Effectiveness of text message reminders on nonattendance of outpatient clinic appointments in three different specialties: a randomized controlled trial in a Saudi Hospital

Nonattendance at outpatient appointment is a major problem particularly in public hospitals that leads to long waiting time and inefficient use of hospital recourses. The aim of this study was to evaluate the effectiveness of sending short message service [SMS] reminders to the mobile phones of patients scheduled for an outpatient appointment on nonattendance rate. A randomized controlled trial was conducted at three outpatient clinics [General Medicine [GM], Neurology [Neuro], Obstetrics and Gynecology [OB/GYN]. Eligible patients were randomly allocated to either receive SMS reminder message of their outpatient appointment [intervention group] or receive no reminder [control group]. The electronic database of the hospital was used to collect patient appointment information, mobile phone number, type of clinic and other patient characteristics. The primary outcome measure was nonattendance rate. Chi-square test and multivariate logistic regression were used to compare nonattendance rate between the two groups. A total of 1499 patients were entered in the two arms of the study between April 2011 and June 2011. These were divided as follows [GM= 502, Neuro =297, and OB/GYN =700]. The nonattendance rate was significantly lower in the reminder groups compared to the nonreminder groups in the GM and Neuro clinics [26.3% vs. 39.8% and 29.3% vs. 43.9%, respectively P

Physicians' override of computerized alerts for contraindicated medications in patients hospitalized with chronic kidney disease

Objectives: To determine the effectiveness of a clinical decision support system [CDSS] as indicated by a lower proportion of receiving contraindicated medications by patients with severe chronic kidney disease [CKD] compared with patients with less severe CKD

Materials and Methods: This was a retrospective analysis of inpatients with CKD [ICD9-CM 585.xx] admitted to a major tertiary hospital in Saudi Arabia and receiving one of the medications that were documented in the knowledge base of the hospital CDSS to be renally cleared and/or nephrotoxic. Using the Chi square test, the proportion of receiving contraindicated medication was compared between patients with severe CKD and patients with mild/moderate CKD. Multivariate logistic regression was then used to examine the adjusted risk of receiving contraindicated medications among patients with severe CKD despite the presence of guided medication by CDSS

Results: The final analysis was conducted on 346 patients who received prescriptions that were renally cleared and/or nephrotoxic. Of these patients, 17% [n = 58] had severe CKD and 83% [n = 288] had mild/moderate CKD. Among patients with severe CKD, 51.7% [n = 30] received contraindicated medications compared with patients with mild/moderate CKD, 4.9% [n = 14], P < 0.01. Multivariate logistic regression showed that the likelihood of receiving contraindicated medications was several folds higher among patients with severe CKD compared with patients with mild/moderate CKD [P < 0.001]

Conclusion: Patients with severe CKD continued to receive contraindicated medications despite the availability of medication guidance by the CDSS to prescribing physicians. Improved compliance by physicians to CDSS alerts and better understanding of reasons for non-compliance is still needed, particularly for patients with severe CKD

Physician satisfaction with electronic medical records in a major Saudi government hospital

The objectives of this study were to measure physician satisfaction with a recently introduced electronic medical record [EMR] system and to determine which of the individual attributes of EMR were related to physician satisfaction. One year after introduction of an EMR system, physicians in an inpatient department were asked to answer a self-administered survey. Pearson's correlation coefficient was used to determine which attributes were significantly related to overall satisfaction with the system. Linear regression analysis was then performed to examine the association between the three main domains of the questionnaire and overall satisfaction with the system, with adjustment for physician demographic characteristics. A total of 115 physicians answered the survey. Only 40% were satisfied with the system overall. The best predictors of overall satisfaction were performance in the form of speed, integration with workflow, and patient information, such as accuracy, completeness and timeliness. Physicians were generally not satisfied with the system. Continued evaluation of such systems and feedback from users should guide future selection and implementation