No one seems to be without a cell phone these days, so it only makes sense that we should start using these devices to carry out tasks that we used to do in a more “old-fashioned” way. One obvious application is to use text messaging to remind patients of upcoming appointments. A recent study by a group at King’s College London shows that it can be done cheaply and easily, and that it improves attendance even more than a direct telephone call.
In 2009 and 2010, a London mental health clinic sent text messages to patients seven and five (or seven and three) days prior to their scheduled appointments. The messages were brief and simple, giving the date and time of the appointment and a number to call if the patient couldn’t come. To determine the effectiveness of the messages, researchers compared a roughly three-month period in 2009 and 2010 with the same period in 2008—before the clinic implemented the text message system.
Out of approximately 1,000 appointments each year, the researchers found that missed visits accounted for 36% of all scheduled appointments in 2008, but only 26% and 27% in 2009 and 2010, respectively. This translated into about a 25% decrease in no-shows after the text messages started. They also showed that the drop in missed appointments was not due to people calling back to cancel, as cancellation rates remained steady at about 13% each year; rather, attendance at appointments increased. There was no difference in whether the clinic gave notices five or three days prior to the scheduled appointment.
The program was safe and easy to implement. It was largely automated, didn’t divulge any protected health information, and used technology that most patients already have access to; indeed, they carry them in their pockets every day. It also could potentially save money. No-show patients are estimated to cost the UK’s National Health Service almost $1 billion annually, and the authors estimate this intervention could shave 25% off that sum (Sims et al, Psych Services 2012;63:161–168).
Finding novel and meaningful ways to use new technology can be simple and lead to significant changes in service delivery. Instead of using postcards or telephone calls for patient reminders, consider text messages as a cheaper, non-intrusive alternative with a proven beneficial outcome. While we haven’t personally tested any patient text messaging products, a quick Google search turned up a couple of products you might want to check out: Doctor Connect and Patient Nudge.