Text Reminders Research Articles

The effect of various types of patients’ reminders on the uptake of pneumococcal vaccine in adults: A randomized controlled trial

BackgroundInvasive pneumococcal disease is one of the most important vaccine-preventable diseases threatening the adult community due to missed opportunities for vaccination. This study compares the effect of three different types of patient reminder system on adulthood Streptococcus pneumoniae immunization in a primary care setting. MethodsThe study targeted patients aged 40 and older eligible for pneumococcal vaccine, but did not receive it yet (89.5% of 3072 patients) based on their electronic medical records in a family medicine center in Beirut. The sample population was randomized using an automated computer randomization system into six equal groups, receiving short phone calls, short text messaging system (sms-text) or e-mails each with or without patient education. Each group received three identical reminders spaced by a period of four weeks. Documentation of vaccine administration was then added to the longitudinal electronic patient record. The primary outcome was the vaccine administration rate in the clinics. ResultsOf the eligible patients due for the pneumococcal 23-polyvalent vaccine, 1380 who had mobile phone numbers and e-mails were randomized into six equal intervention groups. The various reminders increased vaccination rate to 14.9%: 16.5% of the short phone calls group, 7.2% of the sms-text group and 5.7% of the e-mail group took the vaccine. The vaccination rate was independent of the age, associated education message and the predisposing condition. ConclusionUse of electronic text reminders via e-mails and mobile phones seems to be a feasible and sustainable model to increase pneumococcal vaccination rates in a primary care center.

The relationship between electronic goal reminders and subsequent drug use and treatment initiation in a criminal justice setting

IntroductionOpportunities to influence behavior through the use of electronic reminders has not been examined in a criminal justice population. The purpose of this study was to assess probationer preferences for short-term goals from a web-based program and evaluate the role of voluntary electronic reminders (e.g., text messaging, email) in achieving early treatment and probation tasks. MethodsWe used data from drug-involved offenders (n=76) participating in a clinical trial of a 2-session motivational computer program. As part of the program, participants could choose to receive text or email reminders about their probation and treatment goals for the next month. Poisson regression models were utilized to evaluate goal and reminder selection in relation to the days of substance use and treatment attendance at two-month follow-up. ResultsThe most common goals were related to probation and treatment tasks, relationships, and cognitive reappraisals. Forty-five percent of probationers elected to receive electronic goal reminders at Session 1 with a slight increase at Session two (49%). Probationers who opted to receive electronic goal reminders at Session one selected significantly more goals on average (M=4.4, SD=2.1) than probationers who did not want reminders (M=3.4, SD=1.8), (t=2.41, p=.019). Reminder selection and total number of goals selected predicted days of substance use and treatment attendance at a two-month follow-up. Probationers who opted not to receive electronic reminders and those who only chose to receive reminders at one visit had more days of substance use compared to those who chose to receive reminders at both visits, 1.66 and 2.31 times respectively. Probationers who chose not to receive electronic reminders attended 56% fewer days of treatment compared to those who chose to receive reminders at both visits. ConclusionsPeople's choice of short-term goals and reminders can provide advance notification of the likelihood of substance use and treatment initiation. Probation systems might use such information to triage at-risk probationers to a higher level of service, before problems have emerged.

Saving lives through effective patient engagement around NHS health checks

Purpose – Putting behavioural insights theory into practice a trial in Southwark using iPLATO Hub to communicate with over 13,000 patients concluded that the right combination of text messaging and letter content increased uptake of NHS Health Checks by 65 per cent. This iPLATO case study, based on a randomised controlled trial with the Department of Health, Public Health England and Southwark Council, reported in July 2015. The purpose of this paper is to spread best practice and help other parts of the country transform uptake to NHS Health Checks. Design/methodology/approach – This research – led by the Department of Health and Southwark Council – was designed to test the impact of certain forms of communication informed by insights from behavioural science. These insights involved small, pragmatic and very low cost or free changes to the invitation process, for example, how messages are framed and the language used. These changes are designed to fit within existing practice, which means they can easily be scaled up across all CCGs. Findings – Results from the trial also indicate that a combination of the deadline commitment letter and just a reminder text message (no primer message) was nearly as effective as two texts, while the new letters on their own (without any text messages) increased uptake to 21 per cent. This suggests that clear and concise text messages from the iPLATO Hub delivered the major impact on uptake. Originality/value – iPLATO is working with the research group to expand the research and improve on the reported findings while helping to spread best practice across the NHS.

PTU-063 Compliance in inflammatory bowel disease (IBD) patients: how big is the problem, who do they tell and what can be done?

<h3>Introduction</h3> Compliance with medication reduces the risk of flares and longer term complications in IBD. Drug non-compliance has been shown to be associated with a 12.5% increase in medical costs.¹ <h3>Aims and objectives</h3> To assess and gain insight into the medication adherence of IBD patients and to explore possible solutions. <h3>Method</h3> Data was collected using a self-reporting paper-based questionnaire. Patients were contacted directly using convenience sampling in the IBD clinics. Patients were split broadly into two groups: immunomodulator (IM) and 5-aminosalicylic acid (5-ASA) groups for analysis. The questionnaire included questions about drug compliance, reasons for missing doses, possible solutions to non-compliance, and if patients reported non-compliance to the professionals responsible for their care. <h3>Results</h3> 147 patients completed the questionnaire. 77 participants were male (52.4%), 67 had Crohn’s, 69 UC, 8 indeterminate colitis, 3 were unsure. 105 patients were included in the 5-ASA group and 67 in the IM group (there were 25 patients who were taking both IM and 5-ASA drugs). Patients from both groups were more likely to take their medication when symptomatic: Always take: 61% in 5-ASA group, 38% in IM group; Very often take 7% in 5-ASA group, 4% in IM. Compliance dropped when asymptomatic: always take: 48% in 5-ASA group, 38% in IM group; very often take 10% in 5-ASA group, 7% in IM group. Only 5% inform their medical team of compliance problems. Suggested solutions to aid compliance (% of participants agreeing): Once a day dosing (20%), more contact with IBD team (19%), text reminders (14%), reduced pill burden (12%), more drug information (12%), phone calls (4%), e-mail reminders (3%). <h3>Conclusion</h3> Self reported drug compliance in IBD is a significant problem. Compliance appears to be poorer for IM drugs than 5-ASA’s. The attending medical team is often not informed of possible compliance problems. Solutions include medication review to ease timing and pill burden, education with more contact and information on therapies and communication via text, phone call and e-mail reminders. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Zelante A, De Giorgi A, Borgoni R, Trevisani L, Gallerani M. Adherence to medical treatment in inflammatory bowel disease. Minerva Gastroenterol Dietol. 2014;60(4):269–74

P51 The utility of personalised short message service (SMS) texts to remind patients at higher risk of STIS and HIV to re-attend for testing

Background Patients at increased risk of STI/HIV acquisition are advised to re-attend for re-testing. A previous study showed that ‘generic’ text reminders did not improve re-attendance. Aim To assess if a personalised text message would increase re- attendance rates of at risk patients who require repeat STI testing. Methods At-risk patients were sent a text reminder to re-attend for re-testing 6 weeks after their initial visit. They were considered to be ‘at risk’ if they had an acute STI or had attended for emergency contraception at the initial visit, or were MSM. Re-attendance rates were measured for September to December 2012 (control group who received a generic text message advising re-attendance) and February to May 2014 (personalised message group who received a text message containing their first name and several different ways to contact the clinic). Re-attendance was counted within four months of the end of the initial episode of care. Results The re-attendance rate was significantly higher for the personalised message group (144/266(54%) than the control group: (90/273 (33%) (P = 0.0001) and was also significantly higher in the personalised message group than the control group in patients with the following risks: recent chlamydia (61/123(50%) vs (43/121(36%) (P = 0.03), recent gonorrhoea (42/64(66%) vs (4/21(19%) (P = 0.0003) and MSM (25/45(56%) vs (3/18(16%) (P = 0.006). New STI rates in the re-attending ‘personalised message’ group and controls were 26/144(18%) and 13/90 (14%) (n.s) respectively. Conclusion Sending a personalised text message as a reminder for re-testing increases re-attendance rates in patients who are at higher risk of STIs.

P30 Gonorrhoea: a rising tide

Background The prevalence of gonorrhoea in England increased by 15% between 2012 and 2013. In contrast, there was a 62% rise in gonorrhoea in our local area in the same time period. Aim To identify potential areas for management improvement that may help reduce infection rates. Methods A retrospective case note review of positive patients between 1st January and 30 th June 2013 was conducted. Positive agar-based gonococcal culture or BD ProbeTec™ GC Q x Amplified DNA Assay results were included. Results The 201 individuals reviewed had a mean age of 24 (range 16–53). 53% were male, 80% Caucasian and 89% heterosexual. There was no geographical postcode pattern seen. 100% resolution of infection at test of cure (TOC) was achieved in the 39% that attended. 10% TOC attendees became re-infected. 100% received Partner Notification (PN), of whom 45% had contacts attending for treatment and 36% declined to provide contact details. Discussion Unlike the epidemic elsewhere in the UK, our outbreak is predominantly amongst male and female heterosexuals. As the majority were in the age range 16–25, targeted screening and health promotion could be delivered using the same resources as the National Chlamydia Screening Programme locally. TOC attendance was poor and the use of automatic text reminders and TOC postal kits maybe beneficial. The quality of information provided for PN can be improved with novel methods of non-standard PN. The high re-infection rate suggests a large reservoir of undiagnosed disease in our local population which needs addressing on a larger public health basis.

PIH26 - A Comprehensive Survey Of Managed Care Organization (Mco) Medication Adherence Intervention Programs

Medication non-adherence causes hundreds of billions of dollars in avoidable costs. This study sought to survey the existing medication adherence programs of managed care organizations (MCOs). Thirty MCOs were interviewed in Spring 2014 about their current and future medication adherence programs. 19 small (<200,000 members) and 11 large (≥200,000 members) filled out a 19-question (excluding 6 on program characteristics) survey covering the strategies and methods used to improve patient adherence. The MCOs dedicate the majority of adherence resources toward cardiovascular disease states but most are looking to expand to more disease states. Just two (7%) of the MCOs surveyed use predictive analytics to target patients for their intervention programs while 12 (40%) use retrospective adherence measures. 75% of MCOs are looking to expand their adherence programs while 60% specifically plan to use predictive analytics in the future. Only two (7%) only used outsourced interventions, 10 (33%) used in-house and 18 (60%) used some combination of the two. 20 (67%) MCOs used live call interventions and only 2 (7%) used text reminders. 14 small (74%) and 9 (82%) large MCOs used direct mail interventions. 20 (67%) of the MCOs rated their intervention programs to be “moderately effective.” Most MCOs prioritize adherence to cardiovascular disease medication but most are also interested in expanding their programs. Few MCOs use enhanced platforms to select patients for interventions but many plan on expanding their platforms. MCOs intervened to improve adherence largely through provider-centric channels and with a combination of in-house and outsourced methods. Many MCOs are interested in adopting a platform that identifies high-value interventions, like AllazoHealth, since current programs aren’t personalized and are perceived as ineffective.

Postpartum SMS reminders to women who have experienced gestational diabetes to test for Type2 diabetes: the DIAMIND randomized trial.

This parallel group randomized controlled trial assessed whether an SMS reminder system for women, after gestational diabetes, would increase their attendance for an oral glucose tolerance test (OGTT) by sixmonths postpartum. Women were eligible for inclusion if they were diagnosed with gestational diabetes in their recent pregnancy, had a mobile phone and normal blood glucose profile prior to postnatal discharge from the Women's and Children's Hospital, Adelaide. A computer-generated random number sequence and telephone randomization were used. Two hundred and seventy-six women were randomized. Women in the six-week group (n=140) were sent a text reminder to attend for an OGTT at six weeks postpartum, with further reminders at three and sixmonths if required. Women in the control group (n=136) received one text reminder at sixmonths postpartum. Blinding was not feasible. The primary outcome was OGTT attendance within sixmonths postpartum. Women in the six-week group did not increase their attendance for an OGTT within sixmonths postpartum compared with women in the control group, 104 (77.6% of 134) versus 103 (76.8% of 134), relative risk (RR) 1.01, 95% confidence interval (CI) 0.89-1.15. The SMS reminder system did not increase postpartum OGTT, fasting plasma glucose or HbA1c completion, although high rates of test completion were measured in both groups. Further research is required into factors influencing attendance for postpartum testing from the perspective of women, and into optimal counselling relating to Type2 diabetes risk in the postpartum period for increasing postpartum glucose testing rates.

Effectiveness of Centralized Text Message Reminders on Human Papillomavirus Immunization Coverage for Publicly Insured Adolescents

PurposeWe evaluated a managed care organization (MCO)–generated text message reminder–recall system designed to improve human papillomavirus (HPV) vaccination coverage. MethodsWe conducted a randomized controlled trial of text reminder–recall for parents of 3,812 publicly insured adolescents aged 11–16 years with no prior HPV vaccinations who were enrolled in a single MCO and were patients at one of 39 primary care practices. We determined the rate of HPV receipt for intervention versus control with the Kaplan–Meier failure function and determined hazard ratios using a clustered stratified Cox model, clustering on primary care provider and stratified on practice. We examined results for all subjects, and for those with a valid phone number, stratified by age group (11–13 years and 14–16 years) and gender. A post hoc analysis included all subjects and controlled for age and gender. ResultsHPV dose 1 vaccination rates were not significantly different when all participants were included, but for the subset of parents (54%) able to receive messages, HPV dose 1 rates were 13% for the control group and 16% for the intervention group; hazard ratio, 1.3 (95% confidence interval, 1.0–1.6; p = .04), when controlling for age and gender. There were no significant findings in the analysis stratified by age and gender. ConclusionsMCO-based text reminders are feasible and have a modest effect on HPV dose 1 vaccination rates for those parents able to receive text messages with valid phone numbers in the MCO database. Future studies should examine a similar intervention for those parents who already accepted the first HPV vaccine dose.

Comparison of Reminder Methods in Selected Adolescents With Records in an Immunization Registry

PurposeThe aim of this study was to assess the effectiveness and cost efficiency of three reminder/recall methods for improving adolescent vaccination rates using the San Diego Immunization Registry. MethodsParents of 5,050 adolescents whose records indicated they lacked one or more adolescent vaccines were identified from the San Diego Immunization Registry and contacted by telephone. Based on their preference, consenting participants were enrolled to receive either postal mail (n = 282), e-mail (n = 963), or text (n = 552) reminders for vaccination. The intervention groups were sent a series of up to three reminders. The vaccination completion rate was compared between the intervention groups and two control groups—the enrollment phone call–only group who declined to participate and a no contact group—using logistic regression. ResultsThe participants who received any reminder were more likely (24.6% vs. 12.4%; p < .001) to become up-to-date (UTD) than those in the enrollment phone call–only group. At the conclusion of the study observation, UTD status was reached by 32.1% of text message recipients, 23.0% of postcard recipients, and 20.8% of e-mail recipients compared to 12.4% for the enrollment phone call recipients. Only 9.7% of nonintervention adolescents became UTD. ConclusionsAll three reminder interventions were effective in improving adolescent vaccination rates. Although postal mail reminders were preferred by most participants, text messaging and e-mail were the more effective reminder methods. Text messaging and e-mail as reminder methods for receiving vaccinations should be considered for use to boost vaccination completion among adolescents.

Abstract MP66: AREST Lifestyle: Adherence Effects of a Comprehensive Reminder System on Exercise Adherence in Post-Myocardial Infarction Patients

Background: The risk of recurrent cardiac events can be reduced by 30-50% through regular, structured exercise; however, there remains a high rate of inactivity in post myocardial infarction (MI) patients. Forgetting to exercise may be a contributor to inactivity. This study assessed the hypothesis that text message reminders may be an effective strategy to reduce forgetfulness and inactivity. Methods: In this one year, single center study, we recruited 50 cardiac rehabilitation patients within 2 weeks of their MI. Participants were randomized to usual care or to receive text message reminders 4 times daily which stated "Please remember to exercise 45 minutes today". The outcomes measured were the frequency and total duration of exercise (assessed by log books) and physical endurance/ aerobic fitness (assessed by exercise stress testing at months 1, 3 and 12). Results: Intervention and control patients had similar baseline characteristics with an average age of 64. In the control group, monthly duration of exercise fell from an average of 683 minutes over 17 days at month 1 to 416 minutes over 11 days at month 12. Patients randomized to text message reminders exercised 772 minutes over 18 days at month 1 and 794 minutes over 18 days in month 12 (p&lt;0.01 for duration of exercise, control versus intervention, month 12). Baseline aerobic fitness and cardiac endurance was similar between control and intervention groups. However, there was a significant improvement in aerobic fitness and cardiac endurance at month 12 with text reminders (7.4 versus 6.1 METS achieved month 12, p&lt;0.01). In all sub-groups analyzed this intervention significantly improved exercise adherence and fitness. Conclusions: In summary, this system improved frequency and duration of exercise, and objective measures of cardiac endurance and aerobic fitness. While this study was not designed to assess clinical outcomes, this text message reminder system represents a simple and scalable method for improving adherence to exercise regimens among post-MI patients.

Abstract MP10: Text Messaging to Reduce Inactivity Using Real-Time Step Count Monitoring in Sedentary Overweight Females

Introduction: Prolonged periods of of inactivity are associated with higher CV morbidity independent of level of activity. Work and lifestyle choices today are associated with long periods of sitting, e.g. computer or screen watching. Wearable activity monitors such as pedometers have focused on increasing daily activity but not on reducing inactivity. Hypothesis: Sedentary women will decrease inactivity if given a real time reminder of inactivity . Method: We developed a program to monitor real-time activity levels generated by a wearable activity monitor (Fitbit). Fitbit communicated step counts to a smartphone which sent this information to a database every 15 minutes. When 10 or fewer steps had been recorded for a 60 min period of time, an inactivity reminder text message was sent to the participant to encourage them to move about. 30 obese women with self-reported &gt; 3 hours of inactivity per day, were enrolled, provided with a Fitbit and smartphone, and monitored for 8 weeks. Women were randomized to two groups. Gp A received inactivity reminders (IR) for the first 4 weeks followed by 4 weeks without IR. Gp B received no IR during the first 4 weeks and IR was given during the second 4 weeks. We defined inactivity as ≤ 20 steps in a 2 hr block. We compared the percent of 2-hr blocks between 8:00 and 24:00 hr where women were inactive during the 4 weeks with IR-on vs IR-off, for each of the 2 groups. The mean number of steps per day over each 4 week block was also compared. Results: Gps A and B were similar in age (51.8 + 12.2 y), BMI (37.1 + 6.9), self-reported hypertension (27% ), diabetes (23 %), and hyperlipidemia (23%). Fitbit data was available from 27 women. Gp A (n=15) self-reported 5.2 + 2.5 hr sitting/day at work during IR-off vs 3.9 + 2.7 with IR-on (p&lt;0.004). Gp B (n=12), who had IR turned on in the second 4 week block, self-reported no change in hours sitting with or without IR. Activity monitoring data showed that Gp A were inactive for 32 + 23% of the 2-hr periods during the 4 weeks with IR-off vs 21 + 14% with IR-on (p &lt; 0.004). However, Gp B had no difference in inactivity periods (28 + 12% with IR-off vs 28 + 14 % with IR-on). There were no differences in mean total daily steps walked during either 4 week block with IR-on or IR-off in either Gp. Conclusion: The use of real-time text messaging to inform women that they had been inactive for more than 60 mins was associated with a reduction in number of inactive periods independent of the number of steps taken a day. However, this effect was seen only when the reminder was implemented soon after enrollment. The behavior change did not persist after the reminders stopped. This study demonstrates that automated real time reminders can reduce periods of inactivity though the timing of the intervention affected the results. Further work will explore the behavioral factors that could improve the effectiveness and sustainability of the intervention.

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.

Individualized Texting for Adherence Building (iTAB): Improving Antiretroviral Dose Timing Among HIV-Infected Persons with Co-occurring Bipolar Disorder

HIV+ persons with co-occurring bipolar disorder (HIV+/BD+) have elevated rates of medication nonadherence. We conducted a 30-day randomized controlled trial of a two-way, text messaging system, iTAB (n = 25), compared to an active comparison (CTRL) (n = 25) to improve antiretroviral (ARV) and psychotropic (PSY) adherence and dose timing. Both groups received medication adherence psychoeducation and daily texts assessing mood. The iTAB group additionally received personalized medication reminder texts. Participants responded to over 90 % of the mood and adherence text messages. Mean adherence, as assessed via electronic monitoring caps, was high and comparable between groups for both ARV (iTAB 86.2 % vs. CTRL 84.8 %; p = 0.95, Cliff's d = 0.01) and PSY (iTAB 78.9 % vs. CTRL 77.3 %; p = 0.43, Cliff's d = -0.13) medications. However, iTAB participants took ARVs significantly closer to their intended dosing time than CTRL participants (iTAB: 27.8 vs. CTRL: 77.0 min from target time; p = 0.02, Cliff's d = 0.37). There was no group difference on PSY dose timing. Text messaging interventions may represent a low-burden approach to improving timeliness of medication-taking behaviors among difficult-to-treat populations. The benefits of improved dose timing for long-term medication adherence require additional investigation.

The impact of text message reminders on adherence to antimalarial treatment in northern Ghana: a randomized trial.

BackgroundLow rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens.MethodsHealth workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression.Results1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028). Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252).ConclusionThe results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency.Trial RegistrationClinicalTrials.gov NCT01722734

Basic investigation into the present burn care system in China: Burn units, doctors, nurses, beds and special treatment equipment

ObjectiveThe aim of the study was to survey the current burn units in China to understand the burn care system in the country and supply basic data for the National Burn Repository of China (NBRC) and further research. MethodA questionnaire was developed and sent to burn unit directors in China via e-mail, which was followed up with reminder text messages to obtain information for the study. ResultsOf the 405 hospitals from the 31 provinces in mainland China that responded to the questionnaire, 63.7% of the responses came from Grade 3A hospitals, and the most popular model of organisation was the Burns and Plastic Surgery arrangement (63.0%). An average of 9.43±0.351 doctors work in each burn unit with 70.4% of all units having 4–11 doctors. The ratio of chief surgeon to associate chief surgeon to attending surgeon to resident surgeon and surgeon assistant was 1:1.8:2.2:2.3. An average of 30% of all doctors in each burn unit held postgraduate degrees, and more than 90% of all surgeons held a bachelor's degree or higher. There were 16.48±0.637 nurses per burn unit, 56.5% of burn units had 8–15 nurses, and the ratio of chief nurse to associate chief nurse to supervisor nurse to nurse practitioner to junior nurse was 1:11.8:57.0:82.1:86.1. More than 80% of all nurses had received a college education or above. However, only 30% of nurses held bachelor's degrees or higher, while only 0.66% of nurses had received postgraduate degrees. A total of 39.91±1.50 beds were available in each burn unit and 45% of burn units had 20–39 beds. Up to 70% of the total beds were prepared for patients with burn, and more than 10% of the beds were specifically for patients with severe burn. The ratios of doctors to nurses, beds to doctors, beds to nurses, and beds to doctors and nurses were 0.64±0.01, 4.48±0.12, 2.67±0.09, and 1.66±0.06, respectively. The workload of each doctor and nurse was most heavy in units with 40–59 beds. In addition, we estimated that there were 0.05, 0.5, 0.8, and 1.9 burn units, burn doctors, nurses, and beds, respectively, per 100,000 members of the population in mainland China. Chinese burn units lack special burn treatments, nursing equipment, and operation apparatuses. ConclusionTo the best of our knowledge, this is the first survey of the present burn care system in China. These results confirm that the burn care system is not equivalent to the national power of this country and the system lacks a great number of trained burn professionals. Burn doctors and nurses bear a heavy burden of work. This report supplies basic data to spur further research. We propose creating a burn unit registration system and a special database in China.

The Digital Divide and Health Disparities: a Pilot Study Examining the Use of Short Message Service (SMS) for Colonoscopy Reminders

The purpose of this study was to determine (a) whether the use of short message service (SMS) appointment reminders is an acceptable form of communication about colonoscopy appointments and (b) whether the use of SMS appointment reminders is as efficacious as the use of telephone reminders calls for colonoscopy completion. Patients referred by a primary care physician for a screening colonoscopy (N = 24) were recruited to participate over a 10-month period. Eligible participants (i.e., owned a cell phone and agreed to receive text reminders) were randomized to receive either usual care (N = 13) or SMS reminders (N = 11). Participants were given 3 months to complete the exam followed by analysis of colonoscopy completion status. In the non-SMS group, 46.2 % participants completed a colonoscopy compared to 72.7 % of participants in the SMS group (p = 0.19). SMS has potential to be an efficacious approach for use within patient navigation interventions for screening colonoscopy and that using SMS reminders for colonoscopy patient navigation interventions should be replicated in a randomized clinical trial, with a larger sample size.

Pregnancy Risk Assessment Monitoring System in Ireland: methods and response rates.

To describe response rates and characteristics associated with response to the Pregnancy Risk Assessment Monitoring System study in Ireland (PRAMS Ireland). Using hospital discharge records of live births at a large, urban, obstetric hospital, a sampling frame of approximately 2,400 mother-infant pairs were used to alternately sample 1,200 women. Mothers' information including name, address, parity, age and infant characteristics such as sex and gestational age at delivery were extracted from records. Modes of contact included an invitation letter with option to opt out of the study, three mail surveys, a reminder letter and text message reminder for remaining non-respondents. Sixty-one per cent of women responded to the PRAMS Ireland survey over a 133 day response period. Women aged <30, single women, multiparous women and women with a preterm delivery were less likely to respond. Women participating in PRAMS Ireland were similar to the national birth profile in 2011 which had a mean age of 32, were 40 % primiparous, 33 % single or never married and had a 28 % caesarean section rate. Survey and protocol changes are required to increase response rates above recommended Centers for Disease Control and Prevention (CDC) thresholds of 65 % within the recommended 90 day data collection cycle. Additional efforts such as stratification and over-sampling are required to increase representativeness among hard to reach groups such as younger, single and multiparous women before expanding the project to an ongoing, national surveillance system in Ireland.

Refining a personalized mHealth intervention to promote medication adherence among HIV+ methamphetamine users

Mobile health (mHealth) interventions to promote antiretroviral therapy (ART) adherence have shown promise; however, among persons living with HIV who abuse methamphetamine (MA), effective tailoring of content to match the expressed needs of this patient population may be necessary. This study aimed (1) to understand patient perspectives of barriers and facilitators of ART adherence among people with HIV who use MA, and (2) to obtain feedback on the thematic content of an mHealth intervention in order to tailor the intervention to this subgroup. Two separate focus groups, each with 10 HIV+/MA+ individuals, were conducted. Transcribed audio recordings were qualitatively analyzed to identify emergent themes. Inter-rater reliability of themes was high (mean Kappa = .97). Adherence barriers included MA use, misguided beliefs about ART adherence, memory and planning difficulties, social barriers and perceived stigma, and mental heath issues. Facilitators of effective ART adherence were cognitive compensatory strategies, promotion of well-being, health-care supports, adherence education, and social support. Additionally, the focus groups generated content for reminder text messages to be used in the medication adherence intervention. This qualitative study demonstrates the feasibility of using focus groups to derive patient-centered intervention content to address the health challenge at hand in targeted populations.

Vaginal delivery after placental abruption and intrauterine fetal death, including failed cases

pia au to riz ad a p or CD R textmessaging that allows for the recipient to replywill bemore appropriate for future studies. Thirdly, although unlikely to influence the overall study outcome, sociodemographic information for both groups was not available. A randomized control trial on this subject would be beneficial. Further areas of researchwill include the use of text reminders for prenatal clinic appointments, child vaccination programs, and drug compliance. In conclusion, text reminders led to a 50% reduction in failure to attend postnatal clinic appointments. Policymakers should consider its implementation within maternal health services in Sub-Saharan Africa.