A Mobile Phone Message Reminder to Improve Adherence of Diabetic Patients for Scheduled Eye Care in Rural China: A Randomized Clinical Trial

Abstract

Purpose : To determine whether short message service (SMS) reminders could improve adherence of diabetic patients with scheduled ocular examinations in rural China. Rates of acceptance of such care are known to be low in this setting, and little is known about how to improve them.

Methods : A total of 233 consecutive diabetic patients enrolled in eye clinics at 5 rural hospitals in Guangdong Province, China from March 1, 2015 to May 31, 2016, were randomized (1:1) to receive automated SMS reminders at 1 week and 3 days prior to scheduled eye appointments (Intervention) or standard appointments without reminders (usual practice in this setting: Control). Patients’ demographic characteristics, knowledge of diabetic retinopathy (DR), satisfaction with care, distance traveled and ocular examination results were assessed at baselines in masked fashion. Main outcome was attending within +/- 1 week of the scheduled visit. Generalized linear models with Poisson regression on intention-to treat principles were used to estimate association between main outcome and membership in the Intervention group, with and without adjustment for other potential determinants.

Results : Among 104 patients (mean age 57.5±11.0 years, 39.4% men) completing follow-up by 30 November 2016, 56 (53.8%) were randomized to Intervention (58.6±11.8 years, 37.5% men), 48 (46.2%) to Control (56.3±9.83 years, 41.7% men). Appointments were scheduled for a median of 30.7 weeks after baseline examination for all subjects (IQR 26.1 to 51.4 weeks). Attendance for the Intervention group (21/56, [37.5%]) was significantly higher than for Control (4/48, [8.33%], P<0.001). Factors associated with attendance in multiple regression models included Intervention group membership (RR, 3.51; 95% CI, 1.19-10.4; P=0.02) and DR knowledge (RR, 1.58; 95% CI, 1.19-2.10; P=0.002). Data on secondary outcomes (knowledge, satisfaction) and for remaining patients will be presented.

Conclusions : The low-cost intervention of text message reminders may significantly improve adherence with eye care in this setting, but further interventions are needed to achieve optimal service uptake.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.