Reminder systems to improve patient adherence to tuberculosis clinic appointments for diagnosis and treatment
Information
- DOI:
- https://doi.org/10.1002/14651858.CD006594.pub3Copy DOI
- Database:
-
- Cochrane Database of Systematic Reviews
- Version published:
-
- 18 November 2014see what's new
- Type:
-
- Intervention
- Stage:
-
- Review
- Cochrane Editorial Group:
-
Cochrane Infectious Diseases Group
- Classified:
-
- Update pending
Studies awaiting assessment
The CIDG is currently examining a search conducted up to 18 Jul, 2018 for potentially relevant studies. These studies have not yet been incorporated into this Cochrane Review.Assessed: 15 April 2019
- Update pending
- Copyright:
-
- Copyright © 2014 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.
- This is an open access article under the terms of the Creative Commons Attribution‐Non‐Commercial Licence, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Article metrics
Altmetric:
Cited by:
Authors
Contributions of authors
This review was designed in collaboration with all six authors. KA and MADL screened the search results; KA retrieved the full papers which met the inclusion criteria. KA and QL assessed the eligibility of the retrieved papers, and MAL acted as third author for this stage. MA and VMB assessed the risk of bias of the included trials and extracted the data from papers; QL acted as a third author for this stage. QL wrote to trial authors for additional information, entered the data into Review Manager 5; QL and DS undertook the analyses and interpreted the data in consultation with the other review authors. QL drafted the review and the other review authors provided comments and helped to revise the review.
Sources of support
Internal sources
-
Chongqing Medical University, China.
External sources
-
Department for International Development (DFID), UK.
Declarations of interest
None known.
Acknowledgements
We thank Dr. Regina P. Berba for her valuable contributions to the previous version of this review. Also we are grateful to Paul Garner, Vittoria Lutje, Anne‐Marie Stephani, and Christianne Esparza for their valuable comments and kind support. This review is part of a project funded by UKaid from the UK Government for the benefit of developing countries.
Version history
| Published | Title | Stage | Authors | Version |
| 2014 Nov 18 | Reminder systems to improve patient adherence to tuberculosis clinic appointments for diagnosis and treatment | Review | Qin Liu, Katharine Abba, Marissa M Alejandria, David Sinclair, Vincent M Balanag, Mary Ann D Lansang | |
| 2008 Oct 08 | Reminder systems and late patient tracers in the diagnosis and management of tuberculosis | Review | Qin Liu, Katharine Abba, Marissa M Alejandria, Vincent M Balanag, Regina P Berba, Mary Ann D Lansang | |
| 2007 Jul 18 | Reminder systems and late patient tracers in the diagnosis and management of tuberculosis | Protocol | Qin Liu, Katharine Abba, Marissa M Alejandria, Vincent M Balanag, Regina P Berba, Mary Ann D Lansang | |
Differences between protocol and review
We amended the original protocol title 'Reminder systems and late patient tracers in the diagnosis and management of tuberculosis'. After publication of the original review, we found that the term 'late patient tracers' was unfamiliar to many readers, hence we used 'pre‐appointment reminders' instead of 'reminder systems' to mean any action to remind patients before they take their medication or attend their appointment; and 'default reminders' instead of 'late patient tracers' to mean similar interventions undertaken when patients fail to keep an appointment. Consequently, we changed the title to 'Reminder systems to improve patient adherence to TB clinic appointments for diagnosis and treatment' and also amended the terminologies in the review.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- *Appointments and Schedules;
- *Reminder Systems;
- Directly Observed Therapy;
- Latent Tuberculosis [prevention & control];
- Patient Compliance [*statistics & numerical data];
- Randomized Controlled Trials as Topic;
- Skin Tests [statistics & numerical data];
- Tuberculosis, Pulmonary [*diagnosis, *drug therapy];
Medical Subject Headings Check Words
Adult; Child; Humans;
PICOs
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included trials.
Risk of bias summary: review authors' judgements about each risk of bias item for each included trial.
Comparison 1 TB treatment: reminder versus none, Outcome 1 Attendance at single clinic appointment.
Comparison 1 TB treatment: reminder versus none, Outcome 2 TB cure or treatment completion.
Comparison 2 TB treatment: comparison of different reminders, Outcome 1 Attendance at single clinic appointment.
Comparison 2 TB treatment: comparison of different reminders, Outcome 2 TB cure or treatment completion.
Comparison 3 TB prophylaxis: reminder versus none, Outcome 1 Attendance at single clinic appointment.
Comparison 3 TB prophylaxis: reminder versus none, Outcome 2 Attendance at final clinic appointment.
Comparison 4 Skin test reading: reminder versus none, Outcome 1 Attendance at single clinic appointment.
Comparison 5 Skin test reading: comparison of different reminders, Outcome 1 Attendance at single clinic appointment.
| TB treatment: pre‐appointment reminder versus no reminder | |||||
| Patient or population: People on TB treatment | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | |
| Assumed risk | Corresponding risk | ||||
| No reminder | Pre‐appointment reminder | ||||
| Attendance at single clinic appointment | 50 per 100 | 66 per 100 (55 to 80) | RR 1.32 (1.10 to 1.59) | 615 | ⊕⊕⊝⊝ low1,2 |
| Completion of TB treatment | 88 per 100 | 100 per 100 (90 to 100) | RR 1.14 (1.02 to 1.27) | 92 | ⊕⊕⊝⊝ low3,4,5 |
| The basis for the assumed risk is the median control group risk across studies. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||
| GRADE Working Group grades of evidence | |||||
| 1Downgraded by 1 for serious risk of bias: This trial was quasi‐randomized and is at high risk of selection bias. | |||||
| TB treatment: defaulter reminder versus no reminder | |||||
| Patient or population: People on TB treatment | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | |
| Assumed risk | Corresponding risk | ||||
| No reminder | Defaulter reminder | ||||
| Attendance at single clinic appointment | 10 per 100 | 52 per 100 (17 to 100) | RR 5.04 | 52 (1 trial) | ⊕⊕⊝⊝ |
| Completion of TB treatment | 78 per 100 | 91 per 100 | RR 1.17 | 680 | ⊕⊕⊕⊝ |
| The basis for the assumed risk is the median control group risk across studies. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||
| GRADE Working Group grades of evidence | |||||
| 1No serious risk of bias: This trial was at low risk of selection bias, but was unblinded. | |||||
| TB skin testing: pre‐appointment reminder versus no reminder | |||||
| Patient or population: People at risk of TB | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | |
| Assumed risk | Corresponding risk | ||||
| No reminder | Pre‐appointment reminder | ||||
| Attendance at clinic | 60 per 100 | 63 per 100 | RR 1.06 | 1189 | ⊕⊕⊝⊝ |
| The basis for the assumed risk is the median control group risk across studies. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||
| GRADE Working Group grades of evidence | |||||
| 1Downgraded by 1 for serious risk of bias: Two trials are quasi‐RCTs and at high risk of selection bias. The third provides few details of randomization and is at unclear risk. | |||||
| Search set | Cochrane SRa | CENTRAL | MEDLINEb | EMBASEb | LILACSb | SCI‐EXPANDED & SSCI | CINAHL | |
| 1 | tuberculosis | tuberculosis | tuberculosis | tuberculosis | tuberculosis | tuberculosis | tuberculosis | |
| 2 | adherence | PATIENT COMPLIANCE | TUBERCULOSIS/DRUG THERAPY/PREVENTION AND CONTROL | TUBERCULOSIS | adherence | adherence | adherence | |
| 3 | compliance | PATIENT DROPOUTS | PATIENT COMPLIANCE | PATIENT‐COMPLIANCE | compliance | compliance | compliance | |
| 4 | monitor* | REMINDER SYSTEMS | PATIENT DROPOUTS | medication adherence | Monitor$ | monitor* | monitor* | |
| 5 | reminder* | TREATMENT REFUSAL | COOPERATIVE BEHAVIOUR | REMINDER‐SYSTEM | Reminder$ | reminder* | reminder* | |
| 6 | phone or SMS* or text or messaging | DIRECTLY OBSERVED THERAPY | TREATMENT REFUSAL | TREATMENT‐REFUSAL | phone or SMS$ or text or messaging | non‐adherence | non‐adherence | |
| 7 | 2 or 3 or 4 or 5 or 6 | medication adherence | medication adherence | DIRECTLY‐OBSERVED‐THERAPY | 2 or 3 or 4 or 5 or 6 | late patient tracer | late patient tracer | |
| 8 | 1 and 7 | electronic monitoring | REMINDER SYSTEMS | electronic monitoring | 1 and 7 | phone or SMS* or text or messaging | phone or SMS* or text or messaging | |
| 9 | — | nonadherence | electronic monitoring | nonadherence | — | 2‐8/OR | 2‐8/OR | |
| 10 | — | non‐adherence | nonadherence | non‐adherence | — | 1 AND 9 | 1 AND 9 | |
| 11 | — | late patient tracer | non‐adherence | late patient tracer | — | — | — | |
| 12 | — | phone or SMS* or text or messaging | DIRECTLY OBSERVED THERAPY | phone or SMS* or text or messaging | — | — | — | |
| 13 | — | 2‐12 | late patient tracer | 1 or 2 | — | — | — | |
| 14 | — | 1 AND 13 | phone or SMS* or text or messaging | 3‐12/OR | — | — | — | |
| 15 | — | — | 1 or 2 | 13 and 14 | — | — | — | |
| 16 | — | — | 3‐14/OR | — | — | — | — | |
| 17 | — | — | 15 and 16 | — | — | — | — | |
| aCochrane Infectious Diseases Group Specialized Register and the Cochrane Effective Practice and Organisation of Care Group Specialized Register. | ||||||||
| Trial ID | Country | Age group | TB status | TB intervention | Supervision of treatment | Type of reminder | Timing of reminder | Pre/post appointment | Control |
| USA | Adults | At risk of TB | Test | N/A | Take home reminder card1 | N/A | N/A | Verbal statement in clinic | |
| USA | Adults | At risk of TB | Test | N/A | Take home reminder card2 | N/A | N/A | Verbal statement in clinic | |
| N/A | Postcard | 1 day | Pre‐appointment | Verbal statement in clinic | |||||
| N/A | Phone call | 1 day | Pre‐appointment | Verbal statement in clinic | |||||
| USA | All | At risk of TB | Test | N/A | Phone call3 | 1 day | Pre‐appointment | No phone call | |
| USA | Children | At risk of TB | Test | N/A | Phone call | 1 day | Pre‐appointment | Take home reminder card | |
| Spain | Children | Asymptomatic | Prophylaxis | Parents | A routine phone call every 3 months | N/A | N/A | One‐off advice to take treatment for 12 months | |
| A routine nurse home visit every 3 months | N/A | N/A | One‐off advice to take treatment for 12 months | ||||||
| A routine doctor clinic appointment every 3 months | N/A | N/A | One‐off advice to take treatment for 12 months | ||||||
| USA | All | Asymptomatic | Prophylaxis | Unclear | Phone call3 | 1 day | Pre‐appointment | No phone call | |
| USA | All | Symptomatic | Treatment | Unclear | Phone call3 | 1 day | Pre‐appointment | No phone call | |
| Thailand | > 15 years | Symptomatic | Treatment | DOTS | Phone call | 1 day | Pre‐appointment | DOTS alone | |
| Iraq | Not stated | Symptomatic | Treatment | DOTS | Home visit | 3 days | Post‐appointment | DOTS alone | |
| India | > 12 years | Symptomatic | Treatment | Self‐monthly pick‐up of meds | Home visit | 4 days | Post‐appointment | Reminder letter | |
| India | Adult | Symptomatic | Treatment | Self‐monthly pick‐up of meds | Reminder card | 3 days | Post‐appointment | No reminder card | |
| 1Roberts 1983b also evaluated the effects of three types of participant commitment to return (no commitment, verbal, verbal plus written), and two types of verbal messaging on the importance of returning (enhanced versus standard). | |||||||||
| Outcome | Hypothesis | Power | α error | Proportion in control group | Proportion in intervention group | Total sample size required |
| Attendance at clinic appointment | Superiority | 80% | 5% | 50% | 75% | 110 |
| 80% | 90% | 394 | ||||
| TB cure or treatment completion | Superiority | 80% | 5% | 50% | 75% | 110 |
| 80% | 90% | 394 | ||||
| We performed calculations using http://www.sealedenvelope.com | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Attendance at single clinic appointment Show forest plot | 2 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 1.1 Pre‐appointment phone call | 1 | 615 | Risk Ratio (M‐H, Random, 95% CI) | 1.32 [1.10, 1.59] |
| 1.2 Defaulter reminder letter | 1 | 52 | Risk Ratio (M‐H, Random, 95% CI) | 5.04 [1.61, 15.78] |
| 2 TB cure or treatment completion Show forest plot | 3 | 778 | Risk Ratio (M‐H, Random, 95% CI) | 1.17 [1.11, 1.23] |
| 2.1 Pre‐appointment phone call | 1 | 98 | Risk Ratio (M‐H, Random, 95% CI) | 1.14 [1.02, 1.27] |
| 2.2 Defaulter reminder letter or home visit | 2 | 680 | Risk Ratio (M‐H, Random, 95% CI) | 1.17 [1.11, 1.24] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Attendance at single clinic appointment Show forest plot | 1 | 121 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.12 [0.87, 1.45] |
| 2 TB cure or treatment completion Show forest plot | 1 | 150 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.2 [0.95, 1.51] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Attendance at single clinic appointment Show forest plot | 1 | 536 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.30 [1.07, 1.59] |
| 2 Attendance at final clinic appointment Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 2.1 Routine phone call every three months | 1 | 157 | Risk Ratio (M‐H, Random, 95% CI) | 1.44 [1.21, 1.72] |
| 2.2 Routine nurse home visit every three months | 1 | 156 | Risk Ratio (M‐H, Random, 95% CI) | 1.46 [1.23, 1.74] |
| 2.3 Routine doctor clinic every three months | 1 | 159 | Risk Ratio (M‐H, Random, 95% CI) | 1.20 [0.98, 1.47] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Attendance at single clinic appointment Show forest plot | 4 | 1900 | Risk Ratio (M‐H, Random, 95% CI) | 1.01 [0.92, 1.10] |
| 1.1 Take home reminder card | 2 | 711 | Risk Ratio (M‐H, Random, 95% CI) | 0.96 [0.88, 1.04] |
| 1.2 Pre‐appointment phone call | 3 | 1189 | Risk Ratio (M‐H, Random, 95% CI) | 1.06 [0.92, 1.21] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Attendance at single clinic appointment Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 1.1 Take‐home card versus postcard | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 1.2 Take‐home card versus telephone call | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 1.3 Postcard versus telephone call | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
