Text Messaging - Benefits for Patient and Health Provider


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Chris Lewis
Dialhog Ltd
(P46, 1/10/09, Sigma Room, 11.28)

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Text Messaging - Benefits for Patient and Health Provider

  1. 1. Text Messaging Benefits for Patient & Health Provider
  2. 2. Did Not Attends (DNA’s) <ul><li>Wasted or underutilised resources </li></ul><ul><li>Patients don’t receive care that may improve quality of life </li></ul><ul><li>May present later with worse problems requiring more resources than previously </li></ul>
  3. 3. Efficiency & cost <ul><li>More cell phones than people in NZ </li></ul><ul><li>Text costs approx half a stamp or call to mobile </li></ul><ul><li>Low human resource cost as many done at once </li></ul>
  4. 4. Text messaging pilots <ul><li>Two District Health Boards – Counties Manukau & Bay of Plenty </li></ul><ul><li>Goal was to reduce DNAs </li></ul><ul><li>Analysis of DNA rates before & after texting </li></ul><ul><li>Analysis included ethnicity in Counties Manukau </li></ul>
  5. 5. Counties Manukau DHB <ul><li>DNA rate constant at 12% for some time </li></ul><ul><li>Research showed “forgot appointment” major reason given for DNA </li></ul><ul><li>Time gap between other reminder methods – letters & phone calls – and appointment </li></ul>
  6. 6. Counties Manukau DHB <ul><li>Two texts sent </li></ul><ul><li>1st text – day before Outbound Callers attempt contact </li></ul><ul><li>2nd text – as close as possible to appointment </li></ul>
  7. 7. Counties Manukau DHB <ul><li>Extracts from Patient Management System uploaded to Dialhog website </li></ul><ul><li>1st text – goal to reduce need for reminder phone call & therefore reduce expenses </li></ul><ul><li>2nd text – different timings for morning & afternoon appointments to increase immediacy </li></ul>
  8. 8. Counties Manukau DHB <ul><li>Text messages generally from family & friends so an opportunity & potential hazard </li></ul><ul><li>Text should be personalised with information relevant to the particular patient </li></ul><ul><li>Text replies routed as emails to relevant booking area for follow up </li></ul><ul><li>Content easily changed e.g. H1N1 </li></ul>
  9. 9. Counties Manukau DHB <ul><li>Manukau SuperClinic rollout started March 07 and was completed mid June 07 </li></ul><ul><li>DNA rate in initial area dropped from 13% to 11% (15% reduction) </li></ul><ul><li>40% of patient records had cellphone numbers recorded in any of three phone fields </li></ul>
  10. 10. Counties Manukau DHB Results
  11. 11. Counties Manukau DHB Analysis of Results <ul><li>17% reduction in overall DNA rate all from 50% of patients who received texts </li></ul><ul><li>Maori DNA rate reduction 10% above average </li></ul><ul><li>Patient reminded by text 33% less likely to DNA </li></ul><ul><li>6500 patients attended who wouldn’t have </li></ul>
  12. 12. Bay of Plenty DHB <ul><li>Utilise most of the Counties Manukau DHB strategy </li></ul><ul><li>Change to reflect difference in their Call Centre system </li></ul><ul><li>1 st text only to unconfirmed patients </li></ul><ul><li>No significant changes to text content </li></ul>
  13. 13. Bay of Plenty DHB <ul><li>Pilot started in November 08 ran till end Mar 09 </li></ul><ul><li>Clinics added during period, particularly March </li></ul><ul><li>Successful results have meant subsequent expansion of program </li></ul>
  14. 14. Bay of Plenty DHB <ul><li>Only clinics in texting program at end Mar available to work with for analysis </li></ul><ul><li>Two comparisons decided on </li></ul><ul><li>Jan – Mar 08 compared with Jan – Mar 09 </li></ul><ul><li>Mar 08 compared with Mar 09 </li></ul>
  15. 15. Bay of Plenty DHB Results Clinics using texts at Mar 09 Clinics NOT using texts at Mar 09 Jan 08 - Mar 08 11.19% 5.72% Jan 09 - Mar 09 9.57% 6.27% Change -14.48% + 9.62% Mar 08 12.03% 5.76% Mar 09 8.85% 6.47% Change -26.4% + 12.3%
  16. 16. Bay of Plenty DHB analysis of results <ul><li>44% of patient records with cell phones. 38% received text </li></ul><ul><li>Patient texted 38% to 69% less likely to DNA </li></ul><ul><li>In Mar 09 there were 510 DNAs from 5764 appointments in texted clinics </li></ul><ul><li>Would have been 693 DNAs based on Mar 08 </li></ul>
  17. 17. Return on investment <ul><li>Appts texted clinics Mar 09 5254 </li></ul><ul><li>DNA’s 510 </li></ul><ul><li>Expected DNA’s (Mar 08%) 708 </li></ul><ul><li>Extra attendees 198 </li></ul><ul><li>Value @ $100 per appointment $20,000 </li></ul><ul><li>Texting cost in March $1200 </li></ul><ul><li>$1 spent on texting = $16 savings </li></ul>
  18. 18. Patient Acceptance “Recently you recvd a txt reminder about appt at {LOCATION} Hospital. Plse text bk YES if you liked reminder txt, NO if you didn't. Any other comments. Thanx “ Texts sent Response rate Approve Disapprove Counties Manukau DHB 361 46% 99% 1% Bay of Plenty DHB 160 55% 99% 1%
  19. 19. Patient Acceptance BOP Comments <ul><li>“ Yes thanks” or “Yes thank you” (5 times) </li></ul><ul><li>“ Yes it’s a great idea” (4 times) </li></ul><ul><li>“ Yes it was good” (2 times) </li></ul><ul><li>“ Yes! What a great service. The reminder text was much appreciated. Thank you!!” </li></ul><ul><li>“ Yes very good. Makes life easy” </li></ul><ul><li>“ Yes I thought it was very helpful we all lead busy lives and a little reminder never hurts” </li></ul><ul><li>“ Yes excellent service thanks” </li></ul>
  20. 20. Patient Acceptance Survey Analysis <ul><li>50% response = high level of engagement </li></ul><ul><li>Surveys confirm each other & very high level of patient acceptance </li></ul><ul><li>Patients see texting as valuable self-management tool </li></ul><ul><li>Patients see texting as the friendly personal face of the Health Provider </li></ul>
  21. 21. Information Security <ul><li>All communication & transmission encrypted using https </li></ul><ul><li>All data stored in encrypted databases in physically highly secure premises </li></ul><ul><li>Different views on text content, privacy requirements and retention periods </li></ul>
  22. 22. Different text content choices <ul><li>No names other identifiers or replies </li></ul><ul><li>*SCREENING APPT REMINDER* - {Appt Date} @ {Appt Time} at {Location}. To change, ph 0800 000 000. PLEASE DO NOT REPLY TO THIS TXT. </li></ul><ul><li>Names NHI Numbers & replies </li></ul><ul><li>{Title} {LastName} {NHI-NO} reminding you of appt at {LOCATION} {APPT-TIME} {APPT-DAY} {APPT-DATE}. Plse reply or ph 222 1234 if you cannot attend </li></ul>
  23. 23. Letter / text security comparison <ul><li>Letters & texts can go to a wrong or an old address </li></ul><ul><li>Letters & texts can be read by others if left unattended </li></ul><ul><li>Texts may be marginally more secure as they do not generally get delivered to a shared space </li></ul>
  24. 24. Scalability <ul><li>Some scalability issues with database searches encountered as service expanded at Counties Manukau </li></ul><ul><li>User setting allows time period to be specified </li></ul><ul><li>Other issues addressed by providing separate database and functional areas for some service areas </li></ul>
  25. 25. Current customers include <ul><li>Counties Manukau DHB </li></ul><ul><li>Bay of Plenty DHB </li></ul><ul><li>Southland DHB </li></ul><ul><li>Capital & Coast DHB </li></ul><ul><li>Waitemata DHB </li></ul><ul><li>BreastScreen Auckland </li></ul><ul><li>BreastScreen South </li></ul><ul><li>BreastScreen Counties Manukau </li></ul><ul><li>BreastScreen Waitemata/ Northland </li></ul>
  26. 26. Other health users <ul><li>Text reminders work as effectively for small as well as large providers </li></ul><ul><li>Physiotherapists </li></ul><ul><li>PHOs </li></ul><ul><li>Addiction helpline </li></ul>