Reminder systems and late patient tracers in the diagnosis and management of tuberculosis

Qin Liu; Katharine Abba; Marissa M Alejandria; Vincent M Balanag; Regina P Berba; Mary Ann D Lansang

doi:10.1002/14651858.CD006594.pub2

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Figure 1

Late patient tracers vs no late patient tracer: Patients who did not complete treatment

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Figure 2

Late patient tracers (home visit) vs letter: Patients who did not complete treatment

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Figure 3

Reminders (automated telephone message) vs no message: Non‐attendance at clinic appointment

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Figure 4

Reminder plus health education vs usual care: Non‐adherence to final clinic appointment

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Analysis 1.1

Comparison 1 Late patient tracers vs no late patient tracer, Outcome 1 Patients who did not complete treatment.

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Analysis 1.2

Comparison 1 Late patient tracers vs no late patient tracer, Outcome 2 Failure of patients to return to treatment after first missed appointment.

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Analysis 2.1

Comparison 2 Late patient tracers (home visit plus health education) vs usual care, Outcome 1 Patients who did not complete treatment.

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Analysis 2.2

Comparison 2 Late patient tracers (home visit plus health education) vs usual care, Outcome 2 Treatment interrupted for 2 consecutive months or more.

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Analysis 2.3

Comparison 2 Late patient tracers (home visit plus health education) vs usual care, Outcome 3 Treatment failure.

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Analysis 2.4

Comparison 2 Late patient tracers (home visit plus health education) vs usual care, Outcome 4 Death.

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Analysis 2.5

Comparison 2 Late patient tracers (home visit plus health education) vs usual care, Outcome 5 Sputum‐smear positive follow up.

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Analysis 3.1

Comparison 3 Late patient tracers (home visit) vs letter, Outcome 1 Patients who did not complete treatment.

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Analysis 3.2

Comparison 3 Late patient tracers (home visit) vs letter, Outcome 2 Failure of patients to return for treatment after missed appointment.

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Analysis 4.1

Comparison 4 Reminders (automated telephone message) vs no message, Outcome 1 Non‐attendance at clinic appointment.

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Analysis 5.1

Comparison 5 Reminders (non‐automated reminder phone call) vs no reminder, Outcome 1 Non‐adherence to Mantoux test reading.

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Analysis 6.1

Comparison 6 Reminder plus health education vs usual care, Outcome 1 Non‐adherence to final clinic appointment.

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Analysis 7.1

Comparison 7 Reminder vs other types of reminders and no reminder, Outcome 1 Failed to return for skin test reading.

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Analysis 7.2

Comparison 7 Reminder vs other types of reminders and no reminder, Outcome 2 Failed to return for skin test reading.

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Table 1. Detailed search strategies

Search set	Cochrane SR^a	CENTRAL	MEDLINE^b	EMBASE^b	LILACS^b	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	2 or 3 or 4 or 5 or 6	DIRECTLY OBSERVED THERAPY	TREATMENT REFUSAL	TREATMENT‐REFUSAL	2 or 3 or 4 or 5	non‐adherence	non‐adherence
7	1 and 6	medication adherence	medication adherence	DIRECTLY‐OBSERVED‐THERAPY	1 and 6	late patient tracer	late patient tracer
8	—	electronic monitoring	REMINDER SYSTEMS	electronic monitoring	—	2‐7/or	2‐7/or
9	—	nonadherence	electronic monitoring	nonadherence	—	1 and 8	1 and 8
10	—	non‐adherence	nonadherence	non‐adherence	—	—	—
11	—	late patient tracer	non‐adherence	late patient tracer	—	—	—
12	—	2‐11/or	DIRECTLY OBSERVED THERAPY	1 or 2	—	—	—
13	—	1 and 12	late patient tracer	3‐11/or	—	—	—
14	—	—	1 or 2	13 and 14	—	—	—
15	—	—	3‐13/or	—	—	—	—
16	—	—	14 and 15	—	—	—	—
^aCochrane Infectious Diseases Group Specialized Register and the Cochrane Effective Practice and Organisation of Care Group Specialized Register. ^bSearch terms used in combination with the search strategy for retrieving trials developed by The Cochrane Collaboration (Lefebvre 2006); upper case: MeSH or EMTREE heading; lower case: free text term.

Table 1. Detailed search strategies

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Table 2. Risk of bias assessment

Intervention	Trial	Design	Generation of allocation sequence	Allocation concealment	Blinded assessment	Inclusion of randomized participants in the analysis	Protection against contamination
Late patient tracers	Krishnaswami 1981	RCT	Unclear	Unclear	Unclear	Adequate	Unclear
	Paramasivan 1993	RCT	Adequate	Adequate	No	Adequate	Done
	Mohan 2003	RCT	Adequate	Adequate	Yes	Adequate	Done
Reminder systems	Roberts 1983i	RCT	Unclear	Unclear	Unclear	Adequate	Unclear
	Roberts 1983ii	RCT	Unclear	Unclear	Unclear	Adequate	Unclear
	Sanmarti 1993	RCT	Unclear	Unclear	Unclear	Adequate	Unclear
	Tanke 1994	Quasi‐RCT	Inadequate	Unclear	Unclear	Adequate	Unclear
	Cheng 1997	Quasi‐RCT	Inadequate	Unclear	Unclear	Adequate	Unclear
	Tanke 1997	RCT	Unclear	Unclear	Unclear	Adequate	Unclear
RCT: randomized controlled trial.

Table 2. Risk of bias assessment

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Comparison 1. Late patient tracers vs no late patient tracer

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Patients who did not complete treatment Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Home visit plus health education vs usual care (directly observed therapy, short‐course)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Reminder letter vs usual care	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Failure of patients to return to treatment after first missed appointment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 1. Late patient tracers vs no late patient tracer

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Comparison 2. Late patient tracers (home visit plus health education) vs usual care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Patients who did not complete treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2 Treatment interrupted for 2 consecutive months or more Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3 Treatment failure Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

4 Death Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

5 Sputum‐smear positive follow up Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

5.1 2 months	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.2 5 months	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.3 End of treatment	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. Late patient tracers (home visit plus health education) vs usual care

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Comparison 3. Late patient tracers (home visit) vs letter

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Patients who did not complete treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2 Failure of patients to return for treatment after missed appointment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 3. Late patient tracers (home visit) vs letter

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Comparison 4. Reminders (automated telephone message) vs no message

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Non‐attendance at clinic appointment Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

1.1 Basic message vs no message	3		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
1.2 Message + authority vs no message	3		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
1.3 Message + importance statement vs no message	3		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
1.4 Message + authority + importance vs no message	3		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
1.5 Any type of message vs no message	3		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. Reminders (automated telephone message) vs no message

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Comparison 5. Reminders (non‐automated reminder phone call) vs no reminder

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Non‐adherence to Mantoux test reading Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Reminder phone call vs no call	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 5. Reminders (non‐automated reminder phone call) vs no reminder

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Comparison 6. Reminder plus health education vs usual care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Non‐adherence to final clinic appointment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Phone call plus health education vs usual care	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Home visit plus health education vs usual care	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 6. Reminder plus health education vs usual care

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Comparison 7. Reminder vs other types of reminders and no reminder

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Failed to return for skin test reading Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Expert vs non‐expert	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Take‐home card vs postcard	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 Take‐home card vs telephone call	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.4 Take‐home card vs person‐to‐person	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.5 Postcard vs telephone call	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.6 Postcard vs person‐to‐person	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.7 Telephone call vs person‐to‐person	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Failed to return for skin test reading Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 7. Reminder vs other types of reminders and no reminder

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