VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA.
Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
J Gen Intern Med. 2023 Jul;38(Suppl 3):894-904. doi: 10.1007/s11606-023-08131-5. Epub 2023 Jun 20.
Missed appointments ("no-shows") are a persistent and costly problem in healthcare. Appointment reminders are widely used but usually do not include messages specifically designed to nudge patients to attend appointments.
To determine the effect of incorporating nudges into appointment reminder letters on measures of appointment attendance.
Cluster randomized controlled pragmatic trial.
There were 27,540 patients with 49,598 primary care appointments, and 9420 patients with 38,945 mental health appointments, between October 15, 2020, and October 14, 2021, at one VA medical center and its satellite clinics that were eligible for analysis.
Primary care (n = 231) and mental health (n = 215) providers were randomized to one of five study arms (four nudge arms and usual care as a control) using equal allocation. The nudge arms included varying combinations of brief messages developed with veteran input and based on concepts in behavioral science, including social norms, specific behavioral instructions, and consequences of missing appointments.
Primary and secondary outcomes were missed appointments and canceled appointments, respectively.
Results are based on logistic regression models adjusting for demographic and clinical characteristics, and clustering for clinics and patients.
Missed appointment rates in study arms ranged from 10.5 to 12.1% in primary care clinics and 18.0 to 21.9% in mental health clinics. There was no effect of nudges on missed appointment rate in primary care (OR = 1.14, 95%CI = 0.96-1.36, p = 0.15) or mental health (OR = 1.20, 95%CI = 0.90-1.60, p = 0.21) clinics, when comparing the nudge arms to the control arm. When comparing individual nudge arms, no differences in missed appointment rates nor cancellation rates were observed.
Appointment reminder letters incorporating brief behavioral nudges were ineffective in improving appointment attendance in VA primary care or mental health clinics. More complex or intensive interventions may be necessary to significantly reduce missed appointments below their current rates.
ClinicalTrials.gov, Trial number NCT03850431.
失约（“no-shows”）是医疗保健中一个持续存在且代价高昂的问题。预约提醒被广泛使用，但通常不包括专门设计来促使患者按时就诊的信息。
确定在预约提醒信中纳入提示对预约就诊率的影响。
集群随机对照实用试验。
2020 年 10 月 15 日至 2021 年 10 月 14 日期间，一家退伍军人事务部医疗中心及其卫星诊所共有 27540 名患者的 49598 次初级保健预约和 9420 名患者的 38945 次心理健康预约符合分析条件。
初级保健（n=231）和心理健康（n=215）提供者被随机分配到五个研究臂中的一个（四个提示臂和常规护理作为对照），采用均等分配。提示臂包括根据退伍军人的意见和行为科学概念（包括社会规范、具体行为指令和错过预约的后果）制定的简短信息的不同组合。
主要和次要结果分别为失约和取消预约。
结果基于调整人口统计学和临床特征的逻辑回归模型，并对诊所和患者进行聚类。
研究臂中的失约率在初级保健诊所为 10.5%至 12.1%，在心理健康诊所为 18.0%至 21.9%。提示对初级保健（OR=1.14，95%CI=0.96-1.36，p=0.15）或心理健康（OR=1.20，95%CI=0.90-1.60，p=0.21）诊所的失约率没有影响，与对照组相比，提示臂。当比较个别提示臂时，未观察到失约率或取消率的差异。
在退伍军人事务部初级保健或心理健康诊所中，纳入简短行为提示的预约提醒信在提高预约就诊率方面效果不佳。可能需要更复杂或强化的干预措施才能将失约率显著降低到当前水平以下。
ClinicalTrials.gov，试验编号 NCT03850431。
