Toll-free Number Research Articles

P6.032 Design of a Complex Intervention: Community-Based Mobile Phone Text Messaging For Sexual and Reproductive Health Referral in Tanzania

<h3>Introduction</h3> In many countries there are private stores known as drug shops that sell medicines for treatment of various illnesses. These shops are licenced to sell non-prescription, pre-packaged medicines only. In Tanzania, evidence shows they sell ‘prescription-only’ drugs including antibiotics and antimalarials. An intervention with objective to increase uptake of reproductive health (RH) services in formal health facilities was designed to facilitate patients’ and drug shops’ access to prescriptions from formal health facilities. <h3>Methods</h3> Nested in a cluster-randomised trial, the intervention is implemented in 9 intervention communities against 9 comparison communities in Mwanza region Tanzania. Using a web-based mobile phone application, an electronic referral platform was designed to host a text messaging referral system. The platform was configured with the telephone numbers of drug shop attendants, dispensary and health centre clinical officers and a toll-free number. Drug shop attendants and clinical officers were trained and given a texting guideline cue card. <h3>Results</h3> Forty-four drug shop attendants, 14 dispensaries, and 3 health centres have enrolled onto the intervention. These facilities use the technology to treat patients with RH needs ranging from family planning to STI and HIV treatment. On average 14 patients pass through the system per week. We expect data on at least 700 patients by the end of a 12-month implementation period. This data will be analysed to report on family planning and contraception, pregnancy and antenatal care, STI and HIV/AIDS outcomes. <h3>Conclusions</h3> The system has proved to work effectively. Participation of stakeholders in the design was optimal. Given the automatic data collection facility of this system, data for research, monitoring and reporting is readily accessible to researchers, district health authorities and the ministry of health through authorised logins. The contribution of this system to RH service uptake and health system strengthening will be verified after an impact evaluation.

Educating patients about FDA’s MedWatch

Many patients may be unaware of FDA's MedWatch Adverse Reporting Program and the role they can play in helping the agency identify potential safety issues with products in the marketplace. Educating patients about the program, the importance of reporting, and how to submit a report to FDA will aid in safeguarding future patients from potentially serious adverse events.

Satisfaction and Public Health Cost of a Statewide Influenza Nurse Triage Line in Response to Pandemic H1N1 Influenza

BackgroundThe 2009 H1N1 pandemic strained healthcare systems. There was a need for supportive services, rapid antiviral access, and minimization of unnecessary healthcare contacts particularly face-to-face interactions. In response, the Minnesota Department of Health (MDH) launched a telephone-based nurse triage line (NTL) called the Minnesota FluLine coordinating all major MN healthcare systems with NTLs to form a single toll-free number triage service. Callers were evaluated for symptoms of influenza-like illness (ILI) and were prescribed an antiviral if indicated, using nurse administered protocols.MethodsTo determine caller outcomes, associated healthcare seeking, and satisfaction a telephone survey of Minnesota FluLine callers was conducted using a 5% random sample of those who completed the protocol and those who did not.ResultsOf 6,122 callers with ILI who began the nurse protocol administered by the contract NTL, 1,221 people were contacted for the survey and 325 agreed to participate; response rate was 26%. Of those who completed the nurse protocol 73% said they would have sought healthcare without the Minnesota FluLine, 89% reported the service was moderately or very helpful, and 91% reported being satisfied or very satisfied. Of those not completing the protocol, 50% reported the service was moderately or very helpful and 50% reported being satisfied or very satisfied. 72% of qualitative responses to open-ended questions were positive regarding the MN FluLine. Cost to MDH for operating the Minnesota FluLine service was $331,226 to service 27,391 callers ($12.09/call).DiscussionThe Minnesota FluLine diverted patients with mild ILI symptoms away from acute care visits at low cost and had a high rate of satisfaction among callers. Early intervention likely prevented morbidity and possibly additional cases. NTLs are powerful and flexible tools for pandemic response and should be considered as an important tool for future emergency responses.

Attitude of Farmers towards Kisan Call Centres

The present study was conducted to measure the attitude of farmers in Kerala, India towards Kisan Call Centre (KCC). Kisan Call Centre provides free agricultural advisory services to every citizen involved in agriculture through a toll free number. One hundred and fifty farmers who have utilized the Kisan Call Centre service were selected from the database of KCC. The results showed that the respondents had moderately favourable attitude towards KCC followed by highly favourable attitude. The variables digital divide, temporal awareness on KCC, satisfaction towards KCC and utilization of KCC were found to have a positive correlation with the attitude of respondents towards KCC.

Getting Good or Getting Well?

Getting Good or Getting Well?

Mapping Tobacco Quitlines in North America: Signaling Pathways to Improve Treatment

This study was designed to better understand how the network of quitlines in the North American Quitline Consortium (NAQC) interact and share new knowledge on quitline practices. Network relationship data were collected from all 63 publicly funded quitlines in North America, including information sharing, partner trust, and reputation. There was a strong tendency for US and Canadian quitlines to seek information from other quitlines in the same country, with few seeking information from quitlines from the other country. Quitlines with the highest reputation tended to more centrally located in the network, but the NAQC coordinating organization is highly central to the quitline network-thus demonstrating their role as a broker of quitline information. This first "snapshot" of US and Canadian quitlines demonstrated that smoking cessation quitlines in North America are not isolated, but are part of an interconnected network, with some organizations more central than others. As quitline use expands with the inclusion of national toll-free numbers on cigarette packs, how quitlines share information to improve practice will become increasingly important.

Drug advertising, response shift in patients with hypertension, and medication error interception

concluded that dif- ferences in the Food and Drug Administra- tion (FDA) and Federal Trade Commission (FTC) regulation of advertising affected the balance of risk and benefit informa- tion that appeared and the specificity of risk information available. Adequacy of information about a pharmaceutical prod- uct after switching from legend to over- the-counter (OTC) status is an important public health issue. Information abstract- ed from pre-and postswitch advertise- ments for loratadine (Claritin—Schering- Plough), cetirizine (Zyrtec—McNeil-PPC), and omeprazole (Prilosec—Procter & Gamble) was evaluated. Information was abstracted from 2,002 ads obtained from the Vanderbilt Television News Archive. Ads for the legend product were sig- nificantly longer than those for the OTC products. Compared with OTC advertise- ments, prescription ads had fewer asser- tions about the product's benefit and more about its risks, possibly because of their longer length. When equal length ads were examined, prescription ads had an equal number of assertions about the products' benefits and risks (1.5 vs. 1.8, P > 0.05) but OTC ads had significantly more as- sertions about benefits versus risk (6.6 vs. 1.2, P < 0.001). Moreover, toll-free numbers and Internet URLs were found more frequently in prescription (97% and 100%, respectively) than OTC (4% and 10%) ads. Implications. For instances in which the product must be prescribed by a health professional, the benefit-to-risk assertion ratio in ads was equal. In the case of OTC ads, where patients are left to their own devices to correctly interpret the mes- sage, the benefit-to-risk assertion ratio is heavily unbalanced toward the benefits. Pharmacists are among the most acces- sible and trusted of professionals. When it comes to self-care decisions based on pro- motional information for these products, pharmacists' counsel may be essential to offset an unbalanced presentation of ben- efit-to-risk information. Response shift in patients with hypertension Gandhi et al. 2 found that some hyperten- sive patients with CAD (coronary artery disease) experienced a response shift over a 1-year period in their physical functioning (n = 909). Recalibration re- sponse shift is based on changes in one's internal standards and not necessarily objective evidence. In the case of physi- cal functioning, the individual's standard of performance for important life tasks may be lowered for health reasons. Self- reported physical functioning was mea- sured using mailed surveys containing items from SF-36 at both baseline and 1 year later. Response shift was assessed using structural equation modeling sta- tistical techniques. Some patients recali- brated perceptions of their health, most likely because they changed their idea of how their health limited their physi- cal activity (e.g., walking, climbing stairs). Implications. After starting treat- ment, how many of you have asked a pa- tient, are you feeling? How do you explain it when the patient replies much better when they can't walk up a flight of stairs without gasping for breath? Are they lying? Identifying response shift is impor- tant to effectively monitoring health out- comes because patients may adjust their perceptions of the benefits of treatment or disease progression to maintain a sense of optimism or protect their self-image. Medication error interception

Interest of pregnant women in the use of SMS (short message service) text messages for the improvement of perinatal and postnatal care

BackgroundMobile health (mHealth) is emerging as a useful tool to improve healthcare access especially in the developing world, where limited access to health services is linked to poor antenatal care, and maternal and perinatal mortality.The objective of this study is to 1) understand pregnant women’s access and usage of cell phones and 2) survey the health information needs and interests in a population attending public hospitals and health centers of two cities in Argentina. This information is not available and it is the basis to develop a strategy for improving maternal care via cell phones.MethodsQuestionnaires were verbally administered to pregnant women who were attending an antenatal care visit in community health centers and public hospitals in Rosario, Santa Fe and Mercedes, Corrientes. Participants were 18 years of age or older and had previously given birth. The data obtained was qualitative and analyzed using SPSS version 18.ResultsA total of 147 pregnant women meeting inclusion criteria (Rosario: 63; Mercedes: 84) were approached and verbally consented to participate. The average age was 29.5 years, most lived in urban areas (89%) with a mean travel time of 43.4 minutes required to get to the health center and 57.3 minutes to get the hospital.Ninety-six percent of women (n = 140) responded that they would like to receive text messages and cell phone calls with information regarding prenatal care, although the topics and period of time to receive information varied greatly.ConclusionsConsidering the vast majority of the interviewed women had access to and were interested in receiving text messages and calls with educational information regarding pregnancy and infant health, pregnant women in Argentina could benefit from such an mHealth program. The low access to Internet suggests it is not an option for this population; however, this cannot be assumed as representative of the country’s situation.To retain active participation, other forms of health communication, such as a 2-way text message systems or toll-free numbers, could be considered in the future. Cost of use and implementing these options should be studied.

Toll-Free Vanity Telephone Numbers: Structuring a Trademark Registration and Dispute Settlement Regime

Toll-Free Vanity Telephone Numbers: Structuring a Trademark Registration and Dispute Settlement Regime

Reach and effectiveness of mailed nicotine replacement therapy for smokers: 6-month outcomes in a naturalistic exploratory study

BackgroundThere are important inequities in smoker access to clinic-based smoking cessation services. Low barrier high-reach interventions are proposed as solutions to these inequities. Although effective, telephone quitlines, which provide multi-session...

Supply shortage, rare tablet mix-up

Supply shortage, rare tablet mix-up

Feasibility and compliance with daily home electrocardiogram monitoring of the QT interval in heart transplant recipients

BackgroundRecent evidence suggests that acute allograft rejection after heart transplantation causes an increased QT interval on electrocardiogram (ECG). The aims of this pilot study were to (1) determine whether heart transplant recipients could achieve compliance in transmitting a 30-second ECG every day for 1 month using a simple ECG device and their home telephone, (2) evaluate the ease of device use and acceptability by transplant recipients, and (3) evaluate the quality of transmitted ECG tracings for QT-interval measurement. MethodsA convenience sample of adult heart transplant recipients were recruited and trained to use the device (HeartOne, Aerotel Medical Systems, Holon, Israel). Lead II was used with electrodes that were easy to slip on and off (expandable metal wrist watch-type electrode for right wrist and C-shaped band electrode for left ankle). Patients used a toll-free number with automated voice prompts to guide their ECG transmission to the core laboratory for analysis. ResultsThirty-one subjects (72% were male; mean age of 52 ± 17 years; 37% were nonwhite) achieved an ECG transmission compliance of 73.4% (daily) and 100% (weekly). When asked, how difficult do you think it was to record and transmit your ECG by phone, 90% of subjects replied “somewhat easy” or “extremely easy.” Of the total 644 ECGs that were transmitted by subjects, 569 (89%) were acceptable quality for QT-interval measurement. The mean QTc was 448 ± 44 ms (440 ± 41 ms for male subjects and 471 ± 45 ms for female subjects). Eleven subjects (35%) had an extremity tremor, and 19 subjects (55%) had ≥ 1+ left leg edema. Neither of these conditions interfered with ECG measurements. ConclusionTransplant recipients are compliant with recording and transmitting daily and weekly ECGs.

Summary of Raptor Encounter Records at the Bird Banding Lab

Since the inception of the North American Bird Banding program through 2008, the United States Geological Survey (USGS) Bird Banding Laboratory (BBL) has received approximately 54 000 encounter reports of banded raptors of 52 species, excluding local recaptures and band-only reports. Between 1960 and 2008, banded raptors were encountered at an overall rate of approximately 2.9%. Since 1996, with the inception of the 1–800 toll-free number, the BBL has regularly processed 1500–2000 encounter reports of raptors annually. Raptors with the highest encounter-report rates were Bald Eagle (Haliaeetus leucocephalus; 14.0% of the banding records), Golden Eagle (Aquila chrysaetos; 8.3%), Great Horned Owl (Bubo virginianus; 8.0%), Snowy Owl (Nyctea scandiaca; 7.6%), and Peregrine Falcon (Falco peregrinus; 7.1%). Over time, raptor encounter reports indicating the bird was shot have greatly decreased, whereas there has been an increase in vehicle collisions. Longevity records of raptors are among some of the oldest in the BBL database, and the age at encounter of raptors caught and released as part of normal banding operations was comparable to that of rehabilitated and released raptors. Mapping of raptor encounter reports in North America indicated that encounter records clustered around dense human populations and along coasts. With advances in marking technology, encounters of living marked raptors may begin to exceed recoveries of dead or injured birds (currently the most common method of encounter).Desde el inicio del programa de Anillamiento de Aves de América del Norte hasta el año 2008, el Laboratorio de Anillamiento de Aves (LAA) del USGS ha recibido aproximadamente 54 000 informes de encuentro de aves rapaces anilladas pertenecientes a 52 especies, excluyendo las recapturas locales y los informes sobre solamente anillas. Entre 1960 y 2008, las rapaces anilladas fueron encontraron a una tasa global de aproximadamente 2.9%. Desde 1996, con la creación de la línea telefónica 1–800 gratuita, el LAA ha procesado regularmente informes de 1500–2000 encuentros de rapaces al año. Las aves rapaces con las tasas más altas de encuentro son Haliaeetus leucocephalus (14.0% de los registros de anillamiento), Aquila chrysaetos (8.3%), Bubo virginianus (8.0%), Nyctea scandiaca (7.6%) y Falco peregrinus (7.1%). Con el tiempo, los informes de encuentros indicando que el ave fue muerta por un disparo han disminuido considerablemente, mientras que ha habido un aumento de informes de muertes por colisión con vehículos. Los registros de longevidad de aves rapaces son algunos de los más antiguos de la base de datos del LAA, y la edad de encuentro de las rapaces capturadas y liberadas como parte de las operaciones normales de anillado es comparable a la de las aves rapaces rehabilitadas y puestas en libertad. El mapeo de los informes de encuentro de rapaces en América del Norte indicó que los registros de encuentran agrupados en torno a poblaciones humanas densas y en las costas. Con los avances en la tecnología de marcado, los encuentros de individuos marcados vivos pueden comenzar a superar las recuperaciones de aves muertas o heridas (en la actualidad el método más común de encuentro).

Toll-free numbers: Demand, property rights, and public policy

The demand for Toll Free Numbers (TFNs) languished from 2000 to 2008; however recent growth in demand caused the FCC to open a new toll-free code (855) with the possibility of new code openings in the next three years. The analysis here indicates the demand for TFNs is highly inelastic (the coefficient for own price elasticity for TFNs is approximately −0.04). This has implications for concerns regarding future exhaust of toll-free codes and the price structure for recovery of SMS/800's costs. This article considers the effects of the limited property rights for TFN, and welfare implications of gray markets for vanity TFNs. The FCC's allocation mechanism for new 855 codes is considered and whether other allocation mechanisms, such as auctions, could be welfare superior.

Abstract 2578: Methods of Recruitment into Familial Intracranial Aneurysm Study

Background Meeting Recruitment goals in a research study can be challenging. Recruitment for pedigree-based research, in which data and DNA are collected from genetically important family members, is especially difficult. The Familial Intracranial Aneurysm (FIA) study is a multicenter international study whose goal is to identify genetic and other risk factors for the formation and rupture of intracranial aneurysms (IAs). The chosen sites for the study are major referral centers for the diagnosis and treatment of IAs. In this analysis, we sought to determine what factors caused a recruited family to be incomplete, and what impact the methods used in identifying families had on the successful completion of family enrollment. Methods Three recruitment strategies were utilized to identify and enroll families: prospective monitoring of every new case of IA, subarachnoid hemorrhage, or intracranial hemorrhage; retrospective review of IA cases; and advertisement on the Internet, in scientific journals, and at professional meetings. An unexpected additional source of recruitment was exposure to the study through the news media. To help with public accessibility to the study, a web site and toll free number were established. Families were eligible for the study if they fit one of 4 patterns: [1] ≥2 living siblings affected with IA; [2] ≥2 affected siblings, 1 living and 1 genotype reconstructed from living spouse and children; [3] ≥3 affected members, 2 living and 1 reconstructed; [4] ≥ 3 affected members, 1 living, ≥1 reconstructed, and ≥1 living connecting relative. Exclusion criteria included fusiform-shaped IA; IA part of an AVM; family history of polycystic kidney disease; Ehlers-Danlos, Marfan, or moyamoya syndrome; fibromuscular dysplasia; or failure to obtain informed consent. Results Between 8/2002 and 10/2007, 3771 IA patients were screened for family history, and 681 potential families were identified, of which 441 successfully completed enrollment. There were 240 families which did not complete enrollment, due to refusal to participate (97), inability to locate needed relatives (87), exclusion criteria (50), no reason documented (5), and duplication (1 recruited at two sites). Completion of study enrollment was not significantly different by recruitment category (p=.17): 191 of 311 prospectively-recruited (61%), 66 of 89 retrospective (74%), 95 of 145 advertisement (66%), and 89 of 136 methods not documented (65%) families successfully completed enrollment. Conclusion In our study, the major reason for family exclusion was the inability to enroll needed family members, through refusal or failure to locate. All three methods used to identify potential families were successful in completing eligible families. The combination of recruitment strategies can be effectively implemented in future studies.

Development OF Express Highways And Trauma Care Centers In Indian Scenario

This is with reference to the recently constructed express national highways by the honorable state governments in India, for the sole purpose of speedy connectivity and hustle free transport from one place to another. The aim lies good as far as accidents do not occur. State governments are doing really excellent jobs by connecting major cities and metros across India but side by side creating an open space for accidents to happen and casualties to be added to annual tally of Indian Road traffic accidents list. We have express highways with very good road management. But we are lacking an excellent trauma management centers across express highways within approachable limit and well equipped ambulance system backup with across India toll free number as compared to any of the developed nation basically what constitutes express highways are speedy traffic in terms of two wheelers and four wheelers, absence of proper lightening polls, improper traffic sense and accident caused due to above mentioned factors to a certain extent accidents on national highways/express highways can be prevented as far as Indian scenario is concerned by managing following factors:

Shaping Policy: The Canadian Cancer Society and the Hormone Receptor Testing Inquiry

In 2007, the Government of Newfoundland and Labrador established the Commission of Inquiry on Hormone Receptor Testing to examine problems with estrogen and progesterone hormone receptor tests conducted in the province between 1997 and 2005. Using the Inquiry as a case study, we examine the knowledge transfer activities used by the Canadian Cancer Society - Newfoundland and Labrador Division (CCS-NL) to shape policy and improve cancer control in the province. CCS-NL established a panel to advise its legal counsel and asked academic researchers to prepare papers to submit to the Commission. CCS-NL also interviewed patients to better inform its legal arguments, used its province-wide networks to raise awareness of the Inquiry, and provided a toll-free number that people could call. It also provided basic information, resources, and contact information for people who were affected by the flawed hormone receptor tests. The effectiveness of CCS-NL's activities is reflected by the inclusion of its key messages in the Commission's recommendations, and the investment in cancer care following the Inquiry. The success of the CCS-NL knowledge transfer efforts stemmed from its reputation as an advocate for cancer patients and its long-standing relationship with researchers, especially at the local level. The case illustrates real-world application of knowledge transfer practices in the development of public policy, and describes how community-based non-government organizations can identify and draw attention to important issues that otherwise might not have been addressed.

Now You See It. Now You Don't: Fair Balance and Adequate Provision in Advertisements for Drugs Before and After the Switch From Prescription to Over-the-Counter

The objective of this study was to measure differences in fair balance (benefit and risk statements) and adequate provision (toll-free numbers, Internet URLs, print ad references, and medical professional references) in advertising content for drugs that have switched from prescription to over-the-counter (OTC). The Vanderbilt TV News Archive was used to select products to study, to measure the frequency and placement of ads for those products, and to view advertising content for those products. Unique advertisements (n = 108) for loratadine (Claritin), citirizine (Zyrtec), and omeprazole (Prilosec) were analyzed for the presence of adequate provision statements and for the frequency of benefit, risk, and other statements. OTC ads were shorter than prescription ads by 10.6 seconds but contained the same total number of statements. Most prescription ads (n RX = 31) contained toll-free numbers (97%), Internet URLs (94%), medical professional references (100%) and print ad references (68%). Few OTC ads (n OTC = 77) contained adequate provision statements: 4% contained toll-free numbers and 10% contained Internet URLs. Prescription ads had similar numbers of benefits (1.5) and risks (1.8) per 30 seconds of ad time, and OTC ads had more benefits (6.6) than risks (1.2) per 30 seconds of ad time. Prescription drug ads contained risk statements that listed specific side effects and explicit harms from taking the product, but OTC ads contained nonspecific risk information and statements that implied risk rather than directly identifying risk. Differences in the Food and Drug Administration (FDA) and Federal Trade Commission (FTC) regulation of advertising affected the balance of risk and benefit information that appeared and the specificity of risk information available.

Clinician-delivered Intervention to Facilitate Tobacco Quitline Use by Surgical Patients

Telephone quitlines that provide counseling support are efficacious in helping cigarette smokers quit and have been widely disseminated; currently, they are underused. Surgery represents a teachable moment for smoking cessation, which can benefit surgical outcomes; however, few surgical patients receive smoking cessation interventions. This study developed and tested a clinician-delivered intervention to facilitate quitline use by adult patients scheduled for elective surgery. After formative work involving patients and clinicians, a brief intervention was designed to facilitate telephone quitline use. It was then evaluated in a randomized trial of 300 adults scheduled for elective surgery. A control standard brief stop-smoking intervention served as a comparator, with both interventions delivered by clinicians. The primary outcome was the use rate of a quitline accessed through a dedicated toll-free telephone number, with use defined as completing at least one full counseling session. Secondary outcomes included self-reported abstinence from cigarettes at 30 and 90 days postoperatively. Subject characteristics were similar between the two groups. Records from the designated quitline documented that 29 of 149 subjects (19.5%) in the quitline intervention group and 0 of 151 subjects in the control group completed the first full counseling session (P < 0.0001). There were no significant differences in the self-reported point-prevalent and continuous abstinence rates between groups at either 30 or 90 days postoperatively, although rates tended to be higher in the quitline intervention group. Clinicians can effectively facilitate quitline use by surgical patients. Further work is necessary to evaluate the efficacy of this approach in terms of long-term abstinence from cigarette smoking.

Glaucoma Public Service Announcements: Factors Associated with Follow-up of Participants with Risk Factors for Glaucoma

To determine the prevalence of follow-up and factors associated with completing an eye examination after a glaucoma public service announcement. Cross-sectional observational study. Individuals who participated in the Glaucoma EyeCare Program by calling a toll-free telephone number and receiving referral by meeting inclusion criteria. The Glaucoma EyeCare Program uses public service announcements to encourage those at increased risk for glaucoma to obtain an eye examination. The program requires interested persons to dial a toll-free telephone number to collect demographic, medical, and socioeconomic information, and refers those at higher risk of glaucoma to an ophthalmologist for a free eye examination. The ophthalmologist completes an outcome form, which indicates whether the participant obtained an eye examination and the results of this eye examination. We determined the factors associated with obtaining an eye examination. Sociodemographic characteristics associated with obtaining an eye examination after referral through the Glaucoma EyeCare Program. Ophthalmologists returned outcome forms for 1514 of 6343 participants (24%). Of those with outcome forms, 671 (44.3%) had an eye examination, 756 (49.9%) did not make an appointment, and 87 (5.7%) made an appointment but did not complete the examination. A multivariate logistic regression model showed younger age, female gender, lack of health insurance, medical history of diabetes, and shorter distance to be associated with obtaining an eye examination. Public service announcements encourage participants to have an eye examination. Multiple factors alter the success of obtaining an eye examination. Future studies are needed regarding the best method of decreasing the risk of undiagnosed glaucoma.