Patient-specific reminder letters and pediatric well-child-care show rates

The objective of this study was to determine whether patient-specific letters, which describe the content of an upcoming well-child appointment, improve the show rate of well-child appointments better than postcard reminders. In this prospective clinical trial conducted at a pediatric continuity clinic in a teaching hospital, 288 newborns were randomized to a letter, postcard, or control group. For every well-child appointment, families were sent either a letter pertaining to the particular well-child appointment or a postcard; the control group received no reminders. There were no differences in demographics among the groups. The show rates between the letter and postcard groups were not different, but were significantly higher than the show rate for the control group (75.0%, 73.7%, and 67.5%, respectively; P < .05). A cost comparison between the use of postcards versus not using postcards revealed a benefit in the former. We concluded postcard reminders are effective in improving show rates for well-child-care visits, and that patient-specific letters have no additional benefit above that of postcard reminders.

An appointment-keeping improvement package for outpatient pediatrics: systematic replication and component analysis

Child health-care appointments that are not kept are an important pediatric problem. Previous research has shown that reducing effort (with a parking pass) and reminding patients (with mailed and telephone reminders) significantly improved appointment keeping for first-time and patient-scheduled appointments. This study, using a posttest-only group design, evaluated the effects of various combinations of that intervention applied to clinic-scheduled follow-up appointments. All combinations of the intervention significantly increased cancellations, but none increased appointments kept or decreased appointments not kept significantly. Log linear analyses showed that the lag time between scheduling and the appointment significantly influenced appointment keeping. The results suggest that if clinics want to increase cancellations, a mailed reminder and effort reduction are sufficient. To increase appointment keeping, other interventions, such as reduced lag time, may be necessary.

A profile of the noncompliant patient: a thirty-month review of outpatient psychiatry referrals

Missed appointments to outpatient psychiatry programs have been identified as a major form of noncompliance in the literature. Over a two-and-a-half year period, 874 referrals to the outpatient psychiatry department of a large teaching hospital were examined for significant differences between compliant and noncompliant patients. Noncompliant patients comprised 17.8% of the total number of cases dispositions and were significantly more likely to be single, diagnosed personality disorder or substance abuse, and referred from the Emergency Department than complaint patients. Further analysis of emergency referrals, the single most significant predictor, indicated that patients from this referral source were more likely to be male, unmarried, unemployed or on welfare, and diagnosed personality disorder or substance abuse than referrals from general practice and internal sources. The results are discussed in light of previous research, and recommendations are made for increasing compliance to outpatient appointments.

A preschool child psychiatric service: predictors of post-assessment default

A study of post-assessment default from a preschool child psychiatric service found that about two-thirds of the sample defaulted (two-thirds of these immediately after assessment) and, as in other services, most referrals were seen three times or less. Default, as predicted, was not related to sociodemographic factors. In addition, in contrast to previous studies, there was no overall relationship to type or severity of child symptoms nor to maternal mood disorder. However, default was unexpectedly associated with staff inexperience, shorter initial interview duration and type of treatment offered. Possible explanations for these results and further avenues of research are discussed.

Who misses appointments? An empirical analysis

Patient noncompliance is a major problem in clinical practice. In order to better understand this issue, 236 appointments at an outpatient psychiatry clinic of a large urban general hospital were examined. Five variables significantly discriminated patients who kept their appointments from patients who did not. Patients who were younger, had a history of missed appointments, were scheduled to see a resident physician, had a routine appointment and lived a distance from the hospital, were at greater risk of missing their appointment. This information helps to identify patients at high risk of nonattendance and allows clinicians to plan schedules and appointments more efficiently.

Failure to keep appointments at a community health centre. Analysis of causes

The scheduled appointment system in primary care clinics became popular recently in Israel. Failed appointments created a problem for the doctors, patients and the clinic in Netivot. During 11 months, 2,317 appointments were surveyed. The survey showed 36% of failed appointments, with a decrease to 28% one year later. Rates of failed appointments were 38% for the paediatric population, 35% for adults, and 34% for pensioners. Market days and holidays predisposed to more failed appointments, representing community customs. The presence of a chronic disease that needed follow-up ensured a higher rate of attendance (76%), especially among the paediatric population (92% attendance rate). By contrast, a geriatric patient with an acute disease had difficulty attending the clinic (only 16% attending). 512 people (35% of the population) were responsible for the 827 failed appointments, and among them only 12% of the population accounted for 59% of the failed appointments. These findings have important implications in the planning of an appointment system in an urban health centre, and they strengthen the assumption that a small number of patients cause a large number of failed appointments.

Failure to keep appointments at a community health centre. Analysis of causes

The scheduled appointment system in primary care clinics became popular recently in Israel. Failed appointments created a problem for the doctors, patients and the clinic in Netivot. During 11 months, 2.317 appointments were surveyed. The survey showed 36% of failed appointments, with a decrease to 28% one year later. Rates of failed appointments were 38% for the paediatric population, 35% for adults, and 34% for pensioners. Market days and holidays predisposed to more failed appointments, representing community customs. The presence of a chronic disease that needed follow up ensured a higher rate of attendance (76%), especially among the paediatric population (92% attendance rate). By contrast, a geriatric patient with an acute disease had difficulty attending the clinic (only 16% attending). 512 people (35% of the population) were responsible for the 827 failed appointments, and among them only 12% of the population accounted for 59% of the failed appointments. These findings have important implications in the planning of an appointment system in an urban health centre, and they strengthen the assumption that a small number of patients cause a large number of failed appointments.

Evaluating the impact of a service fee on patient compliance

This paper addresses an evaluation of an administrative decision to change the manner in which services were paid for at a Student Health Center (SHC). The impact of the change in payment was observed through monitoring the number of scheduled appointments at the SHC which the patient failed to attend, reschedule, or cancel. The impact was assessed through a comparison of the weekly no-show rates from the year prior to the change in payment practices through the year following the change. A time-series statistical package was used to analyze the no-show data. Collateral measures on the number of students attending the university, staff opinions, and usage of the SHC by different student groups were collected. Evaluations of the impact of administrative decisions on health related behavior were discussed, in addition to a discussion of the usefulness of time-series models for this type of evaluation.

Experimental analysis of adherence counseling: implications for hypertension management

A time series "reversal" design demonstrated that behavioral counseling increased medication adherence from about 60 to 100% for a black, hypertensive patient. However, inadequate pharmacological treatment yielded no clinically important blood pressure decrease. The combination of improved compliance and minimal blood pressure reduction led the patient's physician to explore higher doses and alternate medications to achieve blood pressure control. The physician's aggressive medical treatment was initiated only after the patient's compliance had been improved. Thus, this study suggests that paraprofessional counseling can increase compliance and illustrates the need for both behavioral and physiological data in clinical management to avoid blaming patients for poorly controlled blood pressure.

Experiments to increase return in a medical screening drive: two futile attempts to apply theory to practice

Two experiments are reported which attempted to apply techniques derived from an extensive set of psychological theories and research to enhance return compliance in a tuberculosis detection drive. Experiment 1 manipulated four methods of providing return reminders (postcard, telephone call, direct person-to-person or take-home card) in combination with two types of authority sources (expert vs nonexpert). Experiment 2 manipulated types of patient commitment (verbal, verbal plus written or no commitment) and importance-or-returning message (enhanced vs standard) in combination with two types of return reminders (take-home card vs no reminder card). These theoretically-derived procedures failed to significantly enhance return compliance. The experiments are examined for procedural failures and the findings are discussed in terms of the limited applicability of some theoretical notions in health settings and particular populations. It is asserted that through such failures useful knowledge is gained for understanding the complex phenomenon of compliance.