Improving Adherence to Hysterosalpingography After Hysteroscopic Sterilization Using an Electronic Reminder

Abstract Study Objective The US package labeling of the Essure system (Bayer Healthcare, Whippany, NJ) requires hysterosalpingography (HSG) as a confirmatory test after hysteroscopic sterilization to ensure proper placement and tubal occlusion. Previous studies have shown that implementation of a protocol to track patients after Essure procedures can improve HSG adherence. The primary objective of this study was to investigate whether implementation of an electronic reminder for the office staff increases post-Essure HSG adherence. Design Retrospective cohort study of patients who underwent the Essure procedure between January 2005 and January 2012 (Canadian Task Force classification II-3). Setting University-affiliated hospital. Patients Two hundred eleven patients underwent the Essure procedure during the study period. Interventions Implementation of an electronic reminder for the office staff. Measurements and Main Results One hundred thirty-seven (64.9%) patients underwent the procedure before implementation of the electronic reminder, and 74 (35.1%) patients underwent the procedure after implementation. Although the odds of post-Essure HSG adherence increased in the overall (odds ratio [OR] = 1.7; 95% confidence interval [CI], .9–3.2) and faculty practice (OR = 2.1; 95% CI, .2–18.6) patient population, these results were not statistically significant. In contrast, the odds of post-Essure HSG adherence increased by almost 3-fold (OR = 2.9; 95% CI, 1.4–6.3) in the resident clinic patient population (p = .003). Conclusion Implementation of an electronic reminder increases post-Essure HSG adherence in the resident clinic patient population.