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Using digital notifications to improve attendance in clinic: systematic review and meta-analysis
  1. Dan Robotham1,
  2. Safarina Satkunanathan1,
  3. John Reynolds2,
  4. Daniel Stahl1,
  5. Til Wykes1,2
  1. 1Institute of Psychiatry, Psychology & Neuroscience, King's College London (KCL), London, UK
  2. 2South London and Maudsley NHS Foundation Trust, London, UK
  1. Correspondence to Dr Dan Robotham; Dan.Robotham{at}


Objectives Assess the impact of text-based electronic notifications on improving clinic attendance, in relation to study quality (according to risk of bias), and to assess simple ways in which notifications can be optimised (ie, impact of multiple notifications).

Design Systematic review, study quality appraisal assessing risk of bias, data synthesised in meta-analyses.

Data sources MEDLINE, EMBASE, PsycINFO, Web of Science and Cochrane Database of Systematic Reviews (01.01.05 until 25.4.15). A systematic search to discover all studies containing quantitative data for synthesis into meta-analyses.

Eligibility criteria Studies examining the effect of text-based electronic notifications on prescheduled appointment attendance in healthcare settings. Primary analysis included experimental studies where randomisation was used to define allocation to intervention and where a control group consisting of ‘no reminders’ was used. Secondary meta-analysis included studies comparing text reminders with voice reminders. Studies lacking sufficient information for inclusion (after attempting to contact study authors) were excluded.

Outcome measures Primary outcomes were rate of attendance/non-attendance at healthcare appointments. Secondary outcome was rate of rescheduled and cancelled appointments.

Results 26 articles were included. 21 included in the primary meta-analysis (8345 patients receiving electronic text notifications, 7731 patients receiving no notifications). Studies were included from Europe (9), Asia (7), Africa (2), Australia (2) and America (1). Patients who received notifications were 23% more likely to attend clinic than those who received no notification (risk ratio=1.23, 67% vs 54%). Those receiving notifications were 25% less likely to ‘no show’ for appointments (risk ratio=.75, 15% vs 21%). Results were similar when accounting for risk of bias, region and publication year. Multiple notifications were significantly more effective at improving attendance than single notifications. Voice notifications appeared more effective than text notifications at improving attendance.

Conclusions Electronic text notifications improve attendance and reduce no shows across healthcare settings. Sending multiple notifications could improve attendance further.

  • Reminders
  • clinic attendance
  • no shows
  • healthcare efficiency

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  • Contributors DR, JR and TW designed the study and formulated the clinical question. JR and SS performed the literature search and, with DR, reviewed the search results for study inclusion. DR, JR and SS designed the data extraction form, extracted the data and assessed risk of bias. DS developed the analysis strategy, DR and DS performed the statistical analyses. DR led the writing of the final manuscript with support from SS and JR. All authors critically revised drafts and the final manuscript. All authors approved the final manuscript for submission.

  • Funding The authors would like to acknowledge the support the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley National Health Service (NHS) Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests All authors have completed the International Committee of Medical Journal Editors (ICMJE) uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Transparency declaration The lead author affirms that this manuscript is an honest, accurate and transparent account of the review being reported, that no important aspects of the study have been omitted and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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