Ir J Med Sci (2009) 178:121–122 DOI 10.1007/s11845-009-0288-6
LETTER TO THE EDITOR
Clinic appointment reminders among rheumatology patients M. B. O’Connor Æ U. Bond Æ M. J. Regan Æ M. J. Phelan
Received: 12 October 2008 / Accepted: 14 January 2009 / Published online: 11 February 2009 Ó Royal Academy of Medicine in Ireland 2009
Dear Editor, We read with interest the publication by Hogan AM et al. [1], which looked at the potential impact of text message reminders on non-attendance at surgical outpatient (OPD) clinics in Ireland and reported that such a service would encourage 51% to attend or cancel their missed OPD appointment. As the authors pointed out, little work has been carried out in this area in Ireland. Recently, we also examined the topic, focusing on Rheumatology patients attending our outpatient services, who had a ‘‘did not attend’’ (DNA) rate of almost 18% (525/2,924) in 2007 [2] compared to 16.8% in the Hogan AM et al. study. Many patients DNA their OPD clinic appointments for one reason or another, for example a lapse in memory or forgetfulness has been estimated for up to 50% of DNA cases [3, 4]. The level of DNA can be extremely high in many departments. In the department of care for the elderly at Hammersmith Hospital, London, in 1996–1997, DNA rates were a staggering 21% [5]. This is at the backdrop of a national mean DNA rate of 12% for all clinics in the UK for the same period [6]. These results compare to 16% forgetting their appointment in Hogan et al. with 20% due to clerical errors.
M. B. O’Connor (&) Department of Medicine, South Infirmary-Victoria University Hospital, Old Blackrock Road, Cork, Ireland e-mail:
[email protected] U. Bond M. J. Regan M. J. Phelan Arthritis and Osteoporosis Centre, Department of Rheumatology, South Infirmary-Victoria University Hospital, Old Blackrock Road, Cork, Ireland
DNA has many implications for both the patients and the services involved. Regarding the patient, missed valuable clinical input may result in suboptimal health. This is very well documented among the diabetic population where patients who DNA clinic appointments have significantly greater risk factors and complications from their chronic condition [7]. Focusing on the services provided, the implications include vacant clinic appointments, which can be a waste of scarce financial resources. In our study, we conducted a cross-sectional selfadministered anonymous questionnaire with 166 patients (159 return patients) who attended Rheumatology clinics at the South Infirmary, Victoria University Hospital, Cork, Ireland. Patients were recruited intermittently, but consecutively, while the researchers were in attendance between September and October 2007. A response rate of 98% (163/166) was achieved. New patients were not analysed due to low numbers. Ninety-eight percentage (156/ 159) of return patients responded. Overall, 99% felt OPD appointment reminders to be a good idea. Interestingly, on logical regression analysis, those who had previously attended OPD were significantly more likely to view reminders as a positive idea (P \ 0.0005, OR = 57.72, 95% CI 15.14–220.03). This may suggest that those who have had more OPD exposure appreciate the possibility of missed appointments and the benefits of reminders. These findings were recorded in a setting of 65% (104), 16% (26), 96% (153), 59% (94), and 46% (73) having competence in or access to a mobile phone SMS, e-mail, a landline telephone, a landline voice messaging service and a mobile phone voice messaging service, respectively. Text/SMS messaging (47%) is the most preferred method of appointment reminder followed by a telephone call (26%) and postal letter (25%). The mean age of those
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preferring SMS was 46.11 years, while it was 64.5 years for those preferring a telephone call and 66 years for a letter. As one would expect significantly more mobile phone users preferred an SMS (P \ 0.0005), e-mail users an e-mail (P \ 0.0005) and landline owners a telephone call (P = 0.01). Focusing on those who preferred text/SMS messaging, it was noted that 66% (47/71) were in favour of receiving a reminder 5–7 days prior to their appointment, followed by 21% (15/71) at 3–4 days and 10% (7/71) at 1–2 days before the OPD clinic. Only 2% (2/71) requested their reminder to be C8 days before the clinic. Significantly more male mobile phone owners preferred their reminder to be \5 days prior to clinic (P = 0.042), while it was 5–7 days for females (P = 0.029). Of these patients, C94% were agreeable to receiving their reminder on any day or time of day, including holidays (P = 0.0005). Of those who would prefer a telephone call, either to their landline telephone or mobile phone, all wished the reminder to be B7 days prior to the OPD clinic. The commonest time frame before the OPD was 5–7 days (76%, 32/42), followed by 3–4 days (19%, 8/42) and 1–2 days (5%, 2/42). Of the responders C88% in this category were receptive to a reminder at any day or time of day, including holidays (P \ 0.0005). Regarding those who were in preference of a mailed letter as an OPD reminder, 77% (30/39) wished the reminder to be received 5–7 days before clinic, with 13% (5/39) 3–4 days before and 3% (1/39) 1–2 days before clinic. The day of receiving this reminder was not an issue in Ireland as the postal service only operates from Monday to Friday inclusive. From our findings (Table 1) and those of Hogan et al., we feel that a pilot into the use of text/SMS messages as patient OPD clinic appointment reminders would be beneficial to assess the benefits and viability of a reminder service in surgical and medical patients in Ireland.
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Table 1 Some study findings for return patients Has access to A mobile phone
65%
E-mail
16%
Landline telephone
96%
Views clinic reminders as a good idea
99%
Preferred type of reminder Text/SMS message
47%
Telephone call
26%
Letter
25%
Time of reminder before clinic 1–2 days
6%
3–4 days
20%
5–7 days
70%
References 1. Hogan AM, Mc Cormack O, Traynor O, Winter DC (2008) Potential impact of text message reminders on non-attendance at outpatient clinics. Ir J Med Sci 177(4):355–358. doi:10.1007/ s11845-008-0187-2 2. O’Connor MB, Bond U, Saunders JA, Casey P, Mohammad A, O’Dwyer M, Daly N, Regan MJ, Phelan MJ (2008) The preferences for outpatient clinic appointment reminders among Irish Rheumatology patients. Poster 91, 2nd Annual Joint UCC/Cork University Teaching Hospitals Health Research Day, 6 June 2008 3. Pal B, Taberner DA, Readman LP et al (1998) Why do outpatients fail to keep their clinic appointments? Results from a survey and recommended remedial actions. Int J Clin Pract 52:436–437 4. National Audit Office (1995) National health services in England and Wales. Report by the Comptroller and Auditor General, London, National Audit Office, April 1995 5. Dockery F, Rajkumar C, Chapman C, Bulpitt C, Nicholl C (2001) The effect of reminder calls in reducing non-attendance rates at care-of-the-elderly clinics. Postgrad Med J 77:37–39. doi:10.1136/ pmj.77.903.37 6. Department of Health (1997) Government Statisical Services outpatient and ward attenders, England 1996–1997, London 7. Griffin SJ (1998) Lost to follow-up: the problem of defaulters from diabetes clinics. Diabet Med 15(S3):S14–S24
