Reminder systems to improve patient adherence to tuberculosis clinic appointments for diagnosis and treatment
Reminder systems to improve patient attendance at tuberculosis clinics
Qin Liu1, Katharine Abba2, Marissa M Alejandria3, David Sinclair4, Vincent M Balanag5, Mary Ann D Lansang3
1 School of Public Health & Management, Chongqing Medical University, China Effective Health Care Network, Chongqing, China
2 Liverpool School of Tropical Medicine, International Health Group, Liverpool, Merseyside, UK
3 Department of Medicine, Philippine General Hospital, University of the Philippines, Department of Clinical Epidemiology and Section of Infectious Diseases, Manila, Philippines
4 Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
5 Lung Center of the Philippines, Quezon City, Philippines
Reminder systems to improve patient adherence to tuberculosis clinic appointments for diagnosis and treatment. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD006594.
To read the full review please follow this link: DOI: 10.1002/14651858.CD006594.pub3.
This Cochrane Review summarizes trials evaluating the effects of reminder systems on attendance at tuberculosis (TB) clinics and completion of TB treatment. After searching for relevant trials up to 29 August 2014, we included nine trials, including 4654 people.
What are reminder systems and how might they help?
Effective treatment for TB requires people to take multiple drugs daily for at least six months. Consequently, once they start to feel well again, some patients stop attending clinics and stop taking their medication which can lead to the illness returning and the development of drug resistance. One strategy the World Health Organization recommends is that an appointed person (a health worker or volunteer) watches the person take their medication everyday (called direct observation). Other strategies include reminder systems to prompt patients to attend for appointments on time, or to re-engage people who have missed or defaulted on a scheduled appointment. These prompts may be in the form of telephone calls or letters before the next scheduled appointment ("pre-appointment reminders"), or phone calls, letters, or home visits after a missed appointment ("default reminders").
What the research says:
For people being treated for active TB:
- More people attended the clinic and completed TB treatment with pre-appointment reminder phone-calls (low quality evidence).
- More people attended the clinic and completed TB treatment with a policy of default reminders (low and moderate quality evidence respectively).
For people on TB prophylaxis:
- More people attended the clinic with pre-appointment phone-calls, and the number attending the final clinic was higher with three-monthly phone-calls or nurse home visits.
For people undergoing screening for TB:
- Similar numbers of people attended clinic for skin test reading with and without pre-appointment phone-calls (low quality evidence).
- Similar numbers of people attended clinic for skin test reading with and without take home reminder cards.