E-mail Reminders: A Novel Method to Reduce Outpatient Clinic Nonattendance

Lionel S. Lim; Prathibha Varkey

摘要

Introduction: Although reminder systems have been studied previously, there is no published study on the effectiveness of e-mail reminders in reducing clinic nonattendance. Our objective was to evaluate the effectiveness of e-mail reminders in reducing clinic nonattendance.Methods: We measured the monthly nonattendance rate at an employee health outpatient clinic in an academic medical center 3 months before and after implementing an e-mail reminder system. The nonattendance rate of patients who received e-mail reminders was compared to a control group. Results: The mean nonattendance rate for patients (5,407 appointments) who received e-mail reminders decreased by 35% (from 9.7% to 6.3%, p = 0.002). There was no change in the nonattendance rate among patients (567 appointments) who did not receive the intervention (pre- and post-intervention 5.3% & 4.7%, p = 0.8). Conclusions: E-mail reminders were effective in reducing clinic nonattendance in an academic outpatient clinic. Background In the current milieu of system inefficiency, medical errors and rising costs, a careful and systematic examination of the various aspects of healthcare delivery is essential to the success of any organization. ‘No-shows' or ‘nonattendance' to a clinic are a cause of significant concern to the delivery of optimal quality of care. Prior studies suggest that nonattendance rates range from 3% to 80% based on the type of clinic and characteristics of the patient population (Hixon, Chapman, & Nuovo, 1999). For the purpose of this study, clinic nonattendance has been defined as patients who are expected, but do not turn up for their appointments. We did not include patients who cancel their appointment in advance. Prior studies suggest that numerous factors (Andrews, Morgan, Addy, & McNeish, 1990; Moore, Wilson-Witherspoon, & Probst, 2001) including barriers to access, forgetfulness (Little, Cannon, Whitson, & Jarolim, 1991), lack of transportation, particularly for low-income and elderly patients (Little et al., 1991; Paul & Hanna, 1997), personal or family illness (Little et al., 1991), chronicity of illness or chronic medical problems (Bigby, Pappius, Cook, & Goldman, 1984; Vikander et al., 1986), fear of medical encounter (Little et al., 1991), insurance status (Lilja, 1994; Rose & Chung, 2003; Rust, Gallups, Clark, Jones, & Wilcox, 1995), age (Campbell, Staley, & Matas, 1991; Weingarten, Meyer, & Schneid, 1997), race (Goldman, Freidin, Cook, Eigner, & Grich, 1982), socioeconomic status (Ide, Curry, & Drobnies, 1993), provider experience (Moser, 1994) and lack of prior provider-patient relationship (Bean & Talaga, 1995) influence no-show rates. However, demographic information is often an inconclusive predictor of non-attendance (Bean & Talaga, 1992). In addition, there is often a poor correlation between the research findings of different studies due to the heterogeneity of research design and populations studied, which leads to variations in study outcomes. One significant factor related to nonattendance that can be successfully addressed, is patient forgetfulness (Little et al., 1991). To our knowledge, there are no published studies examining the effectiveness of e-mail reminders. This study was conducted to determine the effectiveness of an e-mail reminder system on reducing patient nonattendance in an Academic Outpatient Clinic. Methodology DesignA retrospective study was conducted analyzing attendance rates of all appointments to the clinic between December 2003 to May 2004. As a routine, patients to the Clinic usually receive a mailed letter reminder confirming the time and venue of the appointment. These reminders are sent shortly after the appointments are made, and are not necessarily shortly before the scheduled appointment.The e-mail reminder system was introduced as an intervention in March 2004. Nonattendance rates were obtained for all Clinic patients 3 months prior to, and after the intervention, from December 2003 through May 200

机译：简介：尽管以前已经研究过提醒系统，但尚未发表有关电子邮件提醒在减少诊所缺勤方面的有效性的研究。我们的目标是评估电子邮件提醒在减少门诊无人值守方面的有效性。方法：我们在实施电子邮件提醒系统前后3个月，在学术医疗中心的员工保健门诊中测量了每月的无门诊率。将收到电子邮件提醒的患者的缺勤率与对照组进行比较。结果：收到电子邮件提醒的患者（5,407个约会）的平均缺勤率降低了35％（从9.7％降至6.3％，p = 0.002）。没有接受干预的患者（567名预约者）的未就诊率没有变化（干预前后分别为5.3％和4.7％，p = 0.8）。结论：电子邮件提醒可以有效地减少学术门诊中的诊所缺勤情况。背景技术在当前系统效率低下，医疗错误和成本上涨的环境中，对医疗保健提供方方面面进行认真而系统的检查对于任何组织的成功都是至关重要的。对诊所的“缺席”或“缺席”是提供最佳护理质量的重要原因。先前的研究表明，根据诊所的类型和患者人群的特征，无人值守率从3％到80％不等（Hixon，Chapman和＆Nuovo，1999）。出于本研究的目的，门诊就诊已定义为预期但未预约的患者。我们不包括提前取消预约的患者。先前的研究表明，许多因素（安德鲁斯，摩根，阿迪和麦克尼什，1990年;摩尔，威尔逊·威瑟斯彭和普罗布斯特，2001年）包括通行障碍，健忘（利特尔，坎农，惠特森和哈罗里姆，1991年），缺乏交通运输，尤其是针对低收入和老年患者的交通运输（Little等，1991; Paul＆Hanna，1997），个人或家庭疾病（Little等，1991），疾病的慢性或慢性医疗问题（Bigby，Pappius， Cook＆Goldman，1984; Vikander等，1986），对医疗遭遇的恐惧（Little等，1991），保险地位（Lilja，1994; Rose＆Chung，2003; Rust，Gallups，Clark，Jones，＆ Wilcox，1995年），年龄（Campbell，Staley和Matas，1991; Weingarten，Meyer和Schneid，1997），种族（Goldman，Freidin，Cook，Eigner和Grich，1982），社会经济地位（Ide，Curry和Drobnies，1993年），服务提供者的经历（Moser，1994年）以及缺乏事先的服务提供者与患者之间的关系（Bean和Talaga，1995年）影响了缺席率。但是，人口统计学信息通常是不出席的不确定因素（Bean＆Talaga，1992）。此外，由于研究设计和研究人群的异质性，不同研究的研究结果之间往往存在较弱的相关性，这导致研究结果的差异。与缺勤有关的一个重要因素是患者的健忘（Little等，1991）。据我们所知，目前尚无公开研究检查电子邮件提醒的有效性。进行这项研究的目的是确定电子邮件提醒系统对减少学术门诊患者无人看管的有效性。方法设计进行了一项回顾性研究，分析了2003年12月至2004年5月期间所有门诊的出诊率。作为常规，诊所的患者通常会收到一封信件提醒函，以确认预约的时间和地点。这些提醒是在约会后不久发送的，不一定是在预定约会之前发送的。电子邮件提醒系统于2004年3月被引入。在此之前的3个月，以及干预后，从2003年12月到200年5月

E-mail Reminders: A Novel Method to Reduce Outpatient Clinic Nonattendance

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