Cost-specific texts reduce missed appointments

PATIENT reminder text messages highlighting the specific cost of missed appointments helped reduce non-attendance by almost a quarter, a Department of Health (DoH) study has shown.

Telling patients exactly how much money would be wasted if they failed to show for a hospital appointment proved most effective, reducing non-attendance by 23 per cent.

One example text message reminded the patient of the date and time of their appointment and added: "Not attending costs NHS £160 approx.". It then provided a telephone number to cancel or rearrange.

Almost one in 10 hospital outpatient appointments are missed in England every year, with 5.6 million missed last year, costing the NHS as much as £225 million.

The standard NHS appointment reminder tends to only include the time, date and place of appointment, plus general information on how to cancel/rearrange.

A team of researchers from the DoH and Barts NHS Trust tested various forms of wording in text reminders sent to 20,000 patients five days before their appointments at five Barts clinics. Two randomised controlled trials were carried out from November 2013 to May 2014.

One approach made reference to general costs, stating that: "Not attending wastes money". It then asked the patient to call the number provided if they needed to cancel/rearrange. Another made it easier for the patient to cancel/rearrange by providing a specific telephone number.

A third option encouraged attendance by giving the place, date and time of the appointment and adding: "We are expecting you…", "9 out of 10 people attend". Another appealed to patients to "Please be fair to others" and call the number provided if they had to cancel/rearrange. The final message warned patients that non-attendance would be noted in their records as a missed appointment.

Results of the trial showed the "specific costs" message was the most effective in reducing non-attendance and the only one that gave a statistically significant result. Despite the similarities, the text making a general reference to wasted money was less effective than the one detailing a specific number.

Surgeon Dr Dominic King, who was involved in the study, told the Daily Mail that he and his colleagues were "struck by the magnitude of the effect" of telling people the cost of missing an appointment.

He said: "We already know that simple text reminders work well in helping to encourage people to attend clinic.

"What is really fascinating with this study is the added impact of the extra sentence telling them about the cost of an NHS appointment."

The DoH hopes the findings will encourage NHS organisations to revise their standard reminder messages in a bid to improve attendance.

The study concludes: "This approach is cost-free (where text messages are already being sent), easy to implement, and may highlight opportunities for further research."