Can text messaging results reduce time to treatment of Chlamydia trachomatis?
- 1Infectious Disease/Sexual Health, Waikato Hospital, Hamilton, New Zealand
- 2Department of Strategy & Human Resource Management, University of Waikato, Hamilton, New Zealand
- Dr Jane Morgan, MRCP, Consultant Sexual Health Physician, Waikato Hospital, Private Bag 3200, Hamilton, New Zealand;
- Accepted 11 August 2008
- Published Online First 22 August 2008
We assessed the impact of text messaging as the preferred method of communicating positive Chlamydia trachomatis test results in an urban sexual health clinic. Following the introduction of a text messaging service to communicate positive C trachomatis test results to patients, the time between test and treatment in 293 consecutive patients was compared with 303 historic controls. No significant difference was found in either median time to treatment for all patients (3 days in 2005; 4 days in 2007) or median time to treatment (both 7 days) for those not treated immediately. There was no significant difference in time to treatment between those using a landline or mobile phone. Mobile phone use was significantly higher in 2007. Overall, we treated more cases within 4 weeks in 2007 (98.6% cf 96%).
The lack of difference in time to treatment showed the use of this technology is as effective as more traditional means of communication. The increase in cases of C trachomatis treated within 4 weeks may reflect the significant increase in mobile phone use and improved ability to contact people rather than simply the introduction of text messaging.
Reducing time to effective treatment for Chlamydia trachomatis has the potential for personal and public health gain through reduced complication rates and limiting further transmission.1 In 2006, the introduction of text messaging test results in a UK genitourinary medicine (GUM) clinic was associated with a decrease in median time to treatment from 15 to 9 days.2 This study aims to assess any impact of introducing text messaging in a different locality.
All sexually active patients were offered testing for sexually transmitted infections. Men with symptomatic urethritis and sexual contacts of confirmed cases of C trachomatis were treated immediately. Results were available over the telephone within 7 days or at a follow-up appointment. Laboratory test (Roche PCR, Roche Diagnostics Corporation, Indianapolis, USA) results were received within 3–5 days. A designated nurse contacted any patient with a positive result. Anyone untreated was offered an appointment within 24 h.
In 2005, initial communication was by landline or mobile telephone with letters sent if uncontactable. In 2006, text messaging was introduced as the preferred method of communicating positive results. Desktop software (Healthcare Communications Ltd, UK) was used to generate multiple text messages. A generic message with no personal information or diagnoses was sent asking recipients to contact the clinic nurse. Other types of communication were used (for example, landline, letter) if this was the patient’s preference or if software audit reports indicated message delivery failure (for example, poor rural network coverage).
Notes of those with uncomplicated C trachomatis infection in the same 6 month period (1 March to 31 August) in 2005 and 2007 were reviewed and their demographical and attendance data compared. The interval from testing to appropriate treatment, either in a clinic or documented treatment elsewhere, was calculated.
Data were analysed using SPSS for Windows (V.14.0) software. Differences between age groups and ethnicity were tested using analysis of variance (ANOVA), and t tests were used to determine differences by gender and service variables (treated immediately and delay to treatment).
Between March and August 2005, 303 cases of uncomplicated C trachomatis (293 individuals) were diagnosed. Five cases were untraceable. Of the remaining 298, 140 (47%) were treated immediately. Between March and August 2007, 293 cases (281 individuals) were diagnosed; one case was untraceable. Of the remaining 292, 139 (49%) were treated immediately. There was no significant difference between the groups in terms of gender, age, ethnicity, number of patients treated immediately or time between testing and treatment (table 1).
The majority of patients provided a mobile phone rather than a landline number (81% vs 42% in 2005, p<0.001; 88% vs 37% in 2007, p<0.001), with significantly more mobile phone numbers in 2007 (p<0.05). Between March and August 2007, 237 text messages were sent with 93% successfully delivered. Excluding those treated immediately, 311 cases had delayed treatment (158 from 2005, 153 from 2007). There was a trend to earlier treatment between those with mobile phones compared with those without (t = −1.300, p<0.1). There were no significant differences between the groups in terms of age, gender and ethnicity.
We found no significant difference in median time to treatment for all patients (3 days in 2005; 4 days in 2007) and for delayed treatment there was no change in median time to treatment (both 7 days) following the introduction of text messaging. Our results contrast with Menon-Johansson who found the introduction of text messaging reduced median time to treatment for 28 patients, but from 15 to 9 days, which suggests the clinical settings are not directly comparable.2
Our outcome measures compare well to others,3–5 although an Australian audit reported median time to treatment of 2 days, with 97% treated within 2 weeks.6 Rapidity of receiving laboratory results appears to be a major difference between our services. We treated more cases within 4 weeks in 2007 than in 2005 (98.6% cf 96%), possibly because a greater number of mobile phones in 2007 made contacting people easier. Studies of factors affecting time to treatment have found prompt notification important, with letters being associated with greatest treatment delay.7 8
Limitations include the retrospective study design with historical controls and a potential lack of generalisability to other clinical settings. The interval between testing and treatment is affected by many service delivery factors and these may vary considerably. Common to New Zealand health statistics,9 Māori was over-represented in our study (44% in 2007 vs 20% of all attendees). It is reassuring that we did not find any ethnicity disadvantage associated with text messaging.
Our study adds further support that the use of this technology is at least as effective as more traditional means of communication in service delivery.
We would like to thank the staff of the Hamilton Sexual Health Clinic, and especially Carole MacKay, for enthusiastically implementing the text messaging service.
Competing interests: None.
Contributors: JM initiated the text messaging service; EL collated the study data; JH provided statistical analysis; all authors contributed to writing the manuscript and all have reviewed and approved the final version.