Postal Reminders Research Articles

A community-based vasectomy service in Leicestershire and Rutland – The patients' perspective

Objectives To evaluate the community-based vasectomy service from the patients' perspective and consider service provision in terms of access, process, quality and outcome.Method A prospective questionnaire was handed to 150 consecutive men attending for vasectomy from February to June 2007, for completion two weeks after surgery. Postal reminders were sent at four and eight weeks.Results The response rate was 73%, with 93% (n = 102) of the respondents considering the vasectomy unit to be of high quality. The comprehension of written information (93%) and the approachability of staff (83%) were both considered highly satisfactory. Most men were equivocal regarding proposed ‘holistic’ changes to the service. Men under 40 were more likely to be neutral or agree that vasectomy was embarrassing and preferred a male surgeon. The occurrence of complications did not affect satisfaction but increased the mean number of disturbed nights sleep and days taking analgesia. Suggestions for improvement pertained to the pre-operative information and the use of skin sutures.Conclusions The patients' evaluation of our vasectomy unit identified areas for improvement and reinforced good clinical practice. More research is needed to clarify the impact of age, ethnicity and other factors on the accessibility, acceptability and experience of vasectomy.

The Cost-Effectiveness of Postal and Telephone Methodologies in Increasing Routine Outcome Measurement Response Rates in CAMHS.

This small evaluation compared the cost effectiveness of different methods of questionnaire administration (General system improvements, postal reminders and telephone reminders) sent as part of the CORC protocol employed by three community CAMHS teams. Return rates and costs of these different methods were recorded and compared with a 3-month baseline (during which questionnaires were distributed using existing systems) and following 3-month intervention period. Comparison of return rates between baseline and intervention periods indicated that administrative improvements and a centralised mailing process increased the return rate of questionnaires by 11%. A further limited increase of 16% was achieved when a postal reminder was added, whilst an additional telephone reminder significantly increased the return rate by 34%. Telephone administration and telephone follow-up to initial postal administration is more expensive overall than postal methods alone; however, the cost per return is substantially less. An initial postal mailing plus telephone reminder is predicted to provide services with more representative data on service effectiveness and acceptability than postal methods alone. The findings of this small scale project are useful in informing the Routine Outcome Measurement (ROM) administration protocol and highlight the importance of resourcing ROM and increasing the quality of the data collected.

A Randomized Controlled Trial of SMS Text Messaging versus Postal Reminder to Improve Attendance after Lipid Lowering Therapy in Primary Care

Sung Ja Cho, Young Sik Kim, Ho Cheol Shin, Eun Ju Sung, Dae Hyun Kim, Sangyeoup Lee, Tae Hee Jeon, Yun Jun Yang, Chung Hwan Cho, Hee-Cheol Kang, Yoo Seock Cheong Department of Family Medicine, University of Ulsan College of Medicine, Seoul, Sungkyunkwan University School of Medicine, Seoul, Keimyung University College of Medicine, Daegu, Pusan National University School of Medicine, Busan, Seoul Veterans Hospital, Seoul, Inje University College of Medicine, Goyang, Jeunju Jesus Hospital, Jeonju, Yonsei University College of Medicine, Seoul, Dankook University College of Medicine, Cheonan, Korea

Large scale questionnaire survey on respiratory health in Sweden: Effects of late- and non-response

Participation rates in epidemiologic studies conducted with postal questionnaires have steadily declined since 1970s. This can lead to an increased risk for selection bias. The aim of this study was to examine cause and effect of non-response in a large cross sectional study assessing respiratory health in western Sweden. The study sample was 29,218. The response rate to the initial postal questionnaire was 33%. The response rates to subsequent postal reminders were 15%, 7% and 7% of eligible participants totalling a participation of 62%. Of those who did not respond to the postal survey, a random sample of 400 subjects were identified and contacted for interview by telephone. Non-responders did not differ significantly in prevalence of airway diseases or symptoms when compared with responders. Male sex, young age and smokers were underestimated among non-responders. No clear trends in prevalence of respiratory symptoms and report of asthma were found with delayed response to the postal survey. The proportion of smokers and men increased with increasing number of reminders. Letters reminding subjects about the study did increase the participation rate but did not alter the risk estimates. We conclude that with a response rate of 62%, our estimate of disease and symptom prevalence was not biased in this Swedish population. However, smoking was underestimated. No general trend for late-responders was seen and therefore we conclude that extrapolation of results to non-responders is not possible in our study. Causes of non-response were mainly due to circumstantial factors.

Quality of life in adults with childhood-onset of Complex Regional Pain Syndrome type I

Introduction The clinical presentation of Complex Regional Pain Syndrome type I (CRPS I) in children differs compared to the presentation in adults. Reported results of treatment of CRPS I in children are usually more favourable and seem better than the reported treatment of adults with CRPS I. We investigated the quality of life (QoL) in adults who have been treated for childhood-onset CRPS I. Methods We performed a retrospective chart review on signs, symptoms and treatment of all patients, seen and treated for CRPS I in childhood (age <16 years). At one time point a survey was sent by mail to all adult patients with onset CRPS I in childhood with a postal reminder after one month. The first part of the survey consisted of questions focused on the experience of chronic pain and other current complaints in the affected extremity. The second part consisted of a generic-health-related quality of life instrument (SF-36). Results Forty-two patients (75%) responded to our survey. The median follow-up period was 12 years (SD 4.7; range 2–22). Fifty-two percent of all patients complained about pain at the time of follow-up. Of the 12 symptoms and signs, 4 are improved, 1 is worse and the remainder are unchanged. Fifteen patients experienced one or more documented relapses. General health and physical functioning (2 out of 8 scales on the SF 36) were lower in patients compared to those of the literature. Conclusion In contrast to the literature, the prognosis of childhood-onset CRPS I seems less favourable than usually reported, and is comparable to the prognosis of the adult-onset CRPS I in view of a decreased quality of life and a large relapse percentage (33%) at long-term follow-up.

Do postal reminders increase postpartum screening of diabetes mellitus in women with gestational diabetes mellitus? A randomized controlled trial

Women with previous gestational diabetes mellitus rarely receive the recommended 2-hour oral glucose tolerance test (OGTT) after delivery. We sought to determine whether postal reminders to be sent after delivery to a patient, her physician, or both would increase screening rates. Patients were assigned randomly to 4 groups: reminders sent to both physician and patient, to physician but not patient, or to patient but not physician or no reminders were sent. The primary outcome was the proportion of patients who underwent an OGTT within 1 year after delivery. The secondary outcome was the performance of other postpartum screening tests. OGTT rates were significantly increased in the physician/patient reminder group (49/81 women; 60.5%), in the patient-only reminder group (42/76 women; 55.3%), and in the physician-only reminder group (16/31 women; 51.6%) compared with the no reminder group (5/35 women; 14.3%; P < .05). Postpartum reminders greatly increased screening rates for women with gestational diabetes mellitus.

Out-patient appointments: a necessary evil? a literature review and survey of patient attendance records

Aims and MethodTo describe the effect of a postal reminder system on UK adult psychiatry clinic attendance. A literature review was completed and a serial cross-sectional survey of patient attendance records in an inner-city psychiatric hospital during 2006 and 2007 was undertaken.ResultsA simple postal prompt reduces non-attendance by up to 50% and data from the serial cross-sectional survey of attendance records (n=36) powered at 77% supported this finding. Postal prompts in the survey accounted for 30% improvement in the variance (r2).Clinical ImplicationsA simple postal prompt that takes less than 30 s to read, sent up to 2 weeks prior to the appointment improves attendance by up to 50% and is useful for maintaining standards of excellence.

Family Physicians' Experiences With Community Mental Health Centers: A Multilevel Analysis

Family Physicians' Experiences With Community Mental Health Centers: A Multilevel Analysis

Prevalence of widespread pain and associations with work status: a population study

BackgroundThis population study based on a representative sample from a Swedish county investigates the prevalence, duration, and determinants of widespread pain (WSP) in the population using two constructs and estimates how WSP affects work status. In addition, this study investigates the prevalence of widespread pain and its relationship to pain intensity, gender, age, income, work status, citizenship, civil status, urban residence, and health care seeking.MethodsA cross-sectional survey using a postal questionnaire was sent to a representative sample (n = 9952) of the target population (284,073 people, 18–74 years) in a county (Östergötland) in the southern Sweden. The questionnaire was mailed and followed by two postal reminders when necessary.ResultsThe participation rate was 76.7% (n = 7637); the non-participants were on the average younger, earned less money, and male. Women had higher prevalences of pain in 10 different predetermined anatomical regions. WSP was generally chronic (90–94%) and depending on definition of WSP the prevalence varied between 4.8–7.4% in the population. Women had significantly higher prevalence of WSP than men and the age effect appeared to be stronger in women than in men. WSP was a significant negative factor – together with age 50–64 years, low annual income, and non-Nordic citizen – for work status in the community and in the group with chronic pain. Chronic pain but not the spreading of pain was related to health care seeking in the population.ConclusionThis study confirms earlier studies that report high prevalences of widespread pain in the population and especially among females and with increasing age. Widespread pain is associated with prominent effects on work status.

Views, attitudes and self-assessed training needs of Scottish community pharmacists to public health practice and competence

To assess the education and training needs of community pharmacists to support the delivery of an expanded public health role. Setting Community pharmacy in Scotland. Two focus groups of community pharmacists (n = 4 in each) in geographically distinct regions of Scotland explored issues of public health function, competencies and education and training. Findings from thematic analysis were used to develop a draft postal questionnaire. Following piloting, pharmacist managers from a random sample of 500 community pharmacies in Scotland were contacted by telephone to ascertain the number of pharmacists working in each pharmacy in the following 14-day period. A survey pack containing questionnaires for each identified pharmacist working in the study period was sent by post to the pharmacist manager in each pharmacy. The questionnaire contained items on: demographics; views and attitudes towards: public health; competencies for public health practitioners; and education and training needs. One postal reminder was sent 2 weeks later. Main themes identified from focus group discussions; questionnaire response rate; views and attitudes towards public health competencies and education and training. Four hundred and fifteen managers agreed to participate, providing 904 potential participants. The response rate was 25% (223/904). Most (n = 179, 80%) were aware of the term 'pharmaceutical public health'. While a majority saw the importance of public health to their practice (n = 177, 79%) agreeing/strongly agreeing, they were less comfortable with the term 'specialist'. Respondents viewed competencies relating to health promotion (n = 192, 86%) more relevant than surveillance (n = 70, 31%), risk management (n = 29, 13%) and strategic developments (n = 12, 5%). Responses indicated a desire for education and training with more than half (n = 121, 54%) agreeing/strongly agreeing that they had a need now, with 69% (n = 153) expressing a future need. Results should be interpreted with caution due to the response rate. However, this research highlights the self assessed gap in competence related to pharmaceutical public health for community pharmacists in Scotland.

Impact of postal and telephone reminders on pick-up rates of unclaimed e-prescriptions

To investigate the impact of a reminder (i.e., a mailed letter or short telephone call) from the pharmacy to patients, compared with no reminder in a control group, on the pick-up rates of unclaimed e-prescriptions. Patients, with e-prescriptions transmitted to four large community pharmacies in two counties in northern Sweden and remaining unclaimed after 4 weekdays, were randomised to one of two intervention groups (a mailed reminder or a short telephonic reminder) or a control group. Rates of patients' pick-up of their e-prescriptions at follow-up after about 1, 2 and 3 weeks. Altogether, 320 patients with e-prescriptions, transmitted from March 21 through April 6 and not picked-up or dispensed, were identified and randomised to the study. There were no statistically significant differences in overall pick-up rates between the groups or with respect to gender. However, pick-up rates increased with increasing age. Higher pick-up rates were observed for two subgroups (but only in the mailed reminder group compared with controls)--for cardiovascular drugs to men and for respiratory drugs to adolescents and young adults. A reminder (i.e., a mailed letter or short telephone call) from the pharmacy to the patient had no statistically significant effect on overall pick-up rates of unclaimed e-prescriptions compared with no reminders.

Encouraging Attendance at Outpatient Appointments: Can We Do More?

Non-attendance at new outpatient appointments is a challenge for health services. Patients with treatable morbidity may fail to receive care from which they would benefit, and scarce resources are wasted. Therefore, a literature review was undertaken to assess the effectiveness of appointment reminders as a means of increasing attendance and reducing 'Did not Attend' rates at new outpatient appointments. Electronic databases were interrogated using a combination of MeSH terms and truncated keywords. In addition, the reference lists of papers were studied to identify additional relevant material. Telephone and postal reminders appear effective, particularly if received within a day of scheduled appointments. Postal reminders offering a reward for attendance, threatening sanctions for non-attendance, and providing information about the clinic appear more effective than standard reminders. No studies assessing the impact of measures including e-mail or text messaging were identified. Many studies were conducted in psychiatric settings outwith the United Kingdom raising issues of generalisability. In addition, no assessment of how initiatives impact on inequalities in service access were found. There is scope to increase attendance and reduce non-attendance at outpatient appointments but initiatives should be piloted in conjunction with robust evaluative frameworks.

172 - 18 Month Developmental Outcome of Children Born to Mothers with Type 1 Diabetes who Experienced Severe Hypoglycemia During Pregnancy.

A 2 hr oral glucose tolerance test will identify more women at risk for type 2 diabetes when screening postpartum in gestational diabetics. Heather D. Clark*, Alan Karovitch, Erin J Keely, Departments of Medicine and Obstetrics/Gynecology, University of Ottawa, Ottawa ON The CDA 2003 Clinical Practice guidelines recommends screening women with gestational diabetes (GDM) in the first 6 months postpartum for type 2 Diabetes Mellitus (T2DM) with a 2 hour 75 g oral glucose tolerance test (2 hr GTT) as a fasting glucose may lead to under-diagnosis of T2DM (Grade D, consensus) and can not identify impaired glucose tolerance (IGT). We performed a randomized controlled trial evaluating the effect of postal reminders on screening rates in women with GDM. All women from this cohort who completed a 2 hr GTT were included. We determined the rates of impaired fasting glucose (IFG) and T2DM diagnosed by a fasting glucose and IGT and T2DM diagnosed by a 2 hr GTT. Of the 428 patients 156 women completed a 2 hr GTT. 20/156 (12.8%) were diagnosed with IFG, 27/156 (17.3%) were diagnosed with IGT and 4/156 (2.6%) were diagnosed with both. 3/156 (1.9%) women were diagnosed with T2DM by a fasting glucose and 8/156 (5.1%) were diagnosed based on the 2 hr glucose result only. If a two step testing strategy was utilized (i.e. only women with fasting glucose >5.6 mmol/L screened with 2 hr GTT ) 15/27 (56%) of women with IGT and 3/11 (27%) of women with T2DM would be missed. In summary, we found if women were screened postpartum with a fasting glucose alone or a two step screening strategy miss a substantial proportion of women with IGT and T2DM, were missed supporting the CDA recommendations.

A 2 hr oral glucose tolerance test will identify more women at risk for type 2 diabetes when screening postpartum in gestational diabetics.

The CDA 2003 Clinical Practice guidelines recommends screening women with gestational diabetes (GDM) in the first 6 months postpartum for type 2 Diabetes Mellitus (T2DM) with a 2 hour 75 g oral glucose tolerance test (2 hr GTT) as a fasting glucose may lead to under-diagnosis of T2DM (Grade D, consensus) and can not identify impaired glucose tolerance (IGT). We performed a randomized controlled trial evaluating the effect of postal reminders on screening rates in women with GDM. All women from this cohort who completed a 2 hr GTT were included. We determined the rates of impaired fasting glucose (IFG) and T2DM diagnosed by a fasting glucose and IGT and T2DM diagnosed by a 2 hr GTT. Of the 428 patients 156 women completed a 2 hr GTT. 20/156 (12.8%) were diagnosed with IFG, 27/156 (17.3%) were diagnosed with IGT and 4/156 (2.6%) were diagnosed with both. 3/156 (1.9%) women were diagnosed with T2DM by a fasting glucose and 8/156 (5.1%) were diagnosed based on the 2 hr glucose result only. If a two step testing strategy was utilized (i.e. only women with fasting glucose >5.6 mmol/L screened with 2 hr GTT ) 15/27 (56%) of women with IGT and 3/11 (27%) of women with T2DM would be missed.

Nonresponse Bias and Cost-Effectiveness in a Norwegian Survey of Family Physicians

Low response rates are a common problem in surveys of family physicians leading to uncertainty about the validity of results. In this study, the authors examined the association between multiple reminders and nonresponse bias, survey estimates and costs in a survey of family physicians in Norway (N = 3,463). After three postal reminders and one telephone follow-up, the response rate was 65.9%. They analyzed differences in nine demographic and practice variables between respondents and nonrespondents, the effect of nonresponse bias on survey estimates, and the cost-effectiveness of each reminder. Statistically significant differences between respondents and nonrespondents were found for six variables. However, demographic and practice variables had little association with the main outcome variables, and the overall survey estimates changed little with additional reminders. In addition, the cost-effectiveness of the final reminders was poor.

A survey of midwives’ views on providing aspects of antenatal care in Estonia

Objective to survey the views of midwives in Estonia about who they considered should have responsibility for carrying out certain aspects of antenatal care (ANC) in Estonia. Design, setting and study population in collaboration with key stakeholder organisations, the authors developed eight statements on aspects of ANC and five combinations of possible professionals (including midwives obstetrician-gynaecologists and various combinations of the two) who could have responsibility for carrying out those aspects of ANC and included them in a self-administered questionnaire. The questionnaire was sent with a covering letter and stamped addressed return envelope to all 366 midwives in Estonia. Two postal reminders were sent to non-responders. Results the response rate was 73.5%. There was no consensus among respondents about whose responsibility it was to diagnose pregnancy, carry out the risk assessment of a pregnancy, or carry out fetal monitoring during pregnancy. There was consensus among respondents that either midwives or obstetrician-gynaecologists could have responsibility for referring for further tests and examinations if a pregnancy was thought to be at risk. There was also consensus that counselling, biometry and blood pressure monitoring should be the sole responsibility of midwives. Key conclusions despite national policy to shift ANC towards being midwifery-led and despite provisions in a European Directive permitting most roles in ANC to be performed autonomously by trained midwives, there is no consensus among Estonian midwives that all aspects of ANC should be their responsibility at present. Thorough research is required to establish which specific ANC roles Estonian midwives are not willing to take responsibility for, and to examine why they are not willing to take on such roles.

Ensayo clínico aleatorizado acerca de la efectividad del recordatorio postal para aumentar la cobertura vacunal contra tétanos-difteria en población adulta joven

Objective To evaluate the effectiveness of individual postal reminders compared with no action of any kind in increasing the tetanus-diphtheria immunization rate in the population aged between 24 and 30 years old in an area where a general population strategy was simultaneously being conducted through information posters on tetanus vaccination. Method We performed an open, randomized clinical trial with parallel groups among the population aged 24-30 years old in a basic health area with 13,523 inhabitants over a 3-month period in 2005. There were 311 patients in the control group and 311 in the experimental group, after exclusion of individuals correctly vaccinated according to the computerized medical records system. The intervention evaluated was a postal reminder on tetanus vaccination. The response variable was the immunization rate due to the intervention. Other variables studied were sex, age, reason for seeking vaccination, compliance with the vaccination timetable, whether vaccination was rejected, and whether prior vaccination was verified. The statistical analysis consisted of Student's t-test and the χ 2 test, with a confidence level of 95% (p < 0.05). Results Vaccination coverage among the general population at the end of 2005 was 75.6%. After the postal reminder, 22.2% of the control group and 40.5% of the experimental group were correctly vaccinated. Conclusions Individual postal reminders sent to the population aged between 24 and 30 years is effective in increasing the immunization rate in this age group. Periodic reminders could help to ensure continuity in vaccination of the adult population.

Women?s Views and Outcomes of an Educational Intervention Designed to Enhance Psychosocial Support for Women During Pregnancy

Identification of psychosocial issues in pregnant women by screening is difficult because of the lack of accuracy of screening tools, women's reluctance to disclose sensitive issues, and health care practitioner's reluctance to ask. This paper evaluates if a health professional education program, a new (ANEW) approach, improves pregnant women's ratings of care and practitioner's listening skills and comfort to disclose psychosocial issues. Midwives and doctors from Mercy Hospital for Women, Melbourne, Australia, were trained from August to December 2002. English-speaking women (<20 wks' gestation) were recruited at their first visit and mailed a survey at 30 weeks (early 2002) before and after (2003) the ANEW educational intervention. Follow-up was by postal reminder at 2 weeks and telephone reminder 2 weeks later. Twenty-one midwives and 5 doctors were trained. Of the eligible women, 78.2 percent (584/747) participated in a pre-ANEW survey and 73.3 percent (481/657) in a post-ANEW survey. After ANEW, women were more likely to report that midwives asked questions that helped them to talk about psychosocial problems (OR 1.45, CI 1.09-1.98) and that they would feel comfortable to discuss a range of psychosocial issues if they were experiencing them (coping after birth for midwives [OR 1.51, CI 1.10-2.08] and feeling depressed [OR 1.49, 1.16-1.93]; and concerns relating to sex [OR 1.35, CI 1.03-1.77] or their relationships [OR 1.36, CI 1.00-1.85] for doctors). The ANEW program evaluation suggests trends of better communication by health professionals for pregnant women and should be evaluated using rigorous methods in other settings.

General practitioners' knowledge and practice of complementary/alternative medicine and its relationship with life-styles: a population-based survey in Italy

BackgroundThe growing popularity of CAM among the public is coupled with an ongoing debate on its effectiveness, safety, and its implications on the reimbursement system. This issue is critically important for GPs, who have a "gatekeeping" role with respect to health care expenditure. GPs must be aware of medications' uses, limitations and possible adverse effects. Our objective was to explore GPs' knowledge of CAM and patterns of recommendation and practice, as well as the relationship between such patterns and GPs' life-styles.MethodsA cross-sectional study was conducted in Tuscany, a region of central Italy. One hundred percent female GPs (498) and a 60% random sample of male GPs (1310) practising in the region were contacted through a self-administered postal questionnaire followed by a postal reminder and telephone interview.ResultsOverall response rate was 82.1%. Most respondents (58%) recommended CAM but a far smaller fraction (13%) practised it; yet 36% of CAM practitioners had no certificated training. Being female, younger age, practising in larger communities, having had some training in CAM as well as following a vegetarian or macrobiotic diet and doing physical activity were independent predictors of CAM recommendation and practice. However, 42% of GPs did not recommend CAM to patients mostly because of the insufficient evidence of its effectiveness.ConclusionCAM knowledge among GPs is not as widespread as the public demand seems to require, and the scarce evidence of CAM effectiveness hinders its professional use among a considerable number of GPs. Sound research on CAM effectiveness is needed to guide physicians' behaviour, to safeguard patients' safety, and to assist policy-makers in planning regulations for CAM usage.

Efficacy of an intensive prevention program in coronary patients in primary care, a randomised clinical trial

Background Most studies that have analysed the effect of secondary prevention of coronary heart disease come from hospitals. Those that are community-based have been conducted mainly by nurses and follow-up was generally too short to show impact on cardiovascular events. Methods This is a multi-centre randomised controlled clinical trial in which patients in the intervention group received periodic postal reminders to see their general practitioner every three months during a 3-year follow-up. General practitioners reinforced healthy lifestyle recommendations to patients and reviewed drug therapies at these quarterly intervals. Patients in the control group received usual care. Results A total of 983 patients aged 30–79 were included. During the 3-year follow-up, 67 patients died and 156 experienced a non-fatal cardiovascular event. The event rates and all-cause mortality were similar in the intervention and control groups (24.0% and 23.5%, and 8.1% and 9.9%, respectively). Improvement in quality of life was similar in both groups. Blood pressure and high-density lipoprotein cholesterol were more frequently within recommended levels in the intervention group than in controls: odds ratio 1.63, 95% confidence interval 1.05–2.51, and odds ratio 2.61, 95% confidence interval 1.32–5.18, respectively. Conclusions Intensive secondary prevention conducted by general practitioners may improve long-term blood pressure control and increase high-density lipoprotein cholesterol in patients with stable coronary disease.