Agnes Choi, DNP, FNP-C

Abstract:

Background: Attending primary care appointments is the first step to getting routine health care, maintaining chronic health conditions, and preventing diseases. No-shows to scheduled appointments affect providing continuity of care that reduce morbidity and mortality as well as a financial and operational burden for organizations. The prevalence of missed appointments is high among low socioeconomic, minority ethnicity, increasing the gap in health disparities. Increasing attendance to scheduled appointments using reminder systems can prevent hospitalizations and complications of many conditions, ultimately benefiting both organizations and communities. Objectives: The objective of this project was to determine if additional text message reminders compared to standardized phone call reminders alone improve attendance rates to scheduled appointments for adults aged 21 and older in a primary care setting. Methods: This quality improvement two-group project used a quasi-experimental non-equivalent two-group design. Pre- and post-intervention data were collected from the electronic health record to measure the project outcome. The participants in the comparison group received an automated phone call reminder 24 hours before the appointments. The participants in the intervention group received an automated text message reminder 72 hours before the appointments in addition to the phone call reminder. The outcome variable was the attendance rate. The percentage of attendance, reschedule, and cancellation was measured to further evaluate the primary outcome. Any no-show was counted as nonattendance. The subcategories of the nonattendance included resolvable and unresolvable groups to identify different factors of no-shows. Descriptive data analysis, chi-square, binomial proportion tests, Fisher exact tests, and confidence intervals were used to compare the outcomes between the two groups. Results: The result indicated that the attendance rate was 24.06% higher in the intervention group than that of the comparison group. The sample proportion for attendance was 0.59 for the comparison group and 0.83 for the intervention group, with a confidence interval of 95% and p-value less than 0.05. Conclusion: A combined reminder of text message and phone call reminders is a significantly effective intervention to increase adherence to scheduled appointments in underserved population. The increased adherence will provide additional benefits to both patients and organizations by allowing continuity of care and efficient use of resources. 

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