Abstract
BackgroundTelephone or text-message reminders have been shown to significantly reduce the rate of missed appointments in different medical settings. Since text-messaging is less resource-demanding, we tested the hypothesis that text-message reminders would be as effective as telephone reminders in an academic primary care clinic.MethodsA randomized controlled non-inferiority trial was conducted in the academic primary care division of the Geneva University Hospitals between November 2010 and April 2011. Patients registered for an appointment at the clinic, and for whom a cell phone number was available, were randomly selected to receive a text-message or a telephone call reminder 24 hours before the planned appointment. Patients were included each time they had an appointment. The main outcome was the rate of unexplained missed appointments. Appointments were not missed if they were cancelled or re-scheduled before or independently from the intervention. We defined non-inferiority as a difference below 2% in the rate of missed appointments and powered the study accordingly. A satisfaction survey was conducted among a random sample of 900 patients (response rate 41%).Results6450 patients were included, 3285 in the text-message group and 3165 in the telephone group. The rate of missed appointments was similar in the text-message group (11.7%, 95% CI: 10.6-12.8) and in the telephone group (10.2%, 95% CI: 9.2-11.3 p = 0.07). However, only text message reminders were cost-effective. No patient reported any disturbance by any type of reminder in the satisfaction survey. Three quarters of surveyed patients recommended its regular implementation in the clinic.ConclusionsText-message reminders are equivalent to telephone reminders in reducing the proportion of missed appointments in an academic primary care clinic and are more cost-effective. Both types of reminders are well accepted by patients.
Highlights
Telephone or text-message reminders have been shown to significantly reduce the rate of missed appointments in different medical settings
Among the 6354 analyzed appointments, 78% came from the general primary care clinic in the text messaging group and 79.6% in the telephone group
The rate of missed appointments was similar in the text-message group (11.7%) and in the telephone group (10.2%)
Summary
Telephone or text-message reminders have been shown to significantly reduce the rate of missed appointments in different medical settings. Since text-messaging is less resource-demanding, we tested the hypothesis that text-message reminders would be as effective as telephone reminders in an academic primary care clinic. Missed appointments are a frequent problem in outpatient clinics. They interfere with adequate medical care, misspend administrative and medical resources, and are associated with adverse patient health outcomes [1,2]. Two Asian studies showed that they were effective in primary care settings but sample sizes were small [11,12]. One study in the US showed superiority of telephone reminders over text-messaging in academic outpatient specialty clinics [13]. Its efficacy depends on the penetration rate of mobile phones and may vary from one context to the other
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