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Direct reminder reduces missed appointments, study shows

woman at desk in front of a computer, talking on a phone
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UPDATE: On June 20, 2023, the Journal of General Internal Medicine published a large-scale study led by Alan Teo, M.D., testing behavioral nudges in appointment reminder letters for tens of thousands of appointments scheduled through the VA Portland Health Care System between Oct. 15, 2020 and Oct. 14, 2021. The study found these nudges, contained in mailed reminders, were ineffective in improving appointment attendance. However, the key recommendations in the qualitative study described below are useful guidance, especially in smaller clinics and in-direct outreach, especially via telephone.

For all the innovations in medical science in recent years, mental health care practitioners are the first to acknowledge that good care depends on the patient actually showing up for the appointment.

A new study led by OHSU researchers and published in the journal Psychiatric Services, reveals that directly calling patients by phone – rather than simply leaving a voicemail message – makes a major difference in reducing the number of no-shows.

The rate of missed appointments with a direct telephone reminder was 3 percent, substantially below the 24 percent no-show rate for patients who received a voicemail reminder, and 39 percent among those for whom there was a call but no answer. The study involved 250 patients being treated for depression.

“The health care system can and should do a number of things to better nudge and ensure that patients are aware of their appointments and are likely to attend them,” said study co-author Alan Teo, M.D. M.S., a professor of psychiatry in the OHSU School of Medicine, VA Portland Health Care System. “We learned that it’s not uncommon for people to not get the phone reminder and if they don’t get the reminder their risk for missing an appointment skyrockets.”

Missed appointments drive up costs, estimated at roughly $200 for each no-show because of the ripple effect created by patients, doctors and medical assistants in rescheduling, Teo explained. In addition, he said, reducing the rate of missed appointments can improve outcomes for the people seeking medical attention.

“We know that people who do miss appointments correlate with patients who tend to have a lot more health problems,” Teo said. “It really is a preventable inefficiency in the health care system.”

The study was supported by the Veterans Health Administration HSR& D Career Development Award 14-428 to Teo and by HSR&D grant I50 HX001244-01 to the Center to Improve Veteran Involvement in Care.

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