Effectiveness of reminders via messaging apps in improving clinic attendance and medication compliance among patients with depression / Low Pei Teeng

Low, Pei Teeng (2020) Effectiveness of reminders via messaging apps in improving clinic attendance and medication compliance among patients with depression / Low Pei Teeng. Masters thesis, Universiti Malaya.

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Abstract

Background: Non-attendance at clinic appointments and medication non-compliance are both common issues within psychiatric settings, with forgetting being specified as one the most common reasons. This phenomenon may be worse for patients who are suffering from depression. Thus, the use of regular reminders in some format for such patients could be potentially very beneficial. With cognizance of the exponential growth of smartphone usage and social media awareness during the past decade, a messaging apps maybe a potentially efficient and cost-effective method of sending such reminders in a healthcare setting. Objective: To determine the potential effectiveness of sending reminders via messaging apps to improve clinic attendance and medication compliance among patients with depression. Methodology: This study used an open-label randomized controlled trial design. A total of 183 patients, all diagnosed with major depressive disorder (MDD) were recruited from two psychiatric clinics located in tertiary hospitals. All the participants were randomized into an intervention group and a control group, and followed-up over a period of two months. Participants in the intervention group received two types of reminders via their preferred apps: 1) Clinic appointment reminders which were sent a day before their allocated appointment date, and 2) Medication reminders which were sent weekly. v Results: The Intention-to-treat approach was used for the analysis of the 183 participants. At the close of trial period, the results presented a significant improvement of clinic attendance rates with the intervention group (76.8%) compared to the control group (56.4%) (P = 0.002). Similarly to medication compliance, the intervention group also presented a significantly higher BARS percentage (60.2%) in comparison to the control group (37.1%) (P < 0.001). In this study, the treatment given for the depression was generally effective in all participants as proven by the significant result of the MADRS score change in both groups with the P value of <0.001 respectively. Aside from that, it was found that the intervention group has a significantly higher mean score change (9.4, 95% CI [7.2, 11.6]) as compared with the control group (6.0, 95% CI [4.1, 7.9]) with a mean difference of 3.4 with 95% CI [0.4, 6.3] (P = 0.025). Hence, it may be inferred that there is a significant association between receiving reminders and depressive symptoms. As for reminder preferences, the majority of participants (53%) stated their concerns relate to forgetting. This response was in accordance with the result of reasons for defaulting on appointments, which showed 31% was due to forgetting. Unsurprisingly, WhatsApp was the most preferred messaging service amongst the participants by virtue of its high market penetration rate globally and in Malaysia. Conclusion: Reminders via messaging apps were found to be effective in improving clinic attendance and medication compliance among patients with depression. Messaging apps, with high penetration and effectiveness are able to render useful service for reminder delivery within the healthcare setting. Keywords: reminders; messaging apps; attendance; compliance; depression

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