How can new technologies help reduce absenteeism in pediatric consultation? / Como as novas tecnologias podem auxiliar na redução do absenteísmo em consulta pediátrica?

ABSTRACT

ABSTRACT Objective: To identify the most effective form of contact, as a possible intervention to reduce absenteeism in consultations of children with suspected or confirmed pulmonary tuberculosis. Methods: A randomized clinical trial was conducted with prospective data collection, between March 2017 and February 2018. Patients were randomized into three groups to be reminded about the appointment telephone contact, SMS or WhatsApp, or no intervention. A convenience sample was obtained, with a significance level of 5%. Results: 78 children were included, with a median age of four years old (zero to 14); 59.0% of them were in treatment for a latent infection and 6.4% had active tuberculosis. Among the 78 children, 74.4% lived in Curitiba (Sourhern Brazil); 62.8% lived with both parents; 38.5% of the parents had formal employment and 47.4% of the mothers were housewives; 50.8% of the fathers and 55.7% of the mothers had more than nine years of schooling. In 78.2% of the families, per capita income was up to 0.5 minimum wages; 27.3% were enrolled in social programs; 28.2% lived in homes provided by the government. There was a total of 238 interventions made 85 (35.7%) by telephone contact, 78 (32.8%) by text message (WhatsApp was 97.2% of these) and 75 (31.5%) had no further contact. There was no statistical difference among the sociodemographic and cultural characteristics studied. The absenteeism rate was 24.0% and the abandonment rate was 16.7%. Giving a reminder to the patient's guardian prior to the consultation, regardless of the intervention (p=0.021) and specifically by WhatsApp message (p=0.032) was associated with no absenteeism, though it was not associated with abandonment of the treatment. Conclusions: Using new tools, such as WhatsApp, to remind guardians of appointments reduces absenteeism. Consequently, it may lead to a reduction in abandoning treatment and it may improvetreatment outcome of children with a tuberculosis infection or disease.

RESUMO

RESUMO Objetivo: Identificar a forma mais efetiva de contato, como possibilidade de intervenção, para diminuir o absenteísmo em consultas de crianças com suspeita ou com tuberculose pulmonar. Métodos: Ensaio clínico randomizado com coleta de dados prospectiva, entre março de 2017 e fevereiro de 2018. Os pacientes foram aleatorizados em três grupos para relembrar a consulta contato telefônico; mensagens curtas (SMS) ou WhatsApp; e nenhuma intervenção. Amostra de conveniência, com nível de significância de 5%. Resultados: Incluídas 78 crianças, mediana de idade quatro anos (zero a 14); 59,0% em tratamento para infecção latente e 6,4% com tuberculose ativa; 74,4% moravam em Curitiba, Paraná; 62,8% residiam com ambos os pais; 38,5% dos pais possuíam emprego formal e 47,4% das mães eram do lar; 50,8% dos pais e 55,7% das mães possuíam mais de nove anos de estudo; em 78,2% das famílias a renda per capita foi de até 0,5 salário mínimo; 27,3% estavam inscritas em programas sociais; e 28,2% residiam em casa cedida. Foram 238 intervenções 85 (35,7%) por contato telefônico, 78 (32,8%) por mensagem de texto (WhatsApp 97,2%) e 75 (31,5%) sem nenhum contato adicional. Nas características sociodemográficas e culturais estudadas não houve diferença estatística. O absenteísmo foi de 24,0% e o abandono, de 16,7%. Lembrar o responsável previamente à consulta, independente da intervenção (p=0,021) e especificamente por mensagem por WhatsApp (p=0,032) foi associado ao não absenteísmo, porém não associado ao abandono. Conclusões: O uso de novas ferramentas, como o aplicativo WhatsApp, pode reduzir o absenteísmo, diminuir a possibilidade de abandono no seguimento e melhorar o desfecho do tratamento de crianças com tuberculose, seja a infecção ou a doença.