Review Article
Methods to Reduce Outpatient Non-attendance

https://doi.org/10.1097/MAJ.0b013e31824997c6Get rights and content

Abstract

Non-attendance reduces clinic and provider productivity and efficiency, compromises access and increases cost of health care. This systematic review of the English language literature (November 1999–November 2009) compares telephone, mail, text/short message service, electronic mail and open-access scheduling to determine which is best at reducing outpatient non-attendance and providing net financial benefit. Telephone, mail and text/short message service interventions all improved attendance modestly but at varying costs. Text messaging was the most cost-effective of the 3, but its applicability may be limited. Few data are available regarding electronic mail reminders, whereas open-access scheduling is an area of active research.

Section snippets

Search Methods and Selection Criteria

A professional medical librarian and a medical library technician assisted a physician and a nurse practitioner in performing PubMed searches to identify the English language articles from November 1999 to November 2009 acknowledging changing communication technology usage compared with earlier periods. The physician and a nurse practitioner reviewed the search results and abstracts and obtained full-text copies of potentially relevant articles for further examination. The authors also reviewed

Search Results

Of the 106 articles that felt to warrant more in-depth review, 42 studies met inclusion criteria to be used in the computation of a weighted average effect (Figure 1). Five of these studies had multiple intervention arms against a control group, placing them in more than 1 analysis category,6., 7., 8., 9., 10. while another study reported 2 separate datasets,11 yielding a total of 49 investigations suitable for computing weighted average effects: telephone (25), text/SMS (12), mail (7) and open

Comparison of Interventions

The majority of telephone intervention studies demonstrated significant reductions in non-attendance. However, 1 study7 showed no difference between telephone, postcard and no-reminder groups—explained in part by the fact that study subjects were young (mean age, 29 years) and from a low-income, inner-city clinic—2 qualities characteristic of chronic nonattenders.2 Satiani et al19 found a significantly higher no-show rate in a group contacted by automated telephone reminders (8.9%) compared

CONCLUSION

All interventions seemed to improve attendance modestly but at varying cost. Aggregate analysis of the various reminder systems for traditionally scheduled patients showed the greatest reduction in no-shows with telephone reminders, followed by text messaging/SMS and mail remainders. Cost analyses suggest text messaging to be most cost-effective, but its applicability may be limited by technology penetration for any particular population. Open-access scheduling seems to be beneficial,

REFERENCES (57)

  • MaxwellS. et al.

    Effectiveness of reminder systems on appointment adherence rates

    J Health Care Poor Underserved

    (2001)
  • LeongK.C. et al.

    The use of text messaging to improve attendance in primary care: a randomized controlled trial

    Fam Pract

    (2006)
  • ChenZ.W. et al.

    Comparison of an SMS text messaging and phone reminder to improve attendance at a health promotion center: a randomized controlled trial

    J Zhejiang Univ Sci B

    (2008)
  • IrigoyenM.M. et al.

    Impact of appointment reminders on vaccination coverage at an urban clinic

    Pediatrics

    (2000)
  • CasaverdeN.B. et al.

    The effect of care coordination on pediatric dental patient attendance

    J Dent Child

    (2007)
  • HashimM.J. et al.

    Effectiveness of telephone reminders in improving rate of appointments kept at an outpatient clinic: a randomized controlled trial

    J Am Board Fam Pract

    (2001)
  • OladipoA. et al.

    Preclinic appointment telephone contact: an effective intervention for colposcopy clinic nonattendance

    J Low Genit Tract Dis

    (2007)
  • RobertsN. et al.

    The effect of telephone reminders on attendance in respiratory outpatient clinics

    J Health Serv Res Policy

    (2007)
  • SawyerS.M. et al.

    Telephone reminders improve adolescent clinic attendance: a randomized controlled trial

    J Paediatr Child Health

    (2002)
  • ChristensenA.A. et al.

    The effect of confirmation calls on appointment-keeping behavior of patients in a children’s hospital dental clinic

    Pediatr Dent

    (2001)
  • MacDonaldJ. et al.

    Using telephone prompts to improve initial attendance at a community mental health center

    Psychiatr Serv

    (2000)
  • LeeC.S. et al.

    Telephone reminders to reduce non-attendance rate for endoscopy

    J R Soc Med

    (2003)
  • CorfieldL. et al.

    Non-attendance at the colorectal clinic: a prospective audit

    Ann R Coll Surg Engl

    (2008)
  • AdamsL.A. et al.

    Nonattendance at outpatient endoscopy

    Endoscopy

    (2004)
  • HaynesJ.M. et al.

    The effect of telephone appointment-reminder calls on outpatient absenteeism in a pulmonary function laboratory

    Respir Care

    (2006)
  • DockeryF. et al.

    The effect of reminder calls in reducing non-attendance rates at care of the elderly clinics

    Postgrad Med J

    (2001)
  • HardyK.J. et al.

    Information given to patients before appointments and its effect on non-attendance rate

    BMJ

    (2001)
  • JacksonK.R. et al.

    The effects of telephone prompting on attendance for starting treatment and retention in treatment at a specialist alcohol clinic

    Br J Clin Psychol

    (2009)
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