2. S H Waqar*
M A Zahid**
Haroon Khan†
M Mukhtar Khan***
*Assistant Professor, Department of General Surgery
**Professor, Department of General Surgery
†Consultant Pathologist, Department of Pathology
***Post-Graduate Resident, General Surgery
Pakistan Institute of Medical Sciences
Islamabad
Effectiveness of Mobile Phone SMS
Reminders for Surgical Outpatient
Appointment for Admissions

3. Introduction
• Failure of patients to attend hospital
appointments for admissions is a significant
problem
• Suboptimal use of clinical and hospital
resources
• Longer waiting lists
• Worse outcomes for non-attenders
• Loss of continuity of care

4. Introduction
• Reasons for failure to attend:
o Forgetting the appointment
o Work obligations
o Looking after children
o Transportation problems
o Confusion over the date, time and location

5. Introduction
• Impact of Non-attendance on health care
facilities:
– Missed opportunities by residents to learn
– Productivity loss by non-use of appointment time
– Vacant elective lists
• Impact of Non-attendance on patients
– Increased risk of readmission in non-attendees
– Increased morbidity
– Decreased monitoring of long-term chronic conditions

6. • 111.5 million mobile subscribers in Pakistan
• Pakistan 8th largest mobile consumer
Cell phone facts

8. Short Message Service (SMS)
Short Message Service (SMS) is a text messaging
service component of phone, web, or mobile
communication systems, using standardized
communications protocols that allow the
exchange of short text messages between fixed
line or mobile phone devices
SMS text messaging is the most widely used data
application in the world, with 2.4 billion active
users, or 74% of all mobile phone subscribers.

9. Total SMS Generated in Pakistan

11. • Bundled SMS-offer had lead the rural and
bottom-of-pyramid segments to use the
service instead of voice calls and hence
infused an exponential rise in the percentage
growth trends

13. • Various methods of appointment
reminders, e.g.; Telephone calls, posted
letters and awareness campaigns
• Most studies showed reduction in non-
attendance rate regardless of the method
used as appointment reminder
Background

14. • SMS messages have a number of
characteristics that make them very
appropriate for use in a healthcare setting
including:
– direct patient communication
– privacy
– confidentiality
– swift delivery of messages and receipt of
responses,
– convenience for health providers and patients
– reduced labour expenditure
Background

15. OUR STUDY

16. Objective
• To assess the effectiveness of the use of
SMS-based reminders for hospital
outpatient appointments for admission
in General Surgery Department as a
method of reducing the non-attendance
rates

17. Methodology
• Observational study
• Patients scheduled for admission for surgery
(Elective or Day Case) between January and
June 2010 in Surgical Department, PIMS,
Islamabad
• Contact information obtained at the time of
registration for admission
• Identity protection and privacy honoured

18. Methodology
• FrontlineSMS, a free open source PC based
bulk SMS sending software was used
• SMS sent were timed to avoid arrival at
inappropriate times such as night-time
• “This is a reminder of your appointment for
admission at PIMS Islamabad at <time>
<date>.”

19. Intervention Group
Intervention group included patients who
received SMS reminder for admission
Control Group
Control group comprised of patients who did
not receive SMS reminders
Methodology

20. Results
• Total number of patients: 360
• 12.5% (18/144) of patients who received SMS
appointment reminder were non-attenders
• 24.1% (52/216) of patients who did not receive
SMS appointment reminder were non-attenders

21. SMS Reminder Status
0
5
10
15
20
25
30
SMS Reminder No SMS Reminder
SMS Reminder Status
Non-attendance rate for intervention and control groups

22. Results
Intervention
Group
(n=144)
Control Group
(n=216)
p value
Day Case
Surgery
2/54 (4%) 19/96 (20%) 0.0001
Elective
Surgery
16/90 (18%) 33/120 (28%) 0.0001
Total 18 (12.5%) 52 (24.1%) 0.0001

23. Results
• Non-attendance rates were 49% lower in patients
who received SMS reminder than in patients who
did not receive a reminder
• Relative Risk of non-attendance = 0.52
• 95% Confidence Interval = 0.32 – 0.85

24. Limitations
• A significant number of our population still do not
own mobile phones
• Non-availability of operators network in far flung
or mountainous area
• Non-familiarity with using SMS text messages
• Participation bias
• Confounding factors such as age, gender,
ethnicity and socioeconomic status
• Patients may not receive the SMS reminders due
to incorrect data entry

25. Limitations
• Elderly people have lower ownership rates of
mobile phones and may not be able to use SMS
facilities
• Study was only conducted over a 6 month period
and ideally, information relating to a year, taking
into account seasonal variations, would be
valuable

26. Conclusion
• SMS reminders more cost effective
• Requires less labour
• Carries a great potential for reducing non-
attendance rates in OPDs
• The need for more studies to support this
conclusion

27. Presented at 3rd International eHAP
Conference at University of Health Sciences
Lahore, in January 2012

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29. THANKS!