SMS Reminders for Missed Immunization Appointments
-
Upload
jordan-schermerhorn -
Category
Documents
-
view
217 -
download
0
Transcript of SMS Reminders for Missed Immunization Appointments
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
1/34
Using SMS Reminders to Red
Missed Immunizations
Jordan Schermerhorn
10 August 2014
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
2/34
Overview
Part 1: SMS Reminders
Background
Procedure
Results
Part 2: Patient Interviews
Part 3: Identifying Vulnerable Patients Methods
Results
Future Plans & Recommendations
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
3/34
SMS Reminders
Part 1
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
4/34
Background | SMS Reminders
Goals: Easy way to remind patients about appointments they m
Reduce time nurses spend calling defaulters
Sends SMS to immunization and vitamin A defaulter
Vitamin A: lots of defaulters, but too many wrong numbe
Immunizations: fewer defaulters, more right numbers
Began in June 2013, Taybeh Health Center
Problems with defaulter list corrected in June 2014
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
5/34
Setting | SMS Reminders
Taybeh Health Center
Average 23 defaulters eachweek
~100 births each month
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
6/34
Procedure | SMS Reminders
1. Set Criteria:
Missed appointment
No scheduled future appointment
2. Receive spreadsheet from e-Health
Once per week for immunizations
3. Check & clean numbers
4. Send messages using Clickatell
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
7/34
Results: Return to Care | SMS Reminders
114 patients received messages total 85 received messages before August 6
66 of these 85 have returned to care (77%)
Days Late
(before SMS)
Days until new appointment
(after SMS)
Median 16 1.5
Mean 23 6
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
8/34
Results: Return to Care | SMS Reminders
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
9/34
Results: Message Status | SMS Reminder
Out of 114 phone numbers
Functional 89 78.1%
Out of service or landline 15 13.2%
Missing digit in e-Health 4 3.5%
Wrong number in e-Health At least 2 1.8%
Transfer to other clinic At least 4 3.5%
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
10/34
Vaccine Type | Who received SMS remin
0
10
20
30
40
IPV, OPV, DPT
- Dose 1
IPV, OPV, DPT
- Dose 2
IPV, OPV, DPT
- Dose 3
Measles &
OPV 4
MMR 1 MM
boo
* 12 patients missed >1 appointment
Month of life:
Vaccine Type:
1 2 3 9 12
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
11/34
Gender | Who received SMS reminders
114 patients
43% male 57% fema
Would expect 50/50
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
12/34
Gender | Who received SMS reminders
For MMR2, gender difference is statistically significant (p = 0
0
10
20
30
40
IPV, OPV,
DPT - Dose 1
IPV, OPV,
DPT - Dose 2
IPV, OPV,
DPT - Dose 3
Measles &
OPV 4
MMR 1 MMR 2 &
boosters
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
13/34
Results: Time Cost| SMS Reminders
Simulate defaulter calls Called 25 patients to request interviews; called 3 times if no
Total time: 94 minutes
Time to send SMS: 15 minutes/week
Time spent: 1 hr, 15 minutes (5 weeks)
Total time saved: 5 hours, 35 minutes of calling t
Total cost: $6.84 or 4.04 JOD
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
14/34
Challenges | SMS Reminders
3 local cell providers
Zain expires most quickly, Orange lasts longest
UNRWA patients have:
Orange 2%
Umniah 34%
Zain 64%
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
15/34
Challenges | SMS reminders
Expired numbers
Multiple phones per family
Problems with numbers listed in e-Health Missing digits
Extra digits
Landlines
Some patients go to private clinicsand show up asdefaulters in e-Health
Nonsense data in e-Health (ex. patient missed appoibefore he was born)
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
16/34
Patient Interviews
Part 2
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
17/34
Patient Interviews | Part 2
Goal: get patient feedback on SMS
14 interviews with mothers at Taybeh who
Missed an immunization appointment
Received SMS reminder
Questions about:
Missed appointments
SMS reminders
Scheduling
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
18/34
Patient Interviews | Conclusions
Everyone has at least 2 phones (some 3, 4, 5) People are usually happy with MCH programs at Tay
People like the SMS alerts
They want reminders before appointments, not afte
12 before, 1 after, 1 did not want Some people think wait times are long (9:30 am 1
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
19/34
Patient Interviews | Forgetting Appointm
I do not look at the handbook once a week, but I try to not mappointments. The nurses will talk to me if I miss an appointmIm late. If you come at a time that is not your appointment, ttell you to go home and then reschedule you and ask you to cthat new time.
When my appointments are at 9:30 I cant be there at that stime in Ramadan. I have a kid in high school. My kids dont haon me. The things that happen in the morning get moved to tafternoon.
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
20/34
Patient Interviews | SMS reminders
I was very surprised by it! It is very good, honestly. It is so mueasier.
SMS are good, phone is good, but whats better is when theyhusband a SMS and then called him after when we forgot aga
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
21/34
Patient Interviews | Interesting Quotes
When the neighborhood doesnt have running water, I feel liclinic is unusually crowded. It gets crazy. The health center alwwater so people come here instead.
My husbands family, they are [sabaawiyeh?]. I feel like they aneglectful of their children, I dont know whymy father-in-lahe had a daughter and he didnt want to take her to the immu
didnt want to take her to the doctor, because she is a girl.
The family health team is a wonderful system. They implemerecent times and its fantastic.
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
22/34
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
23/34
Identifying Vulnerable Patie
Part 3
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
24/34
Background | Vulnerable Patients
Mothers said they preferred messages before That costs more money
IF we send messages before, WHO should we r
Goal: identify patients at high risk of defaultiimmunizations
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
25/34
Methods | Vulnerable Patients
Cohort analysis
June birth & July births
BCG vaccine only so far
Given in groups
Late if received BCG after the first group >1 wafter birth
Data obtained from e-Health
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
26/34
Methods | Vulnerable Patients
Child gender
Maternal education
Child birth order
Ramadan or no Ramadan
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
27/34
Results: Ramadan | Vulnerable Patients
99 due during Ramadan, 65 due during not Ramadan
3.40x more likely to be > 1 week late (p < 0.0001)
Average Days Late Late > 1 week Total
Ramadan 8.3 57 99
Not Ramadan 3.1 11 65
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
28/34
Results: Education | Vulnerable Patients
No education: 1.75 RR of >1 week late (n=14, p=0.0
University: may work, have difficulty choosing exact
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
29/34
Results: Gender | Vulnerable Patients
Gender Median Delay # >1 week % Total
Female 4 33 38.8 85
Male 4 31 41.3 75
No statistically significant difference (p = 0.76)
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
30/34
Results: Birth Order | Vulnerable Patient
Born 1 or 2: 29% late > 1 week
Born > 2: 51% late > 1 week
Risk Ratio 1.71, p < 0.01
# Older Siblings Median Delay # >1 wk % Total
0 4 13 32 41
1 3 11 28 40
2 7 18 64 28
3 7 12 46 26
4 8.5 6 60 10
5 0 0 0 6
6 0 1 0 5
7 7 2 100 2
8 7 1 100 1
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
31/34
Future Plans
Send letter to clerks about updating phone numbers
Continue monitoring of patients who received SMSreminders for 6 months
Continue monitoring all patients in June cohort to sechanges by vaccine type and dose
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
32/34
Recommendations
Send SMS reminders to all patients scheduled for
immunizations during Ramadan before appointment
Consider sending pre-appointment reminders to vulpatients
Mothers with no education or primary-school education Girls who need MMR Dose 2
Babies with 2 or more older siblings
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
33/34
Recommendations
Maybe send SMS about prenatal nutrition
Check box in e-Health for patients who want SMS (c
Build system that integrates reminders automatically
Health I cant do this, but could facilitate partnership
Medic Mobile
-
8/12/2019 SMS Reminders for Missed Immunization Appointments
34/34
Questions?
Thanks to everyone at UNRWA HQ and Taybeh Health C
Funding: Duke University
Statistical analysis: STATA software
[email protected] me for raw data, interview transcripts, etc!