Implementation of a patient reminder system in Haiti in a socio-political crisis context: evaluation of outcomes

Abstract

Background: In Haiti, patient’s adherence to treatment and compliance with medical appointments are very challenging due to different local factors. We aimed to assess the effectiveness of a reminder system implemented in health facilities in Haiti in a context of socio-political crisis. Methods: We used appointment data from patients aged 15 years and older between January 2021 and November 2023 from four healthcare centers in the Port-au-Prince metropolitan area. We performed descriptive analysis, crossing covariates with appointment attendance. We performed Pearson’s Chi-squared test, and multivariate regression analysis using a mixed-effect logistic regression model in order to explore the association between sending reminders and appointment attendance, with and without adjustment for other patient-level covariates. Results: A total of 14 108 appointments were registered on the reminder systems, with 2 479 (17.6%) attendances. Among those to whom reminders were sent, the number of attendances was 167 (17.4%) for email recipients only, 199 (36.7%) for SMS recipients only, and 19 (42.2%) for both SMS and email recipients – versus 2 094 (16.7%) for non-reminders. After adjusting on all other covariates, we found that patients to whom a reminder was sent via email (aOR: 1.45; CI: 1.08, 1.94), SMS (aOR: 2.95; CI: 2.41, 3.60), and both SMS and email (aOR: 2.86, CI: 1.37, 5.96) were more likely to show up on their appointment day compared to those who did not receive any reminder. Other socio-demographic factors such as being 50 years and older (aOR: 1.31; CI: 1.10, 1.56) compared to under 30 years, living as couple (aOR: 1.23; CI: 1.10, 1.37), and not having children (aOR: 1.21; CI: 1.07, 1.37) were significantly associated with appointment attendance. Conclusions: Our study suggests that patient reminder systems may be used to reduce non-attendance in Haiti, even in a context of socio-political crisis.