Targeted Reminder Phone Calls to Patients at High Risk of No-Show for Primary Care Appointment: A Randomized Trial

Abstract

BACKGROUND: No-shows, or missed appointments, are a problem for many medical practices. They result in fragmented care and reduce access for all patients. OBJECTIVE: To determine whether telephone reminder calls targeted to patients at high risk of no-show can reduce no-show rates. DESIGN: Single-center randomized controlled trial. PARTICIPANTS: A total of 2247 primary care patients in a hospital-based primary care clinic at high risk of no-show (>15 % risk) for their appointment in 7 days. INTERVENTION: Seven days prior to their appointment, intervention arm patients were placed in a calling queue to receive a reminder phone call from a patient service coordinator. Coordinators were trained to engage patients in concrete planning. All patients received an automated phone call (usual care). MAIN MEASURES: Primary outcome was no-show rate. Secondary outcomes included arrival rate, cancellation rate, reschedule rate, time to cancellation, and change in revenue. KEY RESULTS: The no-show rate in the intervention arm (22.8 %) was significantly lower (absolute risk difference −6.4 %, p < 0.01, 95 % CI [−9.8 to −3.0 %]) than that in the control arm (29.2 %). Arrival, cancellation, and reschedule rates did not differ significantly. In the intervention arm, rescheduling and cancellations occurred further in advance of the appointment (mean difference, 0.35 days; 95 % CI [0.07-0.64]; p = 0.01). Reimbursement did not differ significantly. CONCLUSIONS: A phone call 7 days prior to an appointment led to a significant reduction in no-shows and increased reimbursement among patients at high risk of noshow. The use of targeted interventions may be of interest to practices taking on increased accountability for population health.KEY WORDS: access to care; applied informatics; primary care redesign; behavior change; population health.

If You Book It, Will They Come? Attendance at Postdischarge Follow‐Up Visits Scheduled by Inpatient Providers

“…Many such strategies exist in the ambulatory setting, 13,43,45 for example, better communication with patients through texting or goal-directed, personalized phone reminders. [46][47][48] Our study methodology has several limitations. Most importantly, we were unable to measure PDFVs made with providers unaffiliated with UPHS.…”

Nudging New York: adaptive models and the limits of behavioral interventions to reduce no-shows and health inequalities

“…Due to low costs, simple behavioral interventions such as nudges are an appealing option for implementing at FQHCs [11]. One commonly used nudge to reduce noshow is a reminder in the form of text messages and phone calls (including automated "robocalls") typically sent 7 days to 24 hours before a scheduled appointment [12,13]. While some effects have been found for reminders [14], there is limited information about their value specifically in low-income settings [15].…”

Organizing integrated processes in cancer care

“…In such studies, cancellations are either included as no-shows [104,116], included as shows [126], or excluded from the analysis all together [173,180]. Only a few recent studies have analyzed no-shows and cancellations as two separate conditions [132,221,228,276], despite the different behavior of patient cancellations compared to patient no-shows [132].…”

“…Reminders can be used for a targeted patient population with a high nonattendance rate [276]. Examples of reminders are SMS reminders [38,90,124,165,237,289], email reminders [180], postal reminders [140], and telephone reminders by staff or automated [140,227,237,276].…”

“…Education and reminders are in general considered as an effective method to improve the noshow rate by 10% to 50%, although, in some specific settings, their effectiveness could not be proven (i.e., [72]). However, there is an inverse effect of reminders on the cancellation rate [165,166,276,289]. A possible reason for this could be that when patients are reminded of their appointment, a portion of the patients that would have resulted in a no-show since they forgot about the appointment, now cancel their appointment.…”