Effectiveness of Telephone Reminders in Improving Rate of Appointments Kept at an Outpatient Clinic: A Randomized Controlled Trial

Muhammad Jawad Hashim, MD, Peter Franks, MD, MPH, and Kevin Fiscella, MD, Department of Family Medicine, University of Rochester, Rochester, NY.

J Am Board Fam Med. 2001;14(3) 

In This Article

Abstract and Introduction

Background: Clinic appointments in which patients do not appear (no-show) result in loss of provider time and revenue. Previous studies have shown variable effectiveness in telephone and mailed reminders to patients.
Methods: We conducted a randomized controlled trial of telephone reminders 1 day before the scheduled appointments in an urban family practice residency clinic. Patients with appointments were randomized to be telephoned 1 day before the scheduled visit; 479 patients were telephoned and 424 patients were not telephoned.
Results: The proportions of patients not showing up for their appointments were 19% in the telephoned and 26% in the not-telephoned groups (P = .0065). Significantly more cancelations were made when telephoning patients before their visit, 17% compared with 9.9%. The opened scheduling slots were used for appointments for other patients. This additional revenue offset the cost of telephone intervention in our cost analysis.
Conclusion: Reminding patients by telephone calls 1 day before their appointments yields increased cancelations that can be used to schedule other patients. Telephone reminders provide substantial net revenue, but the results may be population specific.

Outpatient clinics that rely on scheduled appointments lose valuable time and resources when patients do not arrive for their scheduled visits. Various strategies have been suggested to improve the rate of appointments kept, including telephone and mail reminders.[1,2] Automated computer-generated telephone reminders have also been examined.[3] Other studies have focused on reminders for special services, such as for immunizations[4,5,6,7] and mammography,[8,9] and for disease management, such as tuberculosis treatment[10] and cervical cancer-screening follow-up.[11,12] Studies on telephone reminders have shown variable results in improving the rate of appointments kept.[13,14,15,16,17] Most studies show a reduction in the no-show (appointments missed by patients) rate with improvements of up to 50%.

Because telephoning patients is a staff-intensive process, cost considerations are relevant in assessing any benefits in increased rate of appointments kept. Although some studies have shown overall benefit, this benefit has not been shown consistently. We designed a randomized controlled trial of telephone reminders to study their effectiveness in reducing the no-show rate in our clinic population and to evaluate the costs of this intervention.


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