Visual Cue to Reduce False No-Show Registration in Riyadh Primary Healthcare: A Randomized Controlled Trial

Abstract

Introduction: Preliminary field visits to the Saudi Ministry of Health’s primary healthcare centers (PHCs) confirmed a proportion of prior reported no-show appointments to be false due to staff registering patient arrivals inappropriately. We sought to investigate whether visual cue reminders would prime the staff to register patients properly. Methods: A randomized controlled trial was conducted in 2019 involving 35 PHCs in Riyadh, Saudi Arabia. Visual posters were installed in the intervention PHCs wherever patient arrivals were registered. The primary outcome was patient no-show appointments. Staff who registered appointment arrivals were observed and interviewed. Multilevel logistic regression analyzed the change in no-shows across an intervention group and a control group. Results: The intervention group had lower odds ratio (OR) of no-shows than the control group, although not significantly (OR 0.81, 95% confidence interval [CI] = 0.50–1.31). The period during Ramadan saw fewer no-shows than pre-Ramadan (OR 1.60, 95% CI = 1.55–1.66). Compared to family medicine appointments, no-shows were higher for the smoking cessation clinic (OR 3.95, 95% CI = 3.43–4.54), dental appointments (OR 2.14, 95% CI = 1.97–2.32), and vaccine appointments (OR 1.31, 95% CI = 1.27–1.35). Qualitative analysis shows that PHCs’ appointment processing was arbitrary without a unified structure. Conclusion: The reduction in no-show rates using visual cues was not significant. However, certain confounders, if not addressed prior to intervention implementation, can lead to cognitive overload and burnout, inviting unwanted behavior. Further implications are discussed.