Impact of an SMS reminder service on outpatient clinic attendance rates by patients with HIV followed-up at Pointe-à-Pitre University Hospital.

OBJECTIVE: By the end of 2014, 23% of people living with HIV (PWHIV) who had had a scheduled appointment at our outpatient clinic had not attended. We implemented an SMS reminder service and assessed its impact on medical consultation-attendance rate. METHODS: The intervention was directed at all PWHIV with a scheduled appointment between March and April 2015 at our infectious diseases department. Two days before the scheduled visit, an appointment reminder SMS was sent to every other patient at random. On the visit day, a questionnaire was used to determine patient perceptions regarding the SMS. RESULTS: A total of 224 patients (126 males, 98 females, mean age 52 years, 94% taking anti-retroviral therapy) were selected to take part in the study. The medical consultation-attendance rate was 76% in the SMS reminder read group (87 patients) and 72% in the SMS reminder not sent or not read group (137 patients, P=0.6). Among the 66 SMS reminder read patients who attended their consultation and answered the questionnaire, 51% reported that the SMS had contributed to their attendance. CONCLUSION: Sending an SMS reminder had no significant impact on clinic attendance rates. This may have been due in part to the sociocultural characteristics of our patients. Further research should investigate other tools to improve attendance rates.

What, why and how do health systems learn from one another? Insights from eight low- and middle-income country case studies.

BACKGROUND: All health systems struggle to meet health needs within constrained resources. This is especially true for low-income countries. It is critical that they can learn from wider contexts in order to improve their performance. This article examines policy transfer and evidence use linked to it in low- and middle-income settings. The objective was to inform international investments in improved learning across health systems. METHODS: The article uses a comparative case study design, drawing on case studies conducted in Bangladesh, Burkina Faso, Cambodia, Ethiopia, Georgia, Nepal, Rwanda and Solomon Islands. One or two recent health system reforms were selected in each case and 148 key informants were interviewed in total, using a semi-structured tool focused on different stages of the policy cycle. Interviewees were selected for their engagement in the policy process and represented political, technical, development partner, non-governmental, academic and civil society constituencies. Data analysis used a framework approach, allowing for new themes to be developed inductively, focusing initially on each case and then on patterns across cases. RESULTS: The selected policies demonstrated a range of influences of externally imposed, co-produced and home-grown solutions on the development of initial policy ideas. Eventual uptake of policy was strongly driven in most settings by local political economic considerations. Policy development post-adoption demonstrated some strong internal review, monitoring and sharing processes but there is a more contested view of the role of evaluation. In many cases, learning was facilitated by direct personal relationships with local development partner staff. While barriers and facilitators to evidence use included supply and demand factors, the most influential facilitators were incentives and capacity to use evidence. CONCLUSIONS: These findings emphasise the agency of local actors and the importance of developing national and sub-national institutions for gathering, filtering and sharing evidence. Developing demand for and capacity to use evidence appears more important than augmenting supply of evidence, although specific gaps in supply were identified. The findings also highlight the importance of the local political economy in setting parameters within which evidence is considered and the need for a conceptual framework for health system learning.

Life in urban areas and breast cancer risk in the French E3N cohort.

It has been suggested that women living in urban areas are at higher risk of breast cancer (BC) compared to women living in rural areas. However, most published studies on this topic are ecological and did not adjust for individual BC risk factors. We investigated this hypothesis in a French prospective cohort. Cox proportional hazards regression models were used to evaluate the association between birth or residence in an urban area and BC risk among 75,889 women of the French E3N cohort (aged 38-66 years at recruitment in 1990) before and after adjustment for known BC risk factors and stratifying on birth cohort. From 1990 to 2008, a total of 5,145 BC cases were diagnosed. Being born in an urban area was associated with BC risk before (HR 1.11, 95% CI 1.05-1.18) and after (HR 1.07, 95% CI 1.01-1.14) adjustment for known BC risk factors. Living in an urban area in 1990 was not associated with BC risk. Being born in an urban area is associated with a weak increase in BC risk. This may be suggestive of higher exposure to air pollution and to other environmental exposures, to be investigated in future studies.