Cochrane review: Reminder systems and late patient tracers in the diagnosis and management of tuberculosis
Authors: Liu Qin , Abba Katharine , Alejandria Marissa M , Balanag Vincent M , Berba Regina P , Lansang Mary Ann D 
Published: October 2010

Background

Reminder systems and late patient tracers as strategies to improve patients' adherence to tuberculosis screening, diagnosis, and treatment are used in some countries, but their effectiveness has not previously been systematically reviewed.

Objectives

To assess the effects of reminder systems and late patient tracers on completion of diagnostics, commencement of treatment in people referred for curative or prophylactic treatment of tuberculosis, completion of treatment in people starting curative or prophylactic treatment for tuberculosis, and cure in people being treated for active tuberculosis.

Search strategy

We searched the Cochrane Infectious Diseases Group Specialized Register (June 2008), Cochrane Effective Practice and Organization of Care Group Specialized Register (April 2007), CENTRAL (The Cochrane Library 2008, Issue 2), MEDLINE (1966 to June 2008), EMBASE (1974 to June 2008), LILACS (1982 to June 2008), CINAHL (1982 to June 2008), SCI‐EXPANDED (1945 to June 2008), SSCI (1956 to June 2008), mRCT (June 2008), Indian Journal of Tuberculosis (1983 to June 2008), and reference lists. We also contacted researchers working in the field.

Selection criteria

Randomized controlled trials (RCTs), including cluster RCTs and quasi‐RCTs, and controlled before‐and‐after studies comparing any reminders or late patient tracers with no or other kinds of reminders or late patient tracers. We included people in any setting who require treatment for tuberculosis or require prophylaxis against tuberculosis and are referred to tuberculosis diagnostic or screening services.

Data collection and analysis

Two authors independently assessed trial risk of bias and extracted data. No meta‐analysis could be undertaken due to the heterogeneity of interventions across trials.

Main results

Nine trials involving 5257 participants met the inclusion criteria. Three assessed the use of late patient tracers, and six assessed reminder systems. Late patient tracers (home visit and letter) were shown to be beneficial in increasing adherence to tuberculosis treatment compared with no late patient tracer. The results from almost all the reminder trials, except one, show benefits of different types of reminders compared to no reminder on adherence to tuberculosis clinic appointments.

Authors' conclusions

The included trials show significantly better outcomes among those tuberculosis patients for which late patient tracers and reminders are used. Studies of good quality (large and with rigorous study design) are needed to decide the most effective late patient tracer actions and reminders in different settings. Future studies of reminders in chemoprophylaxis and treatment settings would be useful.

Plain Language Summary

Reminder systems and late patient tracers in the diagnosis and management of tuberculosis

This review aimed to assess the effects of reminder systems and late patient tracers on patients' adherence to medical advice (such as attending clinic appointments for taking anti‐tuberculosis drugs) and on clinical outcomes (such as cure of tuberculosis) in the following situations: treatment for active tuberculosis; tests for diagnosis of tuberculosis; and treatment to prevent tuberculosis in high‐risk individuals. Reminder systems are used before a clinic or drug‐collection appointment to remind patients to attend the appointment, or sometimes during treatment at home to remind patients to take their drugs. Late patient tracers are similar interventions undertaken when patients fail to keep an appointment to encourage them to return to treatment. The review found nine trials involving 5257 participants. Six trials assessed reminder systems and three trials assessed the use of late patient tracers. The results from five of the six reminder trials showed benefits. Trials of late patient tracers (home visits and letters) also showed benefits of the intervention in increasing adherence to tuberculosis treatment. Hence, overall, the results showed better outcomes among those patients for whom reminders or late patient tracers were used.