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

Perron NJ, Dao MD, Kossovsky MP, Miserez V, Chuard C, Calmy A, Gaspoz JM - BMC Fam Pract (2010)

Bottom Line: It also proved to be cost effective in providing a total net benefit of 1846. - EUR/3 months.A 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Primary Care, Department of Community Medicine and Primary Care, Geneva University Hospitals, Geneva, Switzerland. noelle.junod@hcuge.ch

ABSTRACT

Background: Missed 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.

Methods: We 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.

Results: 2123 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 >1 year (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).

Conclusion: A 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.

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Related in: MedlinePlus

Participant flow chart.
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Figure 1: Participant flow chart.

Mentions: 2130 patients were included in the study. 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). Before randomisation, 7 patients refused to be included into the study. After randomisation, 1071 patients (50.5%) were included into the control group and 1052 (49.5%) into the intervention group. Patients' characteristics are summarised in Table 1. The randomisation process is summarised in Figure 1. Groups were well balanced; mean age was 46 and 47 years in both groups, and 22% of patients had no health insurance.


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

Perron NJ, Dao MD, Kossovsky MP, Miserez V, Chuard C, Calmy A, Gaspoz JM - BMC Fam Pract (2010)

Participant flow chart.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2984453&req=5

Figure 1: Participant flow chart.
Mentions: 2130 patients were included in the study. 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). Before randomisation, 7 patients refused to be included into the study. After randomisation, 1071 patients (50.5%) were included into the control group and 1052 (49.5%) into the intervention group. Patients' characteristics are summarised in Table 1. The randomisation process is summarised in Figure 1. Groups were well balanced; mean age was 46 and 47 years in both groups, and 22% of patients had no health insurance.

Bottom Line: It also proved to be cost effective in providing a total net benefit of 1846. - EUR/3 months.A 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Primary Care, Department of Community Medicine and Primary Care, Geneva University Hospitals, Geneva, Switzerland. noelle.junod@hcuge.ch

ABSTRACT

Background: Missed 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.

Methods: We 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.

Results: 2123 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 >1 year (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).

Conclusion: A 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.

Show MeSH
Related in: MedlinePlus