
Patients that required an appointment in the clinic or practice (3 studies), middle- and high- income employees or owners of local companies (1 study).
Settings Any setting
Australia (1), China (2), Kenya (1), Malaysia (2) and the United Kingdom (UK) (2). The settings were: one hospital health promotion centre; one inner-city general practice; six ENT clinics (in one hospital); nine primary care clinics; and 12 governmental health clinics.
Outcomes The primary outcome was the rate of attendance at healthcare appointments. Secondary outcomes included health outcomes (e.g. blood pressure, clinical assessments), user evaluation of the intervention, user perceptions of safety, costs, and potential harms.
All studies reported attendance rates at healthcare appointments. The costs of the interventions were reported in two studies. None of the included studies reported health outcomes, user perceptions of safety, or potential harms of the intervention. Only one study measured some form of user evaluation (proportion of participants contacted who had a mobile phone and who were willing to be contacted by SMS).
Date of most recent search: August 2012
Limitations: This is a well-conducted systematic review with only minor limitations.

Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R, Car J. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD007458. DOI: 10.1002/14651858.CD007458.pub3

Summary of findings

ight studies evaluated mobile phone text messaging compared to no reminder, or other types of reminders. The messages were either sent manually, through an automated delivery system, a web-based platform, or via a modem linked to electronic patient medical records, 24 to 72 hours before an appointment. The studies were conducted in four upper-middle or high-income countries (Australia, China, Malaysia and the United Kingdom (UK)), and 1 low‑income country (Kenya), and in different settings (primary, hospital, community, and outpatient). All studies reported attendance rates, but no studies reported health outcomes.

1) Mobile phone text message reminders compared to no reminders for patients with healthcare appointments 

 

  • The use of mobile phone text message reminders compared with no reminders probably leads to an increase in attendance at healthcare appointments. The certainty of this evidence is moderate.
  • No studies were found that evaluated the impact of mobile phone text message reminders compared with no reminders on health outcomes, costs, user evaluation of the intervention, user perception of safety, potential harms ,or adverse events of the intervention.

 

Mobile phone message reminders compared to no reminders

People

Patients with healthcare appointments

Settings

All settings (primary, hospital, community, outpatient)

Intervention

Mobile phone text message reminders

Comparison

No reminders

Outcomes

Absolute effect*

Relative effect

(95% CI)

Certainty

of the evidence

(GRADE)

Without
reminder

With
mobile phone reminder

Attendance at healthcare
appointments

678

per 1,000

773

per 1,000

(698 to 854)

RR 1.14

(1.03 to 1.26)

Moderate

Difference:
95 more patients attending per 1,000

(Margin of error: 20 to 176 more patients)

Other
outcomes

None of the included studies reported on health outcomes, user evaluation of the intervention, user perceptions of safety, costs, potential harms or adverse events of the intervention. 

-

-

Margin of error = Confidence Interval (95% CI)
RR: Risk Ratio

GRADE: GRADE Working Group grades of evidence (see above and last page)

* The risk WITHOUT the intervention is based on the risk of attendance in the control group of the studies identified in the review. The corresponding risk WITH the intervention (and the 95% confidence interval for the difference) is based on the overall relative effect (and its 95% confidence interval).


2) Mobile phone message reminders compared to phone call reminders for patients with healthcare appointments

 

  • The use of mobile phone text message reminders probably leads to little or no difference in attendance at healthcare appointments compared to phone call reminders. The certainty of this evidence is moderate.
  • No studies were found that evaluated the impact of mobile phone text message reminders compared with phone calls on health outcomes, user evaluation of the intervention, user perception of safety, or potential harms of the intervention.
  • Costs per text message per attendance may be lower than mobile phone reminders compared to phone call reminders.

Mobile phone message reminders compared to phone call reminders

People

Patients with healthcare appointments

Settings

All settings (primary, hospital, community, outpatient)

Intervention

Mobile phone message reminders

Comparison

Phone call reminders

Outcomes

Absolute effect*

Relative effect

(95% CI)

Certainty

of the evidence

(GRADE)

With phone call

reminder

With
mobile phone reminder

Attendance at healthcare
appointments

803

per 1,000

795

per 1,000

(763 to 819)

RR 0.99

(0.95 to 1.02)

Moderate

Difference:
8 less patients attending per 1,000

(Margin of error: 40 fewer to 16 more patients)

Other
outcomes

None of the included studies reported on health outcomes, user evaluation of the intervention, user perceptions of safety, costs, potential harms or adverse events of the intervention. 

-

-

Margin of error = Confidence Interval (95% CI)
RR: Risk Ratio
GRADE: GRADE Working Group grades of evidence (see above and last page)

* The risk WITHOUT the intervention is based on the risk of attendance in the control group of the studies identified in the review. The corresponding risk WITH the intervention (and the 95% confidence interval for the difference) is based on the overall relative effect (and its 95% confidence interval).


3) Mobile phone message reminders plus postal reminders compared to postal reminders alone for patients with healthcare appointments

 

  • The use of mobile phone text message reminders plus postal reminders may lead to improved attendance at healthcare appointments compared to postal reminders alone. The certainty of this evidence is low.
  • No studies were found that evaluated the impact of mobile phone message plus postal reminders compared with postal reminders alone on health outcomes, user evaluation of the intervention, user perception of safety, costs, or potential harms of the intervention.

Mobile phone message plus postal reminders compared with postal reminders alone

People

Patients with healthcare appointments

Settings

All settings (primary, hospital, community, outpatient)

Intervention

Mobile phone message plus postal reminders

Comparison

Postal reminders

Outcomes

Absolute effect*

Relative effect

(95% CI)

Certainty

of the evidence

(GRADE)

With postal reminder

With mobile

plus postal reminder

Attendance at healthcare
appointments

858

Per 1,000

944

per 1,000

(875 to 1,000)

RR 1.1

(1.02 to 1.19)

Low

Difference:
86 more patients attending per 1,000

(Margin of error: 17 to 163 more)

Other
outcomes

The included study did not report on health outcomes, user evaluation of the intervention, user perceptions of safety, costs, potential harms or adverse events of the intervention. 

-

-

Margin of error = Confidence Interval (95% CI)

RR: Risk Ratio

GRADE: GRADE Working Group grades of evidence (see above and last page)

* The risk WITHOUT the intervention is based on the risk of attendance in the control group of the studies identified in the review. The corresponding risk WITH the intervention (and the 95% confidence interval for the difference) is based on the overall relative effect (and its 95% confidence interval).

Relevance of the review for low-income countries

Findings Interpretation*
APPLICABILITY

The review identified 8 studies with a total of 6,615 participants that evaluated the use of mobile phone text messages reminders to increase healthcare appointments attendance.

 

è Seven studies were conducted in upper middle- or high-income countries, and 1 in a low-income country

 

è All of the reminders were simple. They did not indicate whether the user had read it, the message did not facilitate the cancellation of the appointment, or any other form of user-sender interaction.

There was moderate uncertainty about the effects of all of the mobile phone reminders tested in these studies.

w Simple reminders are designed to address a single factor (i.e. patients forgetting an appointment) that explains non-attendance. However, the reasons for non-attendance may vary in different settings.

w Other factors besides the scale of mobile phone penetration must be considered when evaluating the applicability of these findings to specific low- income countries. These include phone number portability and which devices are available.

w In low-income countries, mobile phone penetration is increasing rapidly. As more sophisticated devices become available, there is greater opportunity for more meaningful interaction with users.
EQUITY
 The included studies did not directly address equity issues.

This intervention may increase health inequities, by not supporting people without cell phones, those who live in remote areas that do not have signal coverage, those with low literacy levels, or people reluctant to use these forms of technology

w However, where mobile phone reminders are more available or acceptable than other forms of reminders, using them could help to decrease health inequities.
ECONOMIC CONSIDERATIONS
Two studies reported that the costs per text message per attendance were lower than the costs per phone call reminder.

Considering there is uncertainty for most of the critical outcomes for decision-making, the cost-benefit of this intervention is difficult to anticipate.

Mobile phone reminders may decrease the costs of a reminder service compared to other methods.

MONITORING & EVALUATION
The intervention is potentially ineffective

Additional randomised trials are needed to evaluate if more intensive reminders, or messages that allow different types of interactions are effective in specific groups.


 

*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low-income countries. For additional details about how these judgements were made please see: www.supportsummaries.org/methods


 

Additional information

Related literature

Guy R, Hocking J, Wand H, Stott S, Ali H, Kaldor J. How effective are short message service reminders at increasing clinic attendance? A meta-analysis and systematic review. Health Serv Res. 2012 Apr;47(2):614-32. doi: 10.1111/j.1475-6773.2011.01342.x

 

James J. Penetration and Growth Rates of Mobile Phones in Developing Countries: An Analytical Classification. Soc Indic Res. 2010 Oct;99(1):135-145. doi:  10.1007/s11205-009-9572-0

 

van Velthoven MH, Brusamento S, Majeed A, Car J. Scope and effectiveness of mobile phone messaging for HIV/AIDS care: a systematic review. Psychol Health Med. 2013;18(2):182-202. doi: 10.1080/13548506.2012.701310. Epub 2012 Jul 12.

 

This summary was prepared by

Rada G. Evidence-Based Health Care Program, Pontificia Universidad Católica, Chile.

 

Conflict of interest

None declared. For details, see: www.supportsummaries.org/coi

 

Acknowledgements

This summary has been peer reviewed by: Willem Odendaal and Josip Car.

 

This review should be cited as

Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R, Car J. Mobile phone messaging reminders for

attendance at healthcare appointments. Cochrane Database of Systematic Reviews 2013, Issue 12. Art.

No.: CD007458. DOI: 10.1002/14651858.CD007458.pub3

 

The summary should be cited as

Rada G. Does the use of mobile phone messaging reminders increase attendance at healthcare appointments? A SUPPORT Summary of a systematic review. November 2016. www.supportsummaries.org

 

Keywords

evidence-informed health policy, evidence-based, systematic review, health systems research, health care, low and middle-income countries, developing countries, primary health care



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