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

Kossovsky, Michel
Published in BMC Family Practice. 2010, vol. 11, p. 79
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.
Keywords Adult*Appointments and SchedulesCellular PhoneEfficiency, OrganizationalFemaleHospitals, UniversityHumansMaleMiddle Aged*Patient SatisfactionPostal ServicePrimary Health Care/*organization & administration*Reminder SystemsSwitzerlandTelephoneUrban Health Services/organization & administration
PMID: 20973950
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Research groups Groupe Jean-Michel Gaspoz (23)
Unité HIV (46)
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JUNOD PERRON, Noëlle Astrid et al. Reduction of missed appointments at an urban primary care clinic: a randomised controlled study. In: BMC Family Practice, 2010, vol. 11, p. 79. https://archive-ouverte.unige.ch/unige:20657

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Deposited on : 2012-05-22

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