Can Mobile Phone Short Message Service Reminders Improve the Attendance Rate of Multidisciplinary Diabetes Services in a Primary Care Clinic?

Abstract

Problem: Government-funded primary care clinics in Hong Kong serve mainly the elderly and those with financial needs. A multidisciplinary program for diabetes mellitus (DM) patients was available for complication screening and assessment. Internal data showed the attendance rates ranged from 65-90%. Although Short Message Service (SMS) was proven to be an effective strategy to improve attendance rate, the effect for the socially-deprived group was unknown. The aim of this study was to compare the attendance rates of the services using SMS reminder when compared with usual care, and to determine if other demographic and clinical factors were associated with appointment attendance. Approach: This was a randomized-controlled trial in a primary care clinic started in October 2016. DM patients with mobile phone capable to receive SMS and with more than 1 future appointments (i.e. scheduled blood taking, individual or group consultation led by nurses, optometrists, dieticians, physiotherapists) were invited to participate. Subjects were randomized into intervention or control group with random number generator. For the intervention group, SMS reminders with appointment type, date and time, and clinic contact number for enquiry were sent to patients’ mobile phone 24-72 hours before each scheduled appointment. There is no sensitive information in the SMS and the cost for each message was 6 cents (GBP). Control group received no SMS. Interim results were analysed by Statistical Package for the Social Sciences. Patient recruitment is expected to complete in February 2017. Findings: 248 subjects were randomized into intervention group (N=128) and control group (N=120). Their mean age was 63.2 years (Standard Deviation, SD 11.4), male to female ratio was 0.98. The mean years of DM diagnosis was 6.7 years (SD 5.3) and the mean HbA1c was 7.4% (SD 1.4). There was no significant difference of demographic and clinical factors between the two groups. The mean number of appointments was 2.2 (SD 1.0). Time from booking to appointment was 32.5 days (SD 23.7). With the 380 scheduled appointments, the overall attendance rate was 87.4%. Attendance to dietetic services was the lowest (68.1%) while blood taking services was the highest (96.6%). Subjects from intervention group had significantly higher attendance rates than the control group, which was 92.9% and 81.4% respectively (p=0.001, OR 2.98 [95% CI: 1.54-5.76]). Logistic regression showed time from booking to appointment also significantly increased the non-attendance rate (p=0.007, OR 0.98 [95% CI 0.965-0.995]). Other factors such as age, sex, education level, use of smartphones, HbA1c level, duration of DM were not significant. Consequences: SMS reminder is an effective way to improve attendance rate of multidisciplinary healthcare services for DM patients in the socially-deprived group. Further study with a larger scale could be done to determine the feasibility and applicability.