Jayaram Mahesh, Rattehalli Ranganath D, Kader Ihsan
Leeds Partnerships NHS Foundation Trust, Bridge House, Balm Road, Leeds LS10 2TP, UK.
BMC Psychiatry. 2008 Nov 16;8:90. doi: 10.1186/1471-244X-8-90.
Non-attendance rates in psychiatric outpatient clinics have been a topic of considerable interest. It is measured as an indicator of quality of service provision. Failed attendances add to the cost of care as well as having an adverse impact on patients leading to missing medications, delay in identifying relapses and increasing waiting list time. Recent trials have demonstrated that prompting letters sent to patients led to a decrease in non-attendance rates. We applied this evidence based practice in our community mental health setting to evaluate its impact.
Using a before and after study design, we sent prompting letters to all patients due to attend outpatient clinic appointments for a period of six months in 2007. Non-attendance rates were compared with the corresponding period in 2006. We also looked at trends of non-attendance prior to this intervention and compared results with other parts of our service where this intervention had not been applied.
1433 prompting letters were sent out to all out-patient appointments made from June to November 2007. This resulted in an average non-attendance rate of 17% which was significantly less compared to 27% between June and November 2006 (RR 0.65, 95% CI 0.56 to 0.76, NNT 11). No downward trend in non-attendance rate was identified either prior to the intervention or when compared with similar teams across the city.
Prompt letters have been shown to reduce non-attendance rates in previous RCTs and systematic reviews. Our findings demonstrate a reduction in non-attendance rates with prompting letters even under non-trial conditions. Majority of the patients were constant during the two periods compared although there were some changes in medical personnel. This makes it difficult to attribute all the change, solely to the intervention alone. Perhaps our work shows that the results of pragmatic randomised trials are easily applicable and produce similar results in non-randomised settings. We found that prompting letters are a useful and easy to apply evidence based intervention to reduce non-attendance rates with a potential to achieve significant cost savings.
精神科门诊的未就诊率一直是备受关注的话题。它被用作衡量服务提供质量的指标。未就诊会增加护理成本，还会对患者产生不利影响，导致错过服药、延误复发识别以及延长候诊名单时间。近期试验表明，向患者发送提醒信可降低未就诊率。我们在社区心理健康环境中应用了这一循证实践来评估其影响。
采用前后对照研究设计，我们在2007年的六个月时间里，向所有预约门诊就诊的患者发送提醒信。将未就诊率与2006年同期进行比较。我们还观察了此次干预之前的未就诊趋势，并将结果与未应用此干预措施的服务其他部门进行比较。
2007年6月至11月期间，共向所有门诊预约患者发送了1433封提醒信。这使得平均未就诊率为17%，与2006年6月至11月期间的27%相比显著降低（相对危险度0.65，95%置信区间0.56至0.76，需治疗人数11）。在干预之前或与全市类似团队比较时，均未发现未就诊率有下降趋势。
在之前的随机对照试验和系统评价中，提醒信已被证明可降低未就诊率。我们的研究结果表明，即使在非试验条件下，提醒信也能降低未就诊率。尽管医务人员有所变动，但在比较的两个时期，大多数患者保持不变。这使得难以将所有变化都完全归因于干预措施。或许我们的工作表明，实用随机试验的结果易于应用，且在非随机环境中也能产生类似结果。我们发现，提醒信是一种有用且易于应用的循证干预措施，可降低未就诊率，并有可能实现显著的成本节约。
