Improving Attendance at Post–Emergency Department Follow‐up Via Automated Text Message Appointment Reminders: A Randomized Controlled Trial

Abstract

Objectives: Patients discharged from the emergency department (ED) are often referred for primary care, specialty, or other disease-specific follow-up appointments. Attendance at these scheduled followup appointments has been found to improve patient outcomes, decrease ED bounce-backs, and reduce malpractice risk. Reasons for missing follow-up visits are complex, but the most commonly reason cited by patients is simply forgetting. In this study the authors evaluated the ability of an automated text message reminder system to increase attendance at post-ED discharge follow-up appointments in a predominantly Hispanic safety-net population.Methods: This was a randomized controlled trial of ED patients with outpatient follow-up visits scheduled at the time of ED discharge. A total of 374 English-and Spanish-speaking patients with textcapable mobile phones were enrolled. Patients in the intervention arm received automated, personalized text message appointment reminders including date, time, and clinic location at 7, 3, and 1 day before scheduled visits. A t-test of proportions was used to compare outcomes between intervention and control groups. Both an intention-to-treat (ITT) and a per-protocol analysis of the data were performed. The ITT more accurately reflects real-world conditions where errors such as number entry errors are bound to occur. The per-protocol analysis adds value by isolating the effect of the intervention by comparing patients who actually received it compared with those who did not.Results: In the per-protocol analysis of the primary outcome, the overall appointment adherence rate was 72.6% in the intervention group compared with 62.1% in the control group (difference between groups = 10.5%, 95% confidence interval [CI] = 0.3% to 20.8%; p = 0.045; number needed to treat = 9.5). In the ITT analysis, the overall appointment attendance rate 70.2% in the intervention group compared with 62.1% in the control group (difference between groups = 8.2%; 95% CI = -1.6% to 17.7%; p = 0.100). In a secondary largely exploratory analysis, the intervention was found to have the most benefit in patients with the lowest baseline follow-up rate (English speakers with specialty care appointments).Conclusions: Automated text message appointment reminders resulted in improvement in attendance at scheduled post-ED discharge outpatient follow-up visits and represent a low-cost and highly scalable solution to increase attendance at post-ED follow-up appointments, which should be further explored in larger sample sizes and diverse patient populations.ACADEMIC EMERGENCY MEDICINE 2015;22:31-37

Mobile health solutions for the aging population: A systematic narrative analysis

“…Effective, outcomes, and communicative were mentioned in 6/60 occurrences (10%). 27,28,30,[37][38][39][40]45,46,48,53,[54][55][56]58 mHealth can change behaviour through feedback. It can mentally stimulate patients to delay the advance of dementia, improve triage decisions and arrangement of transportation through communication channels, increase self-efficacy augmenting existing interventions and thereby outcomes.…”

“…The outcomes theme included early diagnosis, mobile interventions to stimulate mental activity, encouraging a more active role of patients in their conditions, and increased medication and therapy adherence, and an enabler to detect falls. 27,39,45,46,56,58 Mobile technology can also serve as a tool of communication to augment existing modalities to provide real-time data and increase the level of communication between patient and provider. 28,30,37,40,45,54 Quality of life was mentioned in 5/60 occurrences (8%), and it encompassed observations that mobile technology can make life easier, convenient and more comfortable for the user.…”

“…23,25,52 The improvement of access included technology to enhance coordination of care without the limitations of proximity or mobility. 40,46,55 The theme of convenient was only mentioned once (2%). The authors pointed out that elderly with dementia are willing to wear mobile technology, they willingly accept it, and they feel that it is convenient to use for multiple purposes.…”

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

“…Arora et al 11 performed an RCT of ED patients with an outpatient follow-up scheduled at the time of an ED discharge. Patients who received an automated text message reminder were more likely to attend their scheduled follow-up visit (72.6% in the intervention group compared with 62.1% in the control group; Δ 10.5%; 95% CI: 0.3%, 20.8%; number needed to treat 9.5).…”

“…Patients who received an automated text message reminder were more likely to attend their scheduled follow-up visit (72.6% in the intervention group compared with 62.1% in the control group; Δ 10.5%; 95% CI: 0.3%, 20.8%; number needed to treat 9.5). 11 Wolff et al 12 conducted an RCT of adolescent females diagnosed with pelvic inflammatory disease, which found that patients who received standard discharge instructions plus text message reminders were more likely to receive recommended follow-up care within 72 hours of the ED discharge compared to patients who received standard discharge instructions (relative risk 2.9, 95% CI: 1.4, 5.7; number needed to treat 4, 95% CI: 1.4, 5.7). 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.…”