Content area
Full Text
Non-attendance rates for general practice and hospital outpatient appointments in Britain range from 5% to 34% across different specialties and between regions. 1 2 This not only costs an estimated £185 million per annum in wasted appointments 3 but also introduces significant inefficiency into a healthcare system that is under increasing pressure to achieve strict access targets.
Reasons for and patterns of non-attendance have not been well described. We do however know that patients who miss appointments tend to be young, have more psychological problems and be more socio-economically disadvantaged. 4 - 6 Reasons for non-attendance appear to be complex and multi-factorial ranging from simple memory lapses-cited by patients in one study as the main reason for missing appointments 7 -to disillusionment with the way in which care is structured and delivered. 8 9 Reminding patients of appointments by letter or telephone has previously proved effective in improving attendance, 10 and patients have suggested that texting appointment reminders might similarly reduce those missed appointments associated with memory lapses. 8
Despite interest in the use of novel technologies to improve attendance, evidence from rigorously conducted controlled studies is lacking. 11 We report the results of a randomised controlled study assessing the effectiveness of texting appointment reminders to patients who repeatedly fail to attend their appointments in one inner-city general practice, with a practice population of 5200, in Lothian, Scotland.
METHODS
Participants
The computer records of all patients who failed to attend two or more routine doctor or nurse appointments in the preceding 12 months were flagged. These patients were considered to be the most likely to fail to attend subsequent appointments. All appointments made by these patients between August 2004 and February 2005 other than those made on the day of the appointment were eligible to be included in the study. Appointments made by patients with no mobile phone or who were unable to provide a mobile telephone number were subsequently excluded.
Intervention
The intervention comprised a text message reminder of the appointment sent between 08:00 and 09:00 on the morning preceding afternoon appointments and between 16:00 and 17:00 on the afternoon preceding morning appointments. Reminders for Monday morning appointments were sent on Friday afternoon. The text stated: "You have an appointment at (name of...