短信干预提高儿童就诊失约后就诊率的初步随机对照试验
A Pilot Randomized Controlled Trial of Text Messages to Improve Well-Child Visit Attendance After No-Show.
机构信息
Department of Family and Community Medicine (B Debinski, SS Daniel, and A Mayfield), Wake Forest University School of Medicine, Winston Salem, NC.
Department of Family and Community Medicine (B Debinski, SS Daniel, and A Mayfield), Wake Forest University School of Medicine, Winston Salem, NC.
出版信息
Acad Pediatr. 2024 Nov-Dec;24(8):1210-1219. doi: 10.1016/j.acap.2024.06.003. Epub 2024 Jun 7.
OBJECTIVE
Evaluate the effectiveness of text messages to systematically engage parents/guardians ("caregivers") to reschedule a well-child visit (WCV) that was missed ("no-show") and attend that rescheduled WCV visits.
METHODS
Patients <18 years in one of five pediatrics or family medicine clinics, in one health system in the Southeast US, were eligible. Patients without a rescheduled WCV after a no-show were randomized into intervention (text messages) or care-as-usual comparison, stratified by language (English/Spanish). Enrollment occurred May-July 2022. Up to three text messages were sent to caregivers one week apart via REDCap and Twilio, advising how to reschedule the missed appointment by phone or health portal. Primary outcomes were 1) rescheduling a WCV within 6 weeks of no-show and 2) completing a rescheduled WCV within 6 weeks. Risk differences (RD) and odds ratios (OR) were used to evaluate the effect of text messages.
RESULTS
Seven hundred and twenty patients were randomized and analyzed (texts: 361, comparison: 359). The proportion rescheduling WCV after text versus usual care was English: 18.85% versus 15.02%, respectively, and Spanish: 5.94% versus 8.14%, with overall RD+ 1.98% (95% CI: -1.85, 5.81) and OR 1.21 (95% CI: 0.79, 1.84; P-value .38). Completed WCV rates in text or usual care were English: 13.08% versus 6.59%, and Spanish: 5.81% versus 5.94% with texts associated with RD+ 2.83% (95% CI: 1.66, 4.00) and OR 1.86 (95% CI: 1.09, 3.19).
CONCLUSION
Text message follow-up after a no-show WCV may positively impact attendance at WCVs rescheduled in the subsequent 6 weeks.
TRIAL REGISTRATION
ClinicalTrials.gov NCT05086237.
目的
评估短信系统地联系家长/监护人（“照顾者”）以重新安排错过的儿童健康检查（WCV）并参加该重新安排的 WCV 检查的有效性。
方法
在美国东南部一个医疗系统的五家儿科或家庭医学诊所中，年龄在 18 岁以下的患者符合条件。错过 WCV 后未重新安排 WCV 的患者按语言（英语/西班牙语）分层，随机分为干预（短信）或常规护理比较组。入组时间为 2022 年 5 月至 7 月。通过 REDCap 和 Twilio，在一周内向照顾者发送最多三条短信，告知如何通过电话或健康门户重新安排错过的预约。主要结局为 1）在错过 WCV 后 6 周内重新安排 WCV，2）在 6 周内完成重新安排的 WCV。使用风险差异（RD）和优势比（OR）评估短信的效果。
结果
720 名患者被随机分配并进行分析（短信：361 例，常规护理：359 例）。与常规护理相比，短信组重新安排 WCV 的比例在英语为 18.85%，西班牙语为 5.94%，西班牙语为 15.02%，整体 RD+1.98%（95%CI：-1.85，5.81），OR 1.21（95%CI：0.79，1.84；P 值.38）。短信组或常规护理组完成 WCV 的比例在英语为 13.08%，西班牙语为 5.81%，RD+2.83%（95%CI：1.66，4.00），OR 1.86（95%CI：1.09，3.19）。
结论
错过 WCV 后的短信随访可能会对随后 6 周内重新安排的 WCV 就诊产生积极影响。
试验注册
ClinicalTrials.gov NCT05086237。
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