Reduction of missed appointments at an urban primary care clinic: a randomised controlled study

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.

Missed appointments at maternal healthcare clinics in primary healthcare centres in Riyadh city: reasons and associated factors

“…Numerous empirical studies have reported that when a patient fails to keep scheduled clinical appointments, it leads to severe consequences for the patient's health. In addition, missing appointments jeopardizes all types of medical practices, ranging from maternal practice clinics to general practice clinics [1][2][3] . In some medical settings, such as obstetrics, which encompasses pregnancy planning as well as prenatal and postnatal care, missed appointments pose severe health consequences for women both pre-and post-pregnancy.…”

“…While the international rates of missed clinical appointments vary significantly according to the types of maternal healthcare clinics, the evidence indicates that women miss their appointments at rates ranging from 2% to 30%, with higher rates for psychiatric [1] and maternal healthcare [10] .…”

“…Nonetheless, a notable gap remains in the available literature related to why women miss their appointments or which categories of women are more likely to miss appointments [1][2][3][4][5][6][7][8][9][10] . Researchers have critically debated a wide range of explanations, including socio-demographic characteristics, where by certain groups have been deemed vulnerable due to the presence of multiple health problems, and economic difficulties as reasons for missed appointments at a maternal healthcare clinic [1-5, 9, 10] .…”

‘M-TRACK’ (mobile phone reminders and electronic tracking tool) cuts the risk of pre-treatment loss to follow-up by 80% among people living with HIV under programme settings: a mixed-methods study from Gujarat, India

“…While there are many studies including systematic reviews assessing the use of mobile health technology (mHealth) to address gaps in the cascade of HIV/AIDS care, most of them are focussed on improving health outcomes once the ART has been started but not addressing the gaps between diagnosis and treatment [14,19–23]. The interventions that have been tested to improve linkage to or retention in pre-ART care include point-of-care CD4 testing, providing food incentives, home-based ART initiation and health system interventions such as integration of antenatal services with ART care, adoption of WHO guidelines and introduction of a structured pre-ART care [20].…”

Pesquisa operativa para adequação das agendas num serviço de Atenção Primária

“…Em clínicas de atenção primária de Genebra, os pacientes faltam a 22% das consultas. 10 No sistema de saúde britânico 6,5% das consultas são perdidas por faltas. 11 Nos EUA a prevalência de faltas varia de 5 a 55%.…”