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

BMC Family Practice

Research Article

Carmen Chuard¹  Jean-Michel Gaspoz¹  Michel P Kossovsky¹  Melissa Dominicé Dao¹  Noelle Junod Perron¹  Valerie Miserez¹  Alexandra Calmy² 

[1] Division of primary care, Department of community medicine and primary care, Geneva University Hospitals, 4 rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland;HIV Unit, Department of internal medicine, Geneva University Hospitals, 4 rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland;

关键词: Mobile Phone;    Primary Care Clinic;    Asylum Seeker;    Short Message Service;    Junior Doctor;   

DOI  :  10.1186/1471-2296-11-79

 received in 2010-06-24, accepted in 2010-10-25,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundMissed 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.MethodsWe 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.Results2123 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 >1year (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).ConclusionA 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.

【 授权许可】

CC BY   
© Junod Perron et al; licensee BioMed Central Ltd. 2010