Clinic appointment reminders among rheumatology patients

Abstract

Dear Editor, We read with interest the publication by Hogan AM et al. [1], which looked at the potential impact of text message reminders on non-attendance at surgical outpatient (OPD) clinics in Ireland and reported that such a service would encourage 51% to attend or cancel their missed OPD appointment. As the authors pointed out, little work has been carried out in this area in Ireland. Recently, we also examined the topic, focusing on Rheumatology patients attending our outpatient services, who had a ‘‘did not attend’’ (DNA) rate of almost 18% (525/2,924) in 2007 [2] compared to 16.8% in the Hogan AM et al. study. Many patients DNA their OPD clinic appointments for one reason or another, for example a lapse in memory or forgetfulness has been estimated for up to 50% of DNA cases [3, 4]. The level of DNA can be extremely high in many departments. In the department of care for the elderly at Hammersmith Hospital, London, in 1996–1997, DNA rates were a staggering 21% [5]. This is at the backdrop of a national mean DNA rate of 12% for all clinics in the UK for the same period [6]. These results compare to 16% forgetting their appointment in Hogan et al. with 20% due to clerical errors. DNA has many implications for both the patients and the services involved. Regarding the patient, missed valuable clinical input may result in suboptimal health. This is very well documented among the diabetic population where patients who DNA clinic appointments have significantly greater risk factors and complications from their chronic condition [7]. Focusing on the services provided, the implications include vacant clinic appointments, which can be a waste of scarce financial resources. In our study, we conducted a cross-sectional selfadministered anonymous questionnaire with 166 patients (159 return patients) who attended Rheumatology clinics at the South Infirmary, Victoria University Hospital, Cork, Ireland. Patients were recruited intermittently, but consecutively, while the researchers were in attendance between September and October 2007. A response rate of 98% (163/166) was achieved. New patients were not analysed due to low numbers. Ninety-eight percentage (156/ 159) of return patients responded. Overall, 99% felt OPD appointment reminders to be a good idea. Interestingly, on logical regression analysis, those who had previously attended OPD were significantly more likely to view reminders as a positive idea (P \ 0.0005, OR = 57.72, 95% CI 15.14–220.03). This may suggest that those who have had more OPD exposure appreciate the possibility of missed appointments and the benefits of reminders. These findings were recorded in a setting of 65% (104), 16% (26), 96% (153), 59% (94), and 46% (73) having competence in or access to a mobile phone SMS, e-mail, a landline telephone, a landline voice messaging service and a mobile phone voice messaging service, respectively. Text/SMS messaging (47%) is the most preferred method of appointment reminder followed by a telephone call (26%) and postal letter (25%). The mean age of those M. B. O’Connor (&) Department of Medicine, South Infirmary-Victoria University Hospital, Old Blackrock Road, Cork, Ireland e-mail: mortimeroconnor@gmail.com