Receive Email Reminders Research Articles

Which Outreach Modes Improve Response Rates to Physician Surveys? Lessons from an Experiment at the American Board of Internal Medicine.

Physicians are a notoriously difficult group to survey due to a low propensity to respond. We investigate the relative effectiveness of reminder phone calls, pre-notification postcards, mailed paper surveys, and $1 upfront incentives for boosting survey response rate by embedding a randomized experiment into a mixed-mode operational survey at the American Board of Internal Medicine in 2019. Expected response rates and average marginal effects for each follow-up method were computed from a logistic regression model. The control group which only received email reminders achieved a response rate of 18.2%, 95% CI: (15.0%, 21.9%). The intervention group which included reminder emails, pre-notification postcards, and mailed paper surveys with $1 incentives achieved a response rate of 43.1%, 95% CI: (38.8%, 47.5%). Mailed paper surveys yielded the largest percentage point increase in response rate of 11.2%, 95% CI: (7.3%, 15.2%), while $1 upfront monetary incentives and phone call reminders increased survey response rate by 5.9%, 95% CI: (1.6%, 10.2%) and 5.5%, 95% CI: (2.6%, 8.3%) respectively. Pre-notification postcards are associated with a 2.0%, 95% CI: (-1.7%, 5.6%) increase in survey response rate. Cost-effectiveness for each method is discussed. This research supports optimal decision making for researchers when planning a physician survey study.

Correction: A Smartphone App to Improve Medication Adherence in Patients With Type 2 Diabetes in Asia: Feasibility Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/14914.].

A Smartphone App to Improve Medication Adherence in Patients With Type 2 Diabetes in Asia: Feasibility Randomized Controlled Trial.

BackgroundThe efficacy of smartphone apps for improving medication adherence in type 2 diabetes is not well studied in Asian populations.ObjectiveThis study aimed to determine the feasibility, acceptability, and clinical outcomes of using a smartphone app to improve medication adherence in a multiethnic Asian population with type 2 diabetes.MethodsWe block randomized 51 nonadherent and digitally literate patients with type 2 diabetes between the ages of 21 and 75 years into two treatment arms (control: usual care; intervention: usual care+Medisafe app) and followed them up for 12 weeks. Recruitment occurred at a public tertiary diabetes specialist outpatient center in Singapore. The intervention group received email reminders to complete online surveys monthly, while the control group only received an email reminder(s) at the end of the study. Barriers to medication adherence and self-appraisal of diabetes were assessed using the Adherence Starts with Knowledge-12 (ASK-12) and Appraisal of Diabetes Scale (ADS) questionnaires at baseline and poststudy in both groups. Perception toward medication adherence and app usage, attitude, and satisfaction were assessed in the intervention group during and after the follow-up period. Sociodemographic data were collected at baseline. Clinical data (ie, hemoglobin A1c, body mass index, low-density lipoprotein, high-density lipoprotein, and total cholesterol levels) were extracted from patients’ electronic medical records.ResultsA total of 51 (intervention group: 25 [49%]; control group: 26 [51%]) participants were randomized, of which 41 (intervention group: 22 [88.0%]; control group: 19 [73.1%]) completed the poststudy survey. The baseline-adjusted poststudy ASK-12 score was significantly lower in the intervention group than in the control group (mean difference: 4.7, P=.01). No changes were observed in the clinical outcomes. The average 12-week medication adherence rate of participants tracked by the app was between 38.3% and 100% in the intervention group. The majority (>80%) of the participants agreed that the app was easy to use and made them more adherent to their medication.ConclusionsOur feasibility study showed that among medication-nonadherent patients with type 2 diabetes, a smartphone app intervention was acceptable, improved awareness of medication adherence, and reduced self-reported barriers to medication adherence, but did not improve clinical outcomes in a developed Asian setting.

The Feasibility and Acceptability of a Web-Based Alcohol Management Intervention in Community Sports Clubs: A Cross-Sectional Study.

BackgroundThe implementation of comprehensive alcohol management strategies can reduce excessive alcohol use and reduce the risk of alcohol-related harm at sporting venues. Supporting sports venues to implement alcohol management strategies via the Web may represent an effective and efficient means of reducing harm caused by alcohol in this setting. However, the feasibility and acceptability of such an approach is unknown.ObjectiveThis study aimed to identify (1) the current access to and use of the Web and electronic devices by sports clubs; (2) the perceived usefulness, ease of use, and intention to use a Web-based program to support implementation of alcohol management policies in sports clubs; (3) the factors associated with intention to use such a Web-based support program; and (4) the specific features of such a program that sports clubs would find useful.MethodsA cross-sectional survey was conducted with club administrators of community football clubs in the state of New South Wales, Australia. Perceived usefulness, ease of use and intention to use a hypothetical Web-based alcohol management support program was assessed using the validated Technology Acceptance Model (TAM) instrument. Associations between intention to use a Web-based program and club characteristics as well as perceived ease of use and usefulness was tested using Fisher’s exact test and represented using relative risk (RR) for high intention to use the program.ResultsOf the 73 football clubs that were approached to participate in the study, 63 consented to participate and 46 were eligible and completed the survey. All participants reported having access to the Web and 98% reported current use of electronic devices (eg, computers, iPads/tablets, smartphones, laptops, televisions, and smartboards). Mean scores (out of a possible 7) for the TAM constructs were high for intention to use (mean 6.25, SD 0.87), perceived ease of use (mean 6.00, SD 0.99), and perceived usefulness (mean 6.17, SD 0.85). Intention to use the Web-based alcohol management program was significantly associated with perceived ease of use (P=.02, RR 1.4, CI 1.0-2.9), perceived usefulness (P=.03, RR 1.5, CI 1.0-6.8) and club size (P=.02, RR 0.8, CI 0.5-0.9). The most useful features of such a program included the perceived ability to complete program requirements within users’ own time, complete program accreditation assessment and monitoring online, develop tailored action plans, and receive email reminders and prompts to complete action.ConclusionsA Web-based alcohol management approach to support sports clubs in the implementation of recommended alcohol management policies appears both feasible and acceptable. Future research should aim to determine if such intended use leads to actual use and club implementation of alcohol management policies.

The impacts of email reminder/recall on adolescent influenza vaccination

BackgroundWe sought to: (1) explore the feasibility of using email for seasonal influenza vaccination reminders to parents of adolescents and (2) assess influenza vaccination rates among adolescents whose parents were randomized to either receive or not receive email reminders. MethodsEmail addresses were obtained for parents of patients 10–18years from 4 practices in Michigan. Addresses were randomized to either receive email reminders, or not. Reminder messages were sent during October 2012-March 2013 (Season 1) and October 2013-March 2014 (Season 2). Vaccination status was determined 60days following the last email reminder for each season using the statewide Michigan Care Improvement Registry (MCIR); per protocol bivariate and multivariate logistic regression analyses were conducted to evaluate reminder notification. ResultsAfter email cleaning, testing, and matching with MCIR, approximately half of email addresses (2348 of 5312 in Season 1; 3457 of 6549 in Season 2) were randomized. Bivariate analyses found that influenza vaccination within 60days after notification date was similar among those notified (34%) versus not notified (29%) in both Season 1 (p=0.06) and Season 2 (39% vs. 37%, p=0.20). However, multivariate models adjusted for season, site, and receipt of notification in two seasons found a higher likelihood of influenza vaccination among children that received notification (aOR=1.28, 95% CI=1.09, 1.51); in addition, differences in influenza vaccination were also observed between practice sites (range: p=0.15 to p<0.001). ConclusionsWe found that practice-based email influenza vaccine reminders to parents of adolescents are feasible, but not without complications. Our study demonstrates that email reminders from practices can yield increases in influenza vaccination rates among adolescents. Practices should consider email as an option for influenza reminders and establish business practices for collecting and maintaining patient email addresses.This study is registered at www.ClinicalTrials.gov id #NCT01732315.

Client involvement in a web-based intervention targeting substance abuse treatment in the criminal justice system

Results This study uses data from the first 84 clients who completed the web-based program. The data provided from this study covers probationer involvement with the MAPIT intervention in relation to early goal planning and electronic reminder selection on positive 2-month outcomes. In terms of early goal planning, clients were most likely to select goals such as “Make a list of things I could do to stay sober” (62%); “Write down the date and time of my first PO visit” (52%); and “Get a binder to keep my probation documents in” (50%). In terms of reminder preference, 51 percent wanted to receive text or email reminders about their goals (31% requested text; 20% requested email). Most clients wanted reminders early in the week, and in the morning. Women, low/moderate risk, and older clients (> 35 years old) were more likely to ask for reminders. Those who selected to receive email reminders selected the greatest number of goals (M = 5.3) compared to those who chose text (M = 4.1) or no reminder (M = 3.0), F = 6.20, p = .004. In term of positive 2-month outcomes, probationers in the email reminder group were significantly more likely to be abstinent and were significantly more likely to initiate treatment at follow-up (c = 6.25, df = 2, p < .05 and c = 6.51, df = 2, p < .05, respectively), compared to the text reminder and no reminder groups. Early signs of non-responding were indicated by participants choosing the minimum number of goals (2), not selecting to receive electronic reminders, and not completing any goals by visit two, and were indicative of poorer outcomes.

You've Got Mail … and Need Follow‐up: The Effect and Patient Perception of E‐mail Follow‐up Reminders After Emergency Department Discharge

The hypothesis was that a reminder about recommended primary care physician (PCP) follow-up, sent via e-mail to patients discharged from the emergency department (ED), would increase the proportion of patients who followed up with their PCPs within the recommended time frame. Patient receptiveness to e-mail follow-up reminders was also assessed. This was a mixed methods clinical intervention study with subjects randomized either to receive the usual care discharge instructions only or to also receive a reminder e-mail message the day after the ED visit. The reminder e-mail contained the subject's PCP's name and address and the recommended PCP follow-up time interval. A blinded review of outpatient PCP medical records was conducted to determine whether and when follow-up occurred. Researchers attempted to contact patients with a telephone survey 2 weeks after their ED visits. The primary outcomes between groups were compared using chi-square tests and relative risks (RRs) with 95% confidence intervals (CIs). Thirty-three percent of the intervention group and 32% of the control group followed-up as recommended (RR = 1.04, 95% CI = 0.81 to 1.33); 52% of the intervention group and 48% of the control group followed-up within 10 days of the recommended time (RR = 1.08, 95% CI = 0.91 to 1.29). The 334 patients (57%) successfully contacted via telephone demonstrated a high interest in receiving future e-mail reminders (75%), with the group that received e-mail reminders more likely to want one in the future than those who did not receive e-mail reminders (82.5% vs. 69.76%; p = 0.04). E-mail reminders sent after ED visits did not improve patients' adherence to the recommended timing of primary care follow-up contained in discharge instructions. Subjects in both the control and the intervention groups favorably viewed the concept of e-mail reminders, suggesting that the value of e-mail reminders after ED discharge may be in areas such as patient satisfaction that were not specifically targeted for measurement in this study.

Effectiveness of an internet-delivered cognitive-behavioural aid to improve mental wellbeing: a randomised controlled trial

BackgroundInterventions to promote mental wellbeing can bring benefits both to the individual, improving mood and psychological functioning, and to society, in terms of economic prosperity and social cohesion. An approach using the principles of cognitive behavioural therapy to encourage healthier patterns of thinking and behaviour could offer an individual-level intervention to promote positive mental health. The internet allows large-scale and low-cost delivery of health-promoting interventions. We assessed the effectiveness of a self-directed internet-delivered cognitive behavioural skills training aid in improving mental wellbeing in the general population. MethodsWe undertook a randomised trial with a waiting-list control. Using adverts on a national health portal (NHS Choices) and through its mailing list, we recruited 3070 participants aged 18 years or older, resident in England, willing to give their email address, and with access to a fully automated web-based intervention. Recruitment took place during 2 weeks in September, 2010, with final follow-up in December, 2010. Participants were randomly assigned to intervention or control (1:1) with automated software that was integrated into the online trial administration system (block size of 2). The intervention was the self-directed internet-based cognitive behavioural skills programme MoodGYM. Participants in the intervention group received email reminders every week to log into the trial portal to access the intervention. The comparator was a control group on a waiting list who received access to the intervention after the trial was completed. Participants were not masked to assignment. During the trial, the control participants did not receive any specific intervention or email reminders. The primary outcome was mental wellbeing measured with the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Secondary outcomes were CES-D depression scores, GAD-7 anxiety scores, EQ5D quality of life scores, physical activity, and health service use. All outcomes were measured at baseline, 6 weeks, and 12 weeks. Findings1529 (50%) of 3070 participants completed final follow-up at 12 weeks (1123 of 1536 in the control group and 406 of 1534 in the intervention group). No relation between baseline measures and withdrawal was noted. The analysis of WEMWBS scores with a linear mixed model for repeated measures showed no difference between intervention and control group at baseline (difference −0·124 points, 95% CI −0·814 to 0·566), and significant improvements (p<0·0001 for both) for the intervention group at 6 weeks (2·542 points, 1·693 to 3·390) and at 12 weeks (2·876 points, 1·933 to 3·819). The model showed a highly significant (p<0·0001) intervention by time interaction effect. There were also significant improvements in self-rated scores of depression and anxiety. In view of the attrition rate, a sensitivity analysis with imputed missing values was undertaken, which also showed a significant positive effect (intervention by time interaction effect p<0·001) of the intervention. InterpretationParticipants assigned to the internet-based cognitive behavioural therapy aid MoodGYM had an average increase of roughly 3 points on the WEMWBS mental wellbeing scale compared with no increase for participants on a waiting list. This difference on the WEMWBS scale is about a third of a SD (SD in general population, 8·3). In a low-cost automated public health intervention designed to shift the whole population distribution of mental wellbeing, a small difference per individual could bring a major benefit in population terms. As to limitations, we undertook an unmasked waiting-list controlled study with no placebo; furthermore (as with other web-based interventions), there was high attrition, particularly in the intervention group. This high attrition is perhaps of less importance in a health promotion intervention in a non-clinical population. FundingNHS Choices.

Is Physician Engagement With Web-Based CME Associated With Patientsʼ Baseline Hemoglobin A1c Levels? The Rural Diabetes Online Care Study

To investigate the association between physician participants' levels of engagement in a Web-based educational intervention and their patients' baseline diabetes measures. The authors conducted a randomized trial of online CME activities designed to improve diabetes care provided by family, general, and internal medicine physicians in rural areas of 11 southeastern states between September 2006 and July 2008. Using incidence rate ratios derived from negative binomial models, the relationship between physicians' engagement with the study Web site and baseline proportion of their patients having controlled diabetes (hemoglobin A1c < or = 7%) was explored. One hundred thirty-three participants (intervention = 64; control = 69) provided information for 1,637 patients with diabetes. In the intervention group, physicians in practices in the worst quartiles of A1c control were least engaged with the study Web site in nearly all dimensions. Total number of pages viewed decreased as quartile of A1c control worsened (137, 73, 68, 57; P = .007); similarly, for a given 10% increase in proportion of patients with controlled A1c, participants viewed 1.13 times more pages (95% CI: 1.02-1.26, P = .02). In the control group, engagement was neither correlated with A1c control nor different across quartiles of A1c control. Engagement in Web-based interventions is measurable and has important implications for research and education. Because physicians of patients with the greatest need for improvement in A1c control may not use online educational resources as intensely as others, other strategies may be necessary to engage these physicians in professional development activities.

Library and Informatics Training May Improve Question Formulation among Public Health Practitioners

A review of:&#x0D; Eldredge, Jonathan D., et al. “The Effect of Training on Question Formulation among Public Health Practitioners: Results from a Randomized Controlled Trial.” Journal of the Medical Library Association 96.4 (2008): 299-309. 28 Aug 2009 .&#x0D; &#x0D; Objectives – To determine whether providing library and informatics training to public health professionals would increase the number and sophistication of work-related questions asked by these workers. &#x0D; &#x0D; Design – Randomised controlled trial.&#x0D; &#x0D; Setting – New Mexico Department of Health.&#x0D; &#x0D; Subjects – Public health professionals from a variety of professions, including administrators, nursing professionals, nutritionists, epidemiologists, physicians, social workers, and others. &#x0D; &#x0D; Methods – All subjects received a three-hour training session on finding evidence-based public health information, with a focus on using PubMed. Two sessions were offered, two weeks apart. Participants were randomised to either an intervention group, which received instruction on the first date, or a control group, which received instruction on the second date. &#x0D; &#x0D; The intervening two weeks constitute the study period, in which both groups were surveyed by e-mail about their work-related question generation. Three times per week, subjects received e-mail reminders asking them to submit survey responses regarding all questions that had arisen in their practice, along with information about their attempts to answer them. Questions were tallied, and totals were compared between the two groups. &#x0D; &#x0D; Questions were also analysed for level of sophistication, and classified by the investigators as “background” questions, which are asked when one has little knowledge of the field, and can usually be answered using textbooks or other reference sources; and “foreground” questions, which are often asked when an individual is familiar with the subject, and looking for more sophisticated information that is usually found in journals and similar sources. This scheme for classifying questions was developed by Richardson and Mulrow (2001).&#x0D; &#x0D; Main Results&#x0D; &#x0D; The investigators found differences in both the number and sophistication of the questions asked between the control and intervention groups. The control group averaged only 0.69 questions per participant during the two-week observation period, while the intervention group averaged 1.24 questions. Investigators also found that a higher percentage of the questions asked by the intervention group were foreground questions (50.0%, versus 42.9%) for the control group. However, when two-tailed t-test analysis was performed on both the frequency of questions and the level of sophistication, the findings were no statistically significant within a 95% confidence interval. &#x0D; &#x0D; Conclusion&#x0D; &#x0D; This study suggests that library and informatics training for public health professionals may increase the number of questions that they ask on work-related topics, and also the sophistication of these questions. However, more studies need to be done to confirm these findings.

Computerized Automated Reminder Diabetes System (CARDS): E-Mail and SMS Cell Phone Text Messaging Reminders to Support Diabetes Management

Cell phone text messaging, via the Short Messaging Service (SMS), offers the promise of a highly portable, well-accepted, and inexpensive modality for engaging youth and young adults in the management of their diabetes. This pilot and feasibility study compared two-way SMS cell phone messaging with e-mail reminders that were directed at encouraging blood glucose (BG) monitoring. Forty insulin-treated adolescents and young adults with diabetes were randomized to receive electronic reminders to check their BG levels via cell phone text messaging or e-mail reminders for a 3-month pilot study. Electronic messages were automatically generated, and participant replies with BG results were processed by the locally developed Computerized Automated Reminder Diabetes System (CARDS). Participants set their schedule for reminders on the secure CARDS website where they could also enter and review BG data. Of the 40 participants, 22 were randomized to receive cell phone text message reminders and 18 to receive e-mail reminders; 18 in the cell phone group and 11 in the e-mail group used the system. Compared to the e-mail group, users in the cell phone group received more reminders (180.4 vs. 106.6 per user) and responded with BG results significantly more often (30.0 vs. 6.9 per user, P = 0.04). During the first month cell phone users submitted twice as many BGs as e-mail users (27.2 vs. 13.8 per user); by month 3, usage waned. Cell phone text messaging to promote BG monitoring is a viable and acceptable option in adolescents and young adults with diabetes. However, maintaining interest levels for prolonged intervals remains a challenge.

Using the Internet to Provide Information Prescriptions

An information prescription is the provision of specific information to a patient on how to help manage a health problem. The Internet is being used increasingly as a source for information prescriptions, with clinicians directing patients to specific Web sites. As with any health care intervention, patients' lack of compliance is a barrier to the effectiveness of Web-based information prescriptions (WebIPs). WebIPs cannot be helpful if patients do not review the information prescribed for them. The main objective of this study was to quantify the percentage of families who visit a Web site that was specifically prescribed by their physician. In addition, the use of an e-mail reminder was used to determine if it increases the likelihood that families will visit the prescribed Web site. Finally, barriers to accessing the prescribed Web site were identified. Children were eligible if they presented to the pediatric gastroenterology clinic with chronic constipation and/or encopresis and their family had an active e-mail account and access to the Internet in their home. During their clinic visit, physicians instructed families to visit a Web site that provided educational information pertinent to their child's problem. Families were given a form with the Web-site address and a log-in identification number. Two days after their clinic visit, half of the families received an e-mail reminding them to visit the Web site. Families were contacted 1 week after their clinic visit to identify barriers to accessing the Web site. Eighty-three families participated in the study. Of the 83 families, 54 (65%) visited the prescribed Web site within 1 week of their clinic visit. Families who received e-mail reminders were significantly more likely to visit the Web site than families who did not receive an e-mail reminder (77% vs 53%). This difference could not be explained by the type or speed of Internet connection or how frequently they accessed the Internet or e-mail. The most common reasons that families cited for not accessing the Web site were "I forgot" and "I didn't have time." Few families cited technical reasons for not accessing the Web site. Almost two thirds of the families given a WebIP logged on to the prescribed Web site. The probability that families would access the site was increased by 45% with an e-mail reminder. Clearly, e-mail prompts improve compliance to WebIPs. As content and treatment programs continue to proliferate on the Web, it is important to identify barriers and solutions to them to improve overall compliance.

E-mail Reminders: A Novel Method to Reduce Outpatient Clinic Nonattendance

Introduction: Although reminder systems have been studied previously, there is no published study on the effectiveness of email reminders in reducing clinic nonattendance. Our objective was to evaluate the effectiveness of e-mail reminders in reducing clinic nonattendance. Methods: We measured the monthly nonattendance rate at an employee health outpatient clinic in an academic medical center 3 months before and after implementing an e-mail reminder system. The nonattendance rate of patients who received e-mail reminders was compared to a control group. Results: The mean nonattendance rate for patients (5,407 appointments) who received e-mail reminders decreased by 35% (from 9.7% to 6.3%, p = 0.002). There was no change in the nonattendance rate among patients (567 appointments) who did not receive the intervention (preand post-intervention 5.3% & 4.7%, p = 0.8). Conclusions: E-mail reminders were effective in reducing clinic nonattendance in an academic outpatient clinic.