Division of Primary Care, Department of Community Medicine and Primary Care, Geneva University Hospitals, Geneva, Switzerland.
BMC Fam Pract. 2010 Oct 25;11:79. doi: 10.1186/1471-2296-11-79.
Missed appointments are known to interfere with appropriate care and to misspend medical and administrative resources. The aim of this study was to test the effectiveness of a sequential intervention reminding patients of their upcoming appointment and to identify the profile of patients missing their appointments.
We conducted a randomised controlled study in an urban primary care clinic at the Geneva University Hospitals serving a majority of vulnerable patients. All patients booked in a primary care or HIV clinic at the Geneva University Hospitals were sent a reminder 48 hrs prior to their appointment according to the following sequential intervention: 1. Phone call (fixed or mobile) reminder; 2. If no phone response: a Short Message Service (SMS) reminder; 3. If no available mobile phone number: a postal reminder. The rate of missed appointment, the cost of the intervention, and the profile of patients missing their appointment were recorded.
2123 patients were included: 1052 in the intervention group, 1071 in the control group. Only 61.7% patients had a mobile phone recorded at the clinic. The sequential intervention significantly reduced the rate of missed appointments: 11.4% (n = 122) in the control group and 7.8% (n = 82) in the intervention group (p < 0.005), and allowed to reallocate 28% of cancelled appointments. It also proved to be cost effective in providing a total net benefit of 1846. - EUR/3 months. A satisfaction survey conducted with 241 patients showed that 93% of them were not bothered by the reminders and 78% considered them to be useful. By multivariate analysis, the following characteristics were significant predictors of missed appointments: younger age (OR per additional decade 0.82; CI 0.71-0.94), male gender (OR 1.72; CI 1.18-2.50), follow-up appointment >1 year (OR 2.2; CI: 1.15-4.2), substance abuse (2.09, CI 1.21-3.61), and being an asylum seeker (OR 2.73: CI 1.22-6.09).
A practical reminder system can significantly increase patient attendance at medical outpatient clinics. An intervention focused on specific patient characteristics could further increase the effectiveness of appointment reminders.
众所周知，预约失约会干扰适当的医疗护理，并浪费医疗和行政资源。本研究旨在测试一种针对即将到来的预约提醒患者的序贯干预措施的有效性，并确定失约患者的特征。
我们在日内瓦大学附属医院的一个城市初级保健诊所进行了一项随机对照研究，该诊所主要为弱势患者服务。所有在日内瓦大学附属医院的初级保健或 HIV 诊所预约的患者都会在预约前 48 小时收到提醒，提醒方式如下：1. 电话（固定或移动）提醒；2. 如果没有接听电话：短信（SMS）提醒；3. 如果没有可用的手机号码：邮件提醒。记录预约失约率、干预成本和失约患者特征。
共纳入 2123 例患者：干预组 1052 例，对照组 1071 例。只有 61.7%的患者在诊所记录了移动电话号码。序贯干预显著降低了预约失约率：对照组为 11.4%（n = 122），干预组为 7.8%（n = 82）（p < 0.005），并允许重新安排 28%的取消预约。它还被证明在提供 1846. - 欧元/3 个月的总净效益方面具有成本效益。对 241 名患者进行的满意度调查显示，93%的患者不介意提醒，78%的患者认为提醒有用。通过多变量分析，以下特征是预约失约的显著预测因素：年龄每增加十年（OR 0.82；95%CI 0.71-0.94）、男性（OR 1.72；95%CI 1.18-2.50）、随访预约>1 年（OR 2.2；95%CI 1.15-4.2）、药物滥用（OR 2.09；95%CI 1.21-3.61）和寻求庇护者（OR 2.73；95%CI 1.22-6.09）。
一种实用的提醒系统可以显著提高患者在门诊就诊的出勤率。针对特定患者特征的干预措施可以进一步提高预约提醒的效果。
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