Patient Appointment Reminders Are Associated with Lower Clinic Non-Attendance Rates for Outpatient Rheumatology Clinic

Objectives Outpatient clinic non-attendance for chronic disease management leads to poor outcomes for the patient unable to attend, in addition to longer wait times for other patients waiting for evaluation.[1] Studies of non-attendance in other settings and subspecialties have identified appointment reminders as a useful tool to improve appointment attendance.[2] The value of appointment reminders was explored at Kingston Health Sciences Centre outpatient Rheumatology clinics. The non-attendance rate of clinics utilizing appointment reminders (phone calls or emails) were compared to a clinic not employing appointment reminders.

Methods Three out of 5 Rheumatology clinics at the Kingston Health Sciences Centre employ phone call appointment reminders, a fourth clinic employed phone call or email reminders, while the fifth clinic did not employ any reminders. Our primary outcome measure was the non-attendance rate in the reminder group (clinics 1-4) compared to the no reminder group (clinic 5). Secondary outcomes of interest included the correlation between confirmation of attendance and non-attendance rate across clinics, and whether email reminders were comparable to phone call reminders in reducing the non-attendance rate.

Results The non-attendance rate was lower in clinics utilizing any appointment reminder method (6.9% 95% CI:6.0-7.8) as compared to no reminders (10.0% 95% CI:8.1-12.0) (Chi-square (1,N=3917) 9.73, p=.002). The administrative time cost was the balancing measure for the study and ranged from 28 to 50 hours of administrative time over a 6-month period in the clinics that performed appointment reminders. Appointment confirmation rate correlated with lower non-attendance rate (Pearson r(2) = −0.91, p =.04) at a cost of administrative time if reminders were given by phone call. However, email reminders were a method of increasing confirmation rate with less added time cost and had comparable beneficial influence on non-attendance rate to phone call reminders 5.9% vs 6.9% respectively, (Chi-square (1,N=3346) 0.45, p=.83).

Conclusion Appointment reminders significantly lowered the non-attendance rate for outpatient rheumatology clinics. This was at a cost of 28 to 50 hours of administrative work over a 6-month period. Confirming appointments at the time of reminders also lowered the non-attendance rate but required extra time to do so if done by telephone. Both reminder calls and reminder emails were comparably effective, and email reminders with the added function of confirming appointments could be a method of improving the confirmation rate at a time savings. Utilizing email reminders for those patients who are able to adopt it may be the more efficient method overall.

References [1.] Hwang AS. J Gen Intern Med 2015;30:1426-33. [2.] Liu Q. Cochrane Database Syst Rev 2014;2014(11):CD006594.