The Effectiveness of Appointment Reminder Systems in Reducing No-Show Rates

Purpose Statement

Physicians often schedule appointments with their patients for follow up or for more treatment to provide better health outcomes. However, most healthcare providers face the challenge of patients missing their scheduled appointments, which negatively impacts patient health and treatment outcomes. Since patients commonly cite forgetfulness as a reason for no-show, various reminder methods such as emails, SMS, and phone calls are being usedto alert patients on upcoming appointments. This paper examines the effectiveness of appointment reminder systems in reducing no-show rates.

Research questions

  • Do appointment reminder systems reduce no-show rates?
  • Which reminder methods are preferred by patients?
  • What factors affect the effectiveness of reminder systems?
  • Do reminder systems have a setback?

Hypotheses

  • Appointment reminder systems reduce no-show rates
  • Phone calls are the most preferred reminder methods

No-show appointments refer to patients who do not show up nor cancel scheduled appointments (Davies et al., 2016). Although documented rates of non-attendance vary across countries, clinical settings, or healthcare systems, research around the world consistently report no-show rates of between 15% and 30%. However, no-show rates have been reported to reach as high as 50% (Davies et al, 2016). Missing appointments has adverse effects on the patients, physicians, and the entire systems. No-show can disrupt scheduling and operational programs in clinics reduced productivity of physicians, underutilization of personnel and equipment, and interrupted care continuity and disease management for patients (Nelson et al., 2011). The issue also causes reduced patient satisfaction, poor relationships between clinicians and patients, and high costs of care delivery. Although the magnitude of the economic impact of non-attendance varies, the overall financial cost is substantial. Missed appointments can delay presentation at healthcare facilities, which may, in turn, lead to lack of follow-up of severe conditions that may lead to acute complications and costly hospital admissions (Bos et al., 2005). Medical employees who face pressure from referring agents to manage waiting lists can cause them anxiety, stress, and fatigue (McLean et al., 2016). Due to the adverse effects of patient no-shows, it is essential to examine the effectiveness of the appointment reminder systems to increase the chances of keeping appointments.

Various studies have investigated the effectiveness of appointment reminder systems. McLean et al. conducted a systematic review of the literature of reminder effectiveness (2016). They found out that reminder systems improve appointment attendance in various healthcare settings and different patient populations. Out of the 31 randomized controlled trials, only one failed to show an increase in attendance (McLean et al., 2016). The study demonstrated that “plus reminders” (those that include orientation or health information besides date, time, and location) are more effective than simple reminders (those that show date, time, and location). These findings are evident in Arkansas Children’s Hospital where Twilio Voice appointment reminder has delivered positive outcomes regarding non-attendance. Each year, approximately 20% of children at the hospital missed their appointments, which risked their ongoing care (Twilio.org, 2019). To manage the problem, the hospital utilized Twilio Programmable Voice appointment reminder to allow patients to confirm appointments by responding “yes” or “no”. The system saved the hospital the high costs of on-premises call center along with mailing services that had cost it $250,000. Few months after the installation of the system, the hospital had reduced no-show rates by 2%, which saw 20 additional children to receive quality care each day (Twilio.org, 2019).

A study conducted by Wegrzyniak et al. focused on patient preference when exploring the effectiveness of appointment reminder systems (2018). The study was conducted at a multi-office private orthodontic practice where 6-month data of patients and appointments were collected. The participants were required to choose one of the three methods: e-mail, SMS, and phone call. Inconsistent with the hypothesis, e-mails received the highest number of picks, followed by SMS, then phone calls. The study also revealed that early morning appointments (between 7.00 AM and 9:45 AM) had the lowest attendance rates (Wegrzyniak et al., 2018). This indicates that appointments scheduled past 10.00 AM are more likely to receive a low no-show rate. Davies et al. revealed that appointment age plays a significant role in reducing no-show rates (2016). The team demonstrated that no-show rates increased as the appointment period increases, requiring the systems to send reminders in a short period to the appointment.

While appointment reminder systems have shown to be effective in reducing no-show rates in hospitals, the systems also have their challenges. McLean et al., in their systematic review, revealed that the systems promote appointment cancellation and that they are not optimally used (2016). The study showed that 17% – 26% of patients who received appointment calls were more likely to cancel or reschedule their medical appointment relative to the 8% – 12% control group. Telephone reminders were found to attract the highest number of cancellations and reschedule compared to SMS reminders (McLean et al., 2016). SMS reminders were found to reduce cancellations and rescheduling actively. The researchers also revealed six key areas where the appointment reminder systems are underutilized. For most systems, patient details may be inaccurate or out-of-date, with groups that are socio-economically deprived and less geographic being more vulnerable. These groups, which entail young adults and students, frequently change telephone numbers and addresses. Since most landline calls are made during work hours (9 am – 5 pm), patients are likely to miss the reminders since most of them usually are out of the house (McLean et al., 2016). These findings indicate that SMS reminders can be more effective. Patients’ cognitive ability, language, and literacy level are also determinants of the effectiveness of appointment reminder systems. Older patients, immigrants, and inner-city populations can have problems understanding the systems, requiring special help from caregivers or close people. Other issues that lead to underutilization of these systems include failure to tailor the systems to high-risk populations and patients who do not cancel or reschedule appointments.

This paper looked at the effectiveness of appointment reminder systems in helping patients to keep the doctor’s appointment. The reviewed studies indicate that these systems have a positive outcome on patient no-show rates. The research revealed that issues like patient preference, appointment age, patient literacy level, and cognitive ability, and appointment time determine the effectiveness of the systems. However, the reminder systems have shown to increase appointment cancellation and rescheduling. When the above factors are controlled, appointment reminder systems can have optimal results in improving appointment attendance.

 

 

Abstract

Most healthcare providers around the world experience the challenge of patients missing their medical appointments, which negatively influences patient health and treatment outcomes. Since patients commonly cite forgetfulness as a reason for no-show, various reminder methods such as emails, SMS, and phone calls are being used to alert patients on upcoming appointments. This paper aims at investigating the effectiveness of appointment reminder systems in reducing no-show rates in hospitals. An analysis of various studies reveals that these systems help in reduce no-show rates. Data from Arkansas Children’s Hospital indicates positive outcomes of the appointment reminder system on no-show rates. However, research has also demonstrated the role of the systems in promoting cancellation and rescheduling of appointments.

 

References

Bos, A., Hoogstraten., J. &Prahl-Andersen, B. (2005). Failed appointments in an orthodontic clinic. Am J Orthod DentofacialOrthop, 127,355–357. Retrieved from doi:10.1016/j.ajodo.2004.11.014.

Davies, M.L., Goffman, R.M., May, J.H., Monte, R.J., Rodriguez, K.L., Tjader, Y.C. & Vargas, D.L. (2016, Feb 16). Large-scale no-show patterns and distributions for clinic operational research. Healthcare, 4(15). Retrieved from https://pdfs.semanticscholar.org/57df/3eb2595a353b9a750076f1773c87d471f9cc.pdf

McLean, S.M., Booth,A., Gee, M., Salway, S., Cobb, M., Bhanbhro, S., & Nancarrow, S.A. (2016). Appointment reminder systems are effective but not optimal: Results of a systematic review and evidence synthesis employing realist principles. Patient Prefer Adherence, 10, 479-499. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831598/

Nelson, T.M., Berg, J.H., Bell, J.F., Leggott, P.J. & Seminario AL. (2011). Assessing the effectiveness of text messages as appointmentreminders in a pediatric dental setting. J Am DentAssoc,132, 397–405. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21454845

Twilio.org. (2019). Using Twilio Voice appointment reminder, Arkansas Children Hospital delivers crucial care to more children. Twilio.org. Retrieved from https://www.twilio.org/customer/arkansas-childrens-hospital/

Wegrzyniak, L.M., Hedderly, D., Chaudry, K. & Bollu, P. (2018). Measuring the effectiveness of patient-chosen reminder methods in a private orthodontic practice. Angle Orthodontist, 88(3), 315-318. Retrieved from DOI: 10.2319/090517-597.1