Use of short message service (SMS) reminders to improve the attendance rate of diabetes-related multidisciplinary services in a primary care clinic a randomized controlled trial

Background: Non-attendance of various non-physician-led multidisciplinary (NPLM) services causes wastage of health care resources. This study determined whether using mobile phone text message reminders by Short Message Service (SMS) in patients with type II diabetes attending a primary care clinic resulted in higher attendance rates of NPLM services when compared with those without SMS reminders. Method: A single centre randomized-controlled trial included adult subjects with type II diabetes who could read Chinese or English, possessed an SMS-capable phone and booked at least NPLM service appointments in study site. The main outcomes were comparing attendance rates between the control group and the intervention group of various NPLM services including nurse complication screening, nurse individual counselling, multidisciplinary group education, dietitian counselling, physiotherapist service, retinopathy screening by optometrist and blood taking sessions Results: 297 eligible subjects were approached, 15 were excluded and 11 refused to participate. 271 subjects were recruited (response rate 96%). Their mean (± standard deviation) age was 63.3±11.3. Their mean duration of DM was 6.9±5.3 years with mean HbA1c 7.37±1.32%. They were randomly assigned to intervention (N=135) or control (N=136) group. The Intervention groups received a standard SMS reminder included appointment name, date and time 24-72 hours prior to the scheduled appointment. The Control groups received no reminder. 733 appointments (intervention N=372, control N=361) were analysed. More subjects used smartphone (82.2%) than mobile phone without internet access (17.8%). All SMS were successfully delivered for the 372 appointments with no adverse event reported. The overall attendance rates were 92.7% in the intervention group and 83.1% in the control group (Odds ratio, OR 2.60, 95% confidence interval, CI 1.61-4.19, p<0.001). In subgroup analysis, SMS reminders were particularly useful in reminding nurse clinic (OR 3.06, 95% CI 1.22-7.66, p=0.017) and optometrist clinic (OR 2.73, 95% CI 1.07-7.01, p=0.037). Conclusion: SMS reminder is a reliable method to increase overall attendance rates and health service utilization of NPLM DM services in outpatient setting.