1. Introdução à Medicina’s Annual Assignment 2006/2007 Impact of appointment reminders via SMS in Hospital S. Sebastião

2. We aim to study the changes in outpatient attendance related to appointment reminders via SMS text messaging in São Sebastião Hospital and its impact. Objective

3. Introduction Problem: failure to attend outpatients appointments. [Hashim, 2001] Consequences of non-attendance: - Missed opportunities for diagnosis and treatment; - Reduced opportunities for revenue; - Extended time patients have to wait for an appointment booking. [Downer, 2005]

4. Reasons for non-attendance: - Forgetfulness; - Long distance from home to health services and trip cost; - Inconvenient time of appointment (incompatible with work schedule). [McClure, 1996] Solutions - new techniques related to communication: - Personalized, automated and awareness phone calls; - Awareness campaigns; - E-mails; - SMS (object of our study). [Haynes, 2006]

5. Process of SMS text messaging: 1.The hospital schedules the appointment; 2. The hospital sends each patient a SMS reminding of the date and hour two days before the appointment. Portugal: this method is starting to be used in some hospitals. [Correio da Manhã, 06-04-2006]

6. Advantages of this method: - it is cheap; - it is done by a computing system, without human intervention. Conclusion of previous studies conducted in Portugal related to Hospital São Sebastião: - improving patients attendance; - general reduction in the no-show rate of 14% in general appointments; - most extreme case of Paediatrics with a reduction of 50%; - recovering of about 900 appointments per month; - saving nearly 15.000 euros per month. (information given by administrative services of Hospital S.Sebastião)

7. Methods Population: All patients of Hospital São Sebastião, located in Santa Maria da Feira who have cellular phone number registered at the system. Identification: The population's individuals unique identifier will be their hospital number. Sample’s selection: The sample consists of the set of the Hospital’s patients who have external appointments in the day previously selected.

8. Procedures: Two days before the appointment, the hospital will send an alert SMS as a reminder to the patients with a pair identification number. In opposite, people with an odd identification number won't be reminded. It will be done during a week. Analysis (using SPSS program): 1.Statistical analysis, comparing the number of attendances and non-attendances in reminded and non-reminded groups; 2.Chi-square test, that will allow us to conclude if there is any relation between the sent of SMS appointment-reminders and the patients’ attendance.

9. The contingency table we will obtain will be something like this: Pair Group (Reminded) Odd Group (Non-reminded)TotalAttendances Non-attendances Total

10. 3.Based in the results we will conclude if it exists any association between the sent of SMS appointment-reminders and the patients attendance. 4.In a last phase we will relate these conclusions with decurrent information of the interviews to reach the considered objectives.

11. References (by order of appearance) Hashim MJ, Franks P, Fiscella K. Effectiveness of Telephone Reminders in Improving Rate of Appointments Kept at an Outpatient Clinic: A Randomized Controlled Trial. J Am Board Fam Pract. 2001 May- Jun;14(3):193-6. Haynes JM, Sweeney EL. The Effect of Telephone Appointment- Reminder Calls on Outpatient Absenteeism in a Pulmonary Function Laboratory. Respir Care. 2006 Jan;51(1):36-9. Downer SR, Meara JG, Da Costa AC. Use of SMS text messaging to improve outpatient attendance. Med J Aust. 2005 Oct 3;183(7): Haynes 366-8.

12. Hardy KJ, O'Brian SV, Furlong NJ. Information given to patients before appointments and its effect on non-attendance rate. Abstract. 2001 Dec 1;323(7324):1298-300. McClure RJ, Newell SJ, Edwards S. Patient characteristics affecting attendance at general outpatient clinics. Abstract. 1996 Feb;74(2):121-5. Neal RD, Hussain-Gambles M, Allgar VL, Lawlor DA, Dempsey O. Reasons for and consequences of missed appointments in general practice in the UK: questionnaire survey and prospective review of medical records. Abstract. 2005 Nov 7;6:47.

13. Work done by: Class 4 Ana Margarida Cunha Catarina Dias Denise Sousa Duarte Silva Inês Silva João Costa Leila Cardoso Lília Valente Manuel Tinoco Mariana Lima Pedro Pacheco Sara Viana Orientation by: Dr. Ricardo Correia