Text 2 treat – using SMS to recall clients for treatment

Introduction

The increasing availability and affordability of the short message service (SMS) has enhanced the options available to healthcare workers when communicating with patients outside the clinical environment. SMS has been increasingly utilised in healthcare for client communication such as appointment reminders.^1,2 Sending an SMS is quick, cheap and requires minimal resources, resulting in improved worker efficiency and reduced costs. ³ When received, the SMS can be discreetly read and acted upon by the patient at a convenient time.

Genital Chlamydia infection is the most common sexually transmitted infection (STI) in Australia, with 82,229 cases notified in 2013 alone. ⁴ Prompt treatment of these patients shortens the period of infectivity, with resulting benefits to the individual’s health, as well as community members who would otherwise be exposed to the infection. Sixty per cent of patients positive for Chlamydia in Australia in 2013 were aged between 15 and 24 years. ⁴ In this age group, mobile phone ownership is near universal. ³ The acceptance of communication with healthcare facilities via SMS has also been positively evaluated with regard to reminders to attend appointments and increased staff efficiency.^1,2,3

Research regarding the preferences of young adults for sexual health clinic recall is mixed. A large cross sectional study of people aged 18–29 found that only 5% preferred to be informed of their results by SMS, with a clear preference for verbal communication via mobile phone. ⁵ This was believed to be due to concerns of another person reading their SMS. ⁵ A smaller study that surveyed young adults after receiving a discreetly worded SMS (‘your results are fine’) from a sexual health clinic, found 100% were pleased with the service. ⁶ This suggests that SMS used in a manner that allays the confidentiality fears of clients may be well received by young adults.

The Population Health-Midwest clinic provides free STI screening to the regional community of Geraldton, Western Australia. Clients are informed that they will receive one of two SMS texts at their initial visit when test samples are collected. They receive either ‘all good, (clinician’s first name)’ if no further follow-up is required of the results, or ‘Hi (client’s name) I need 2 c u. Can u contact me? Thanx (clinician’s first name)’ if the client needs to be recalled for treatment. The client then contacts the clinic by phone or SMS to arrange an appointment. This audit aimed to quantify the time between the recall of clients via SMS and their directly observed treatment.

Methodology

All clients diagnosed with genital Chlamydia by the clinic between June 2012 and May 2013 were identified. Their clinic notes were examined with demographic details, the date the client was tested, the date they were recalled via SMS, the date they responded to the SMS and the date of treatment recorded. A search of Medline was conducted using the terms ‘Chlamydia’ and ‘time to treatment’, limited to studies from the last 10 years, to obtain comparative data for clinics that do not use SMS recall.

Results

Sixty-four clients were identified with genital Chlamydia in the year of the study. Sixty-nine per cent of clients (n = 44) were women and 86% (n = 55) aged between 15 and 24 years. Ninety-four per cent (n = 60) of clients responded to the SMS, with 84% (n = 54) responding on the same day they were contacted. Six per cent (n = 4) did not reply to the SMS, but presented spontaneously for treatment. All 64 clients were treated for their infection; 72% (n = 46) were provided with directly observed treatment within one day of being informed of their results via SMS including five who were treated presumptively at the initial appointment.

The literature search found no studies providing detailed data on the length of time between recalling the client, their response and their treatment. However, one study provided sufficient data on the length of time between initial screening test and the provision of treatment when SMS recall was not used. ⁷ This study included both Chlamydia and Gonorrhoea cases and only woman clients. Clients treated presumptively were excluded from this analysis.

Discussion

The success of this programme is in keeping with the broader published literature. Several studies concur that SMS allows faster provision of sexual health results and quicker access to suitable treatment.^3,6 The use of SMS in this setting is further reinforced by studies finding a benefit when SMS is used to recall high-risk clients for re-testing purposes.^8,9 Furthermore, SMS communication is discreet and requires few resources, with one study concluding that SMS communication required 40% less staff time than phone communication. ³

The regional setting of our clinic requires specimens to be transported large distances, which resulted in a median delay of six days between testing and results, likely longer than the metropolitan hospitals in the comparison study. ⁷ This delay may account for the lower proportion of clients treated within seven days but greater proportion at all other time points (Table 1).

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Table 1.

Proportion treated by duration since testing as compared to a similar study. ⁷

Duration since testing	Current study %	Wong et al. 7 study
		Passive recall % (range)*	Phone recall %
≤7 days	56	8–43	66
≤14 days	95	34–67	82
≤30 days	100	68–85	89
Never treated	0	8–18	8
Median time to treatment	7 days	8–18 days	7 days

It is acknowledged that contacting clients in a timely manner is crucial to reducing the transmission of STIs and is considered best practice. Our results suggest that SMS is a highly effective, youth-friendly communication tool which could be utilised in other healthcare setting which interact with this younger population.