- Numerous studies report that reminders via telephone, internet, and short message service (SMS), and other methods are associated with improved outcomes for patients with a variety of disorders.
- Multimedia patient reminders are highly cost effective for control of a number of medical and psychiatric disorders.
- Reminders were found to improve bipolar disorder medication adherence, appointment attendance, vaccination coverage, and substance misuse and abuse outcomes.
A number of recent studies published in a variety of journals show that multimedia reminders from healthcare providers can improve outcomes, improves patient’s lives, are cost effective, and medically effective. New technologies can ease the burden currently borne by our healthcare providers and improve professional satisfaction as well.
Improving Appointment Attendance
A systematic review and meta-analysis published recently in the Journal of Medical Systems shows that short message service (SMS) reminders sent to patients’ cell phones can improve appointment attendance.(Figure 1.)
The reviewers attempted to identify the efficacy of SMS reminders for improving appointment attendance. They identified studies published between 2005 and 2015 that compared the attendance rates of patients receiving SMS reminders with those not receiving a reminder. They then performed a meta-analysis to calculate a pooled estimate odds ratio.
In all they included 28 studies, of which 13 (46%) were randomized controlled trials (RCTs). The pooled odds ratio (OR) of the randomized control trials was 1.62 (1.35-1.94). Half of the studies involved sending the reminder within 48 hours of the appointment time. There were no significant subgroup differences with respect to participant age, SMS timing, rate or type, setting or specialty.
The studies demonstrated a positive OR, indicating that SMS reminders were an effective means of improving appointment attendance. There was no significant difference in OR when controlling for when the SMS was sent, the frequency of the reminders or the content of the reminder.
“SMS appointment reminders are an effective and operative method in improving appointment attendance in a healthcare setting and this effectiveness has improved over the past 5 years,” the researchers noted.
Improving Medication Adherence in Patients with Bipolar Disorder
Results of a systematic review published in early 2016 in the Journal of Affective Disorders revealed that “Even brief interventions can improve medication adherence. Limitations in intervention and study design and reporting prevented assessment of which elements of adherence support are most effective. Applying published guidance and quality criteria for designing and reporting adherence interventions is a priority to inform the implementation of cost-effective adherence support,” the reviewers concluded. (Figure 2.)
Providers who treat patients with bipolar disorders are well aware that medication non-adherence in bipolar disorder is a significant problem resulting in increased morbidity, hospitalization, and suicide. The effects of interventions to enhance adherence are of unknown efficacy.
This group systematically reviewed 18 studies that met inclusion criteria and provided sufficient data for meta-analysis. The pooled OR was 2.27 (95% CI 1.45-3.56)—equivalent to a 2-fold increase in the odds of adherence in the intervention group relative to control. The analyzed studies did not specify the types of interventions used or the pooled intervention types were highly variable. Nonetheless, interventions of various types were found to be highly effective in these patients.
Improving Coverage of Appropriate Vaccinations
Results of a systematic review and meta-analysis published in the American Journal of Preventive Medicine found that 12 interventions recommended by the U.S. The Community Preventive Services Task Force increased vaccination coverage. The interventions differed in reach, cost, and cost effectiveness but achieved similar results. The results “can guide implementers in their choice of interventions to fit their local needs, available resources, and budget,” the reviewers advised. (Figure 3.)
It is well known among healthcare providers that population-level coverage for immunization against many vaccine-preventable diseases remains suboptimal in the U.S. “The Community Preventive Services Task Force recently recommended several interventions to increase vaccination coverage based on systematic reviews of the evaluation literature. The present study provides the economic results from those reviews,” the authors explained.
These researchers conducted a systematic review of studies published between January 1980 and February 2012 to identify economic evaluations of the interventions recommended by the Task Force. “Estimates were constructed for the population reach of each strategy, cost of implementation, and cost per additional vaccinated person because of the intervention. Analyses were conducted in 2014,” they noted.
“Reminder systems, whether for clients or providers, were among the lowest-cost strategies to implement and the most cost effective in terms of additional people vaccinated,” the authors concluded.
Internet-Delivered Treatment for Substance Abuse is Effective, Cost-effective
Results of a multisite, randomized trial of an internet-delivered treatment for substance abuse was published recently in the Journal of Alcohol Dependence. The study was designed to compare a version of the community reinforcement approach (CRA) with contingency management (CM) known as the therapeutic education system (TES). “With regard to the clinical outcome of abstinence, our cost-effectiveness findings of TES+TAU compare favorably to those found elsewhere in the CM literature,” the researchers concluded.(Figure 4.)
It is well known that substance misuse and excessive alcohol consumption are major public health problems in the U.S. and worldwide. Internet-based interventions for substance use disorders (SUDs) are a relatively new method for overcoming barriers to access and supplementing care. This study examined the cost-effectiveness of an internet-based version of the CRA with a contingency management strategy known as the therapeutic education system.
The researchers recruited 507 individuals who were seeking therapy for alcohol or other substance use disorders at 10 outpatient community-based treatment programs. Patients were randomly assigned to either treatment as usual (TAU) or TES+TAU. An economic evaluation of the 12-week trial included follow-up at 24 and 36 weeks.
“From the provider's perspective, TES+TAU as it was implemented in this study costs $278 (SE=87) more than TAU alone after 12 weeks. The quality-adjusted life years gained by TES+TAU and TAU were similar; however, TES+TAU has at least a 95% chance of being considered cost-effective for providers and payers with willingness-to-pay thresholds as low as $20,000 per abstinent year. Findings for the subgroup not abstinent at study entry are slightly more favorable,” the reviewers explained.