Clinical research study
The Effectiveness of Outpatient Appointment Reminder Systems in Reducing No-Show Rates

https://doi.org/10.1016/j.amjmed.2009.11.022Get rights and content

Abstract

Background

Patients who do not keep physician appointments (no-shows) represent a significant loss to healthcare providers. For patients, the cost includes their dissatisfaction and reduced quality of care. An automated telephone appointment reminder system may decrease the no-show rate. Understanding characteristics of patients who miss their appointments will aid in the formulation of interventions to reduce no-show rates.

Methods

In an academic outpatient practice, we studied patient acceptance and no-show rates among patients receiving a clinic staff reminder (STAFF), an automated appointment reminder (AUTO), and no reminder (NONE). Patients scheduled for appointments in the spring of 2007 were assigned randomly to 1 of 3 groups: STAFF (n = 3266), AUTO (n = 3219), or NONE (n = 3350). Patients in the STAFF group were called 3 days in advance by front desk personnel. Patients in the AUTO group were reminded of their appointments 3 days in advance by an automated, standardized message. To evaluate patient satisfaction with the STAFF and AUTO, we surveyed patients who arrived at the clinic (n = 10,546).

Results

The no-show rates for patients in the STAFF, AUTO, and NONE groups were 13.6%, 17.3%, and 23.1%, respectively (pairwise, P < .01 by analysis of variance for all comparisons). Cancellation rates in the AUTO and STAFF groups were significantly higher than in the NONE group (P < .004). Appointment reminder group, age, visit type, wait time, division specialty, and insurance type were significant predictors of no-show rates. Patients found appointment reminders helpful, but they could not accurately remember whether they received a clinic staff reminder or an automated appointment reminder.

Conclusions

A clinic staff reminder was significantly more effective in lowering the no-show rate compared with an automated appointment reminder system.

Section snippets

Study Population

We performed a prospective, randomized, parallel design clinical trial in the Department of Medicine at the Robert Wood Johnson University Medical Group, an outpatient multispecialty practice of the University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School. Study enrollees were patients in 1 or more of 10 specialty outpatient practices: heart transplantation, rheumatology, pulmonary, nephrology, hematology, general internal medicine, gastroenterology, endocrinology,

Study Population

From March to July 2007, 13,505 patients were scheduled for appointments (Figure 1). For technical reasons, data for 9 days were removed from the final analysis because they were not uploaded to the automated appointment reminder system. This resulted in 1413 patients not randomized. The remaining 12,092 patients were randomized to the following groups: Clinic Staff Reminder STAFF (n = 3266), Automated Appointment Reminder AUTO (n = 3219), or NONE (n = 3350). The appointments of 2257 patients were

Discussion

A 1992 meta-analysis of various studies showed that a reminder can be used to decrease the no-show rate.10 A case-control trial of 1296 appointments from a Swiss university outpatient clinic showed a no-show rate of 15.8%.11 Our study's no-show rates were consistent with previous studies showing no-show rates ranging from 2% to 30%.11, 12, 13, 14, 15 Our prospective, randomized study on 13,505 appointments demonstrated a lower no-show rate with a clinic staff reminder compared with an automated

Study Limitations

Limitations included the difference between the number of call attempts between the Clinic Staff Reminder (STAFF) and Automated Appointment Reminder (AUTO) groups, the difference in time of day when calls were made in the Clinic Staff Reminder and Automated Appointment Reminder groups, and only patients who arrived to their appointments were surveyed. Another limitation is that patients may have multiple appointments scheduled on the same day, which would decrease the likelihood of a no-show.

Conclusions

The clinic staff reminder significantly reduced the no-show rate. Although the automated reminder system was significantly less effective, it likely has a cost advantage making it more attractive. Further economic evaluation is required to confirm that the reduction in no-shows compensates for the increased cost of using a clinic staff reminder. Future studies also might explore the use of other reminder systems: electronic mail, cell phone voice message reminders, or text messaging. This may

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Funding: None.

Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

Authorship: All authors had access to the data and played a role in writing this manuscript.

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