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

Article Article scientifique Article Reduction of missed appointments at an urban primary care clinic: a randomised controlled study eng 2010 author Junod Perron Noëlle Astrid 27708 author Dominice Dao Mélissa 81162 author Kossovsky Michel author Miserez Valérie 619718 author Chuard Carmen 704122 author Calmy Alexandra 0000-0002-1137-6826 41032 author Gaspoz Jean-Michel 126367 79 10.1186/1471-2296-11-79 20973950 1471-2296 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984453/pdf/1471-2296-11-79.pdf 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. Adult *Appointments and Schedules Cellular Phone Efficiency, Organizational Female Hospitals, University Humans Male Middle Aged *Patient Satisfaction Postal Service Primary Health Care/*organization & administration *Reminder Systems Switzerland Telephone Urban Health Services/organization & administration Dewey 174.957 Dewey 616 56 Département de médecine 221 69 Institut Ethique Histoire Humanités 22A6 false 16 Groupe Jean-Michel Gaspoz 23 29 Unité HIV 46 BMC family practice 11 ed8a9aca-acb1-4460-aa6c-46e46294c808 Article (Accepted version) Public file1.pdf 274906 application/pdf openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Institut Ethique Histoire Humanités

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Reduction of missed appointments at an urban primary care clinic: a randomised controlled study	BMC family practice			2010	693	485

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Chuard, Carmen