Abstract

Health care systems deliver automated text or telephone messages to remind patients of appointments and to provide health information. Patients who receive multiple messages may demonstrate message fatigue by opting out of future messages. To assess whether the volume of automated text or interactive voice response (IVR) telephone messages is associated with the likelihood of patients requesting to opt out of future messages. This retrospective cohort study was conducted at Kaiser Permanente Colorado (KPCO), an integrated health care system. All adult members who received 1 or more automated text or IVR message between October 1, 2018, and September 30, 2019, were included. Receipt of automated text or IVR messages. Message volume and opt-out rates obtained from messaging systems over 1 year. Of the 428 242 adults included in this study, 59.7% were women, and 66.5% were White; the mean (SD) age was 52.3 (17.7) years. During the study period, 84.1% received 1 or more text messages (median, 4 messages; interquartile range, 2-8 messages) and 67.8% received 1 or more IVR messages (median, 3 messages; interquartile range, 1-6 messages). A total of 8929 individuals (2.5%) opted out of text messages, and 4392 (1.5%) opted out of IVR messages. In multivariable analyses, individuals who received 10 to 19.9 or 20 or more text messages per year had higher opt-out rates for text messages compared with those who received fewer than 2 messages per year (adjusted odds ratio [aOR]: 10-19.9 vs <2 messages, 1.27 [95% CI, 1.17-1.38]; ≥20 vs <2 messages, 3.58 [95% CI, 3.28-3.91]), whereas opt-out rates increased progressively in association with IVR message volume, with the highest rates among individuals who received 10.0 to 19.9 messages (aOR, 11.11; 95% CI, 9.43-13.08) or 20.0 messages or more (aOR, 49.84; 95% CI, 42.33-58.70). Individuals opting out of text messages were more likely to opt out of IVR messages (aOR, 4.07; 95% CI, 3.65-4.55), and those opting out of IVR messages were more likely to opt out of text messages (aOR, 5.92; 95% CI, 5.29-6.61). In this cohort study among adult members of an integrated health care system, requests to discontinue messages were associated with greater message volume. These findings suggest that, to preserve the benefits of automated outreach, health care systems should use these messages judiciously to reduce message fatigue.

Highlights

  • Reminding patients of upcoming clinical appointments, laboratory monitoring, and other scheduled services may be associated with improved efficiency and effectiveness of health care

  • Individuals who received 10 to 19.9 or 20 or more text messages per year had higher opt-out rates for text messages compared with those who received fewer than 2 messages per year, whereas opt-out rates increased progressively in association with interactive voice response (IVR) message volume, with the highest rates among individuals who received 10.0 to 19.9 messages or 20.0 messages or more

  • In this cohort study among adult members of an integrated health care system, requests to discontinue messages were associated with greater message volume

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Summary

Introduction

Reminding patients of upcoming clinical appointments, laboratory monitoring, and other scheduled services may be associated with improved efficiency and effectiveness of health care. Systematic reviews have shown that reminders are associated with reduced missed primary and specialty care appointments, increased delivery of preventive services, improved prescription refill rates, and enhanced laboratory monitoring.[1,2,3] Over time, the technology for delivering reminders has largely shifted from live telephone calls and postal reminders to automated text messages and interactive voice response (IVR) telephone reminders to reduce staff burden and costs.

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