Does an encouraging letter encourage attendance at psychiatric out-patient clinics? The Leeds PROMPTS randomized study

Abstract

Prompting people to go to psychiatric out-patient clinics for the first time encourages them to attend. Pragmatic trials within a busy working environment are possible and informative.

Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis

“…Kitcheman et al 69 incorporated letter reminders on headed paper in their RCT explaining the time of the appointment, name of the doctor, description of the clinic and its routine, a map and a request to bring a list of medication and a friend or family member. This significantly reduced the numbers of people failing to attend a mental health clinic appointment.…”

“…may be more effective at increasing appointment attendance than simple reminders. It has been suggested 69,89 that reminders of this nature may decrease patient perceptions that attendance at the appointment will be difficult and help patients to feel more confident about attending their appointment. Some authors 25,140 have further speculated that orientation information is specifically effective for improving attendance at specific types of appointments, for example new patient appointments or screening appointments for which patients are likely to be attending the clinic for the first time.…”

“…Kitcheman et al 69 observed that an effective reminder system will increase the 'already heavy workload of psychiatric out-patient clinics'. The authors note that 'even when appointments are missed clinicians do not, as a rule, waste their time'.…”

“…Alternative activities include the fact that 'patients are double-booked, dictation is completed, telephone calls made and colleagues consulted'. 69 This highlights that increased attendance at appointments may be welcomed more by managers, primary carers and patients than by those working in outpatient clinics. As a consequence, each service faces the challenging dilemma of whether to build in assumptions of non-attendance without opportunity for appointment cancellation or reallocation or to build in processes that optimise cancellation and rescheduling.…”

“…69,84 These numerous reported reasons for not attending appointments suggest that non-attendance at appointments is a highly complex and multifactorial problem. The following sections throw further light on the processes operating to shape attendance behaviour.…”