Prompts to encourage appointment attendance for people with serious mental illness

 

Abstract

Background

Prompts to encourage attendance at clinics are often used in day-to-day practice by diligent carers of people with mental health problems. These may take the form of telephone prompting, financial incentives or issuing a copy of the referral letter to the appointee.

Objectives

To estimate the effects of simple prompting by professional carers to encourage attendance at clinics for those with suspected serious mental illness.

Search methods

We searched the Cochrane Schizophrenia Group Trials Register (April 2009) and reference lists, as well as contacting authors of studies.

Selection criteria

All relevant randomised (or quasi-randomised) studies comparing the addition of 'prompts' to standard care for those with serious mental illnesses such as schizophrenia. Prompts had the stated purpose of encouraging attendance or contact with mental health teams and could be text-based, (for example in the form of a letter), electronic, by telephone call, by personal visit, or could employ financial or other rewards.

Data collection and analysis

Studies and data were independently selected and extracted. For homogeneous dichotomous data the random effects relative risk (RR), the 95% confidence intervals (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data the reviewers calculated weighted mean differences.

Main results

Only four relevant trials were identified (total n=789). It is not clear whether there is any real difference between attendance of those prompted by telephone one or two days before the appointment, and those given the standard appointment management system (2 RCTs, n=457, RR missed appointment 0.84 CI 0.7 to 1.1). Text-based prompts in the form of a letter, a few days before the appointment day, may increase clinic attendance when compared with no prompt (3 RCTs, n=326, RR missed appointment 0.76 CI 0.43 to 1.32). Only one small study (n=61) reported data on the combination of telephone and text-based prompts versus no prompt, no real difference between groups was apparent (RR missed appointment 0.7 CI 0.4 to 1.2). When telephone prompts were compared with text-based prompts (1 RCT, n=75), the latter, in the form of an 'orientation statement' (a short paragraph, taking about 30 seconds to read, explaining the programme of care, the fee system, and providing gentle encouragement) may be somewhat more effective than the telephone prompt (RR missed appointment 1.9 CI 0.98 to 3.8). One study (n=120) compared a standard letter prompt with a letter 'orientation statement'. Overall, results tended to favour the orientation statement approach rather than the simple letter prompting attendance but the results did not reach conventional levels of statistical significance (RR missed appointment 1.6 CI 0.9 to 2.9). When prompts were considered regardless of their type, the results were of greater significance and suggested an effect to increase the rate of attendance (RR missed appointments 0.80 CI 0.65 to 0.98)

Authors' conclusions

There is evidence that a simple prompt to attend clinic, very close to the time of the appointment may encourage attendance, and a simple orientation-type letter may be more effective than a telephone prompt. This simple intervention could be a more cost effective means of encouraging compliance at first attendance, but supplementing these data with the results of large, well designed, conducted and reported randomised studies would be desirable.

 

Plain language summary

Prompts to encourage appointment attendance for people with serious mental illness

First appointments at a mental health clinic can be a daunting prospect. Failure to attend is common, wastes time, and can result in important delays in getting proper care. A gentle prompt, near to the time of appointment, would, if effective, seem a cost effective way of encouraging attendance. This review sought evidence for the effects of telephoning or sending a letter, in the days just before the appointment. Relevant studies were found, and although none were conclusive, all suggested that a simple prompt could indeed encourage attendance.

 

摘要

背景

鼓勵嚴重精神疾患就診的提醒

鼓勵嚴重精神疾患於診所就診的提醒，通常是由勤勞的照護者每天在做。採用的方式可能以電話提醒、給予金錢獎勵或將轉介信影印給患者。

目標

評估由專業照顧者提供簡單提醒，鼓勵嚴重精神疾患於診所就診的效果。

搜尋策略

搜尋 Cochrane Schizophrenia Group's Register (至2009年4月), 以及參考文獻，同時也聯繫研究的作者。

選擇標準

所有相關的隨機(或類隨機)研究，對於嚴重精神疾患如精神分裂症，比較在標準照護之外，加上“提醒”的效果。提醒的目的在於鼓勵就診或與精神健康團隊聯繫，可能以文字(例如信件)或電子的形式，或者以電話、個別訪視的方式進行，又或者提供金錢或是其他的回饋。

資料收集與分析

獨立地選擇並擷取研究及資料。對於同質的二分變項，計算隨機效果相對風險(RR)，95%信賴區間(CI)，以及適當的話，以intentiontotreat原則，計算益需治療數(NNT)。對於連續變項，計算加權平均差異(weighted mean differences)。

主要結論

只找到4篇相關的試驗(共789位參與者)。在就診前1天或2天以電話提醒的就診率，與標準預約管理系統相比，並不清楚是否有真正的差異(2個試驗，457位參與者，RR 未就診 0.84 CI 0.7 to 1.1)。在就診前幾天以文字來提醒，與沒有提醒相比，的確增加就診率(2個試驗，200位參與者，RR 未就診 0.6 CI 0.4 to 0.9, NNT 6 CI 2 to 14)。只有1個小研究(61位參與者)報告合併電話與文字提醒與沒有提醒相比，並沒有顯示出差異(RR未就診 0.7 CI 0.4 to 1.2)。電話提醒與文字提醒相比(1個試驗，75位參與者)，文字提醒以“簡介”的形式(即簡短的文字，約需30秒時間閱讀，解釋照護計畫，收費標準，並給予好言相勸)可能會比電話提醒要更有效果(RR未就診 1.9 CI 0.98 to 3.8)。有1個研究(120位參與者)比較標準信件提醒與“簡介”方式的信件提醒，整體來說，結果傾向比簡單信件提醒就診要更有效果，但未達到統計學上的顯著水準(RR未回診 1.6 CI 0.9 to 2.9)。

作者結論

證據顯示在接近就診的時間提供一個簡單的就診提醒可以鼓勵患者，而一個簡單的簡介型式的信，可能比電話提醒更有效。這種簡單的介入可能是一個更具成本效益的方式用來鼓勵個案第一次就診，但仍需要更大及設計、執行且報告良好的隨機研究來支持。

翻譯人

本摘要由彰化基督教醫院陳美雀翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

第一次在精神科診所就診可能是令人害怕的。未依約就診是經常發生且浪費時間的，也可能導致在獲得適當的照護上有顯著的延遲。在接近就診的時間提供一個適當的提醒，如果有效，會是一種具成本效益的方式來鼓勵就診。這篇回顧尋找在就診前幾天以電話或信件提醒的效果。找到相關的研究，雖然沒有確切的結論，所有的研究都發現一個簡單的提醒就有鼓勵就診的效果。