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Editors Selection IGR 7-1

Medical Treatment: Improving adherence to treatment

Comment by Anja Tuulonen on:

67327 Effectiveness and Cost of a Personalized Reminder Intervention to Improve Adherence to Glaucoma Care, Pizzi LT; Tran J; Shafa A et al., Applied health economics and health policy, 2016; 14: 229-240

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In the out-patient clinics of the authors, about one third of patients are lost to follow-up due to cancelling the visit without rescheduling or simply not showing up. Although the adherence to medical treatment has been relatively widely studied, little research is published on interventions increasing follow-up adherence.

Little research is published on interventions increasing follow-up adherence

This prospective study was ran at Wills Glaucoma Service during 14 months in 2012-13. Eligible patients were randomized to either usual care or intervention group. The sample size calculation was based on assumption of 50% decrease in losses of follow-up. Patients under usual care did not receive any reminders prior to the scheduled visit while the intervention group received a letter two weeks prior to the appointment and a phone call two to three days before the visit with an extra cost of US$ 11 per patient. The primary outcome measure was percentage of patients attending the planned visit. The adherence window for one-month visit was two weeks, one month for three-month visits and two months window for six-month visits. The cost analysis was conducted from the perspective of health care provider.

The results of the study indicate that a low cost reminder intervention may improve appointment adherence

The overall adherence of the 126 patients of usual care group was 69% compared to 82% in the 130 patients in the intervention group. Younger patients (< 65 years) with short interval between follow-up visits (one month), new to the service and without secondary insurance were prone to miss an appointment. The Incremental cost-effectiveness ratio (ICER) was US$ 74 per follow-up attended. The results of the study indicate that a low cost reminder intervention may improve appointment adherence and encourages the care givers and patients to innovate simple reminders, e.g., by implementing different cell phone applications.

PS
There is a typo in the paper of Pizzi et al. when they refer to number of patients with glaucoma in 2010 (page 230, ref. 3 Quigley): Quigley's estimate was 79.6 million, not 9.6 million as now written in the article.

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