Abstract
BackgroundMissed appointments are known to interfere with appropriate care and to misspend medical and administrative resources. The aim of this study was to test the effectiveness of a sequential intervention reminding patients of their upcoming appointment and to identify the profile of patients missing their appointments.MethodsWe conducted a randomised controlled study in an urban primary care clinic at the Geneva University Hospitals serving a majority of vulnerable patients. All patients booked in a primary care or HIV clinic at the Geneva University Hospitals were sent a reminder 48 hrs prior to their appointment according to the following sequential intervention: 1. Phone call (fixed or mobile) reminder; 2. If no phone response: a Short Message Service (SMS) reminder; 3. If no available mobile phone number: a postal reminder. The rate of missed appointment, the cost of the intervention, and the profile of patients missing their appointment were recorded.Results2123 patients were included: 1052 in the intervention group, 1071 in the control group. Only 61.7% patients had a mobile phone recorded at the clinic. The sequential intervention significantly reduced the rate of missed appointments: 11.4% (n = 122) in the control group and 7.8% (n = 82) in the intervention group (p < 0.005), and allowed to reallocate 28% of cancelled appointments. It also proved to be cost effective in providing a total net benefit of 1846. - EUR/3 months. A satisfaction survey conducted with 241 patients showed that 93% of them were not bothered by the reminders and 78% considered them to be useful. By multivariate analysis, the following characteristics were significant predictors of missed appointments: younger age (OR per additional decade 0.82; CI 0.71-0.94), male gender (OR 1.72; CI 1.18-2.50), follow-up appointment >1year (OR 2.2; CI: 1.15-4.2), substance abuse (2.09, CI 1.21-3.61), and being an asylum seeker (OR 2.73: CI 1.22-6.09).ConclusionA practical reminder system can significantly increase patient attendance at medical outpatient clinics. An intervention focused on specific patient characteristics could further increase the effectiveness of appointment reminders.
Highlights
Missed appointments are known to interfere with appropriate care and to misspend medical and administrative resources
Postal reminders are effective to a lesser extent, and their effect tends to decrease with time [9]
Seventy five percent of patients came from the general consultation (n = 1600); 6% from the smoking cessation consultation (n = 127), 4% from the dietician consultation (n = 127) and 15% from the HIV consultation (n = 303)
Summary
Missed appointments are known to interfere with appropriate care and to misspend medical and administrative resources. Missed appointments are known to interfere with appropriate care of acute and chronic health conditions and to misspend medical and administrative resources. They represent a major burden on health care systems and costs [1,2], by reducing the effectiveness of outpatient health care delivery. This leads to suboptimal use of Several interventions have been tested to reduce the rate of missed appointments. Patients are often reluctant to give their cell phone number to medical practices and the cell phone penetration in a given population may be lower than expected
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