Appointment reminder systems and patient preferences: Patient technology usage and familiarity with other service providers as predictive variables

General practice preconception care invitations: a qualitative study of women's acceptability and preferences

BACKGROUND

In general practice, primary care providers can potentially use electronic medical records (EMRs) to identify and invite reproductive-aged women with preconception health risk factors to increase their engagement in preconception care (PCC). However, the acceptability of receiving PCC invitations and women's preferences about the invitation process are poorly understood. This study aims to investigate women's acceptability and preferences for receiving PCC invitations from general practice settings.

METHODS

Participants were recruited via convenience, purposive and snowball sampling. Semi-structured interviews were conducted via Zoom from August until November 2023. Interviews were transcribed verbatim and inductive reflexive thematic analysis was undertaken.

RESULTS

PCC invitations sent from general practice are acceptable if the language is sensitive and non-stigmatising. Text or email invitations detailing the importance and scope of the PCC consultation were preferred, after discussing reproductive intentions with a general practitioner or practice nurse. Women with preconception health risk factors or those actively trying to conceive were more likely to engage in PCC. Key strategies to enhance PCC engagement include advertising in waiting rooms, introducing PCC in new patient registration forms, and integrating PCC into holistic care.

CONCLUSION

Using EMRs to identify and invite women with preconception health risk factors to increase their engagement in PCC is generally acceptable. Invitations sent via text messages or emails are preferred. It is crucial to use respectful and appropriate language to avoid stigmatising or offending women, particularly those with infertility issues, those who have completed their families, or those who do not wish to have children.

Consumer Preferences for a Healthcare Appointment Reminder in Australia: A Discrete Choice Experiment

BACKGROUND

It is essential to consider the evidence of consumer preferences and their specific needs when determining which strategies to use to improve patient attendance at scheduled healthcare appointments.

OBJECTIVES

This study aimed to identify key attributes and elicit healthcare consumer preferences for a healthcare appointment reminder system.

METHODS

A discrete choice experiment was conducted in a general Australian population sample. The respondents were asked to choose between three options: their preferred reminder (A or B) or a 'neither' option. Attributes were developed through a literature review and an expert panel discussion. Reminder options were defined by four attributes: modality, timing, content and interactivity. Multinomial logit and mixed multinomial logit models were estimated to approximate individual preferences for these attributes. A scenario analysis was performed to estimate the likelihood of choosing different reminder systems.

RESULTS

Respondents (n = 361) indicated a significant preference for an appointment reminder to be delivered via a text message (β = 2.42, p < 0.001) less than 3 days before the appointment (β = 0.99, p < 0.001), with basic details including the appointment cost (β = 0.13, p < 0.10), and where there is the ability to cancel or modify the appointment (β = 1.36, p < 0.001). A scenario analysis showed that the likelihood of choosing an appointment reminder system with these characteristics would be 97%.

CONCLUSIONS

Our findings provide evidence on how healthcare consumers trade-off between different characteristics of reminder systems, which may be valuable to inform current or future systems. Future studies may focus on exploring the effectiveness of using patient-preferred reminders alongside other mitigation strategies used by providers.

Understanding barriers of receiving short message service appointment reminders across African regions: a systematic review

OBJECTIVE

Patients frequently miss their medical appointments. Therefore, short message service (SMS) has been used as a strategy for medical and healthcare service appointment reminders. This systematic review aimed to identify barriers to SMS appointment reminders across African regions.

METHODS

PubMed, Google Scholar, Semantic Scholar and Web of Science were used for searching, and hand searching was done. Original studies written in English, conducted in Africa, and published since 1 December 2018, were included. The standard quality assessment checklist was used for the quality appraisal of the included studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart diagram was used for study selection and screening, and any disagreements were resolved via discussions.

RESULTS

A total of 955 articles were searched, 521 studies were removed due to duplication and 105 studies were assessed for eligibility. Consequently, nine studies met the inclusion criteria. Five out of nine included studies were done by randomised control trials. The barriers that hampered patients, mothers and other parental figures of children when they were notified via SMS of medical and health services were identified. Among the 11 identified barriers, illiteracy, issues of confidentiality, familiarised text messages, inadequate information communication technology infrastructure, being a rural resident and loss of mobile phones occurred in at least two studies.

CONCLUSIONS

SMS is an effective and widely accepted appointment reminder tool. However, it is hampered by numerous barriers. Hence, we gathered summarised information about users' barriers to SMS-based appointment reminders. Therefore, stakeholders should address existing identified barriers for better Mhealth interventions.

PROSPERO REGISTRATION NUMBER

CRD42022296559.

Prevalence and factors associated with missed hospital appointments: a retrospective review of multiple clinics at Royal Hospital, Sultanate of Oman

OBJECTIVES

Missed hospital appointments pose a major challenge for healthcare systems. There is a lack of information about drivers of missed hospital appointments in non-Western countries and extent of variability between different types of clinics. The aim was to evaluate the rate and predictors of missed hospital appointments and variability in drivers between multiple outpatient clinics.

SETTING

Outpatient clinics in the Royal hospital (tertiary referral hospital in Oman) between 2014 and 2018.

PARTICIPANTS

All patients with a scheduled outpatient clinic appointment (N=7 69 118).

STUDY DESIGN

Retrospective cross-sectional analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

A missed appointment was defined as a patient who did not show up for the scheduled hospital appointment without notifying or asking for the appointment to be cancelled or rescheduled. The outcomes were the rate and predictors of missed hospital appointments overall and variations by clinic. Conditional logistic regression compared patients who attended and those who missed their appointment.

RESULTS

The overall rate of missed hospital appointments was 22.3%, which varied between clinics (14.0% for Oncology and 30.3% for Urology). Important predictors were age, sex, service costs, patient's residence distance from hospital, waiting time and appointment day and season. Substantive variability between clinics in ORs for a missed appointment was present for predictors such as service costs and waiting time. Patients aged 81-90 in the Diabetes and Endocrine clinic had an adjusted OR of 0.53 for missed appointments (95% CI 0.37 to 0.74) while those in Obstetrics and Gynaecology had OR of 1.70 (95% CI 1.11 to 2.59). Adjusted ORs for longer waiting times (>120 days) were 2.22 (95% CI 2.10 to 2.34) in Urology but 1.26 (95% CI 1.18 to 1.36) in Oncology.

CONCLUSION

Predictors of a missed appointment varied between clinics in their effects. Interventions to reduce the rate of missed appointments should consider these factors and be tailored to clinic.

Dental School Patient Preferences for Receiving and Returning Patient Satisfaction Surveys

The aims of this study were to investigate dental school patient, parent, and caregiver preferences for receiving and returning patient satisfaction surveys and to determine how modes of receiving and returning surveys impacted return rates. Two studies were conducted, both of which are reported. In Study 1, adult patients, parents of child patients, and caregivers of patients with special needs were asked to indicate their preferred mode of receiving and returning surveys. In Study 2, patients, parents, and caregivers were randomly assigned to different modes of receiving and returning surveys, and return rates were compared between modes and according to whether the individuals had been assigned to their preferred mode or not. The overall response rates were 90.4% for the first study and 48.1% for the second study. In both studies, the preferred mode was receiving and returning the survey in the clinic (chi-square=84.902 and 32.116; df=3; p<0.001). Younger respondents were more likely to prefer receiving and returning the survey by email (K-W statistics=13.406, 10.241; df=3; p=0.004 and 0.017). In Study 2, respondents were significantly more likely to return surveys in the clinic (chi-square=44.994; df=2; p<0.001) and were also significantly more likely to return surveys if they had received them in their preferred mode (binomial test p<0.001). Although receiving and returning the survey in the clinic was the preferred mode, these respondents' preferences were also related to their age. These results suggest that dental school clinics may be able to expect higher return rates if they can follow patients' preferences for receipt and delivery of surveys.

Measuring the effectiveness of patient-chosen reminder methods in a private orthodontic practice

OBJECTIVE

To evaluate the effectiveness of patient-chosen appointment reminder methods (phone call, e-mail, or SMS text) in reducing no-show rates.

MATERIALS AND METHODS

This was a retrospective case study that determined the correlation between patient-chosen appointment reminder methods and no-show rates in a private orthodontic practice. This study was conducted in a single office location of a multioffice private orthodontic practice using data gathered in 2015. The subjects were patients who self-selected the appointment reminder method (phone call, e-mail, or SMS text). Patient appointment data were collected over a 6-month period. Patient attendance was analyzed with descriptive statistics to determine any significant differences among patient-chosen reminder methods.

RESULTS

There was a total of 1193 appointments with an average no-show rate of 2.43% across the three reminder methods. No statistically significant differences ( P = .569) were observed in the no-show rates between the three methods: phone call (3.49%), e-mail (2.68%), and SMS text (1.90%).

CONCLUSIONS

The electronic appointment reminder methods (SMS text and e-mail) had lower no-show rates compared with the phone call method, with SMS text having the lowest no-show rate of 1.90%. However, since no significant differences were observed between the three patient-chosen reminder methods, providers may want to allow patients to choose their reminder method to decrease no-shows.

"I'm Just Forgetting and I Don't Know Why": Exploring How People Living With HIV-Associated Neurocognitive Disorder View, Manage, and Obtain Support for Their Cognitive Difficulties

HIV-associated neurocognitive disorder (HAND) is common, but the lived experience of HAND is not well-understood. In this descriptive qualitative study, we explored how adults with HAND view, manage, and obtain support for cognitive difficulties. We interviewed 25 participants (20% female; median age = 51 years) who were diagnosed with HAND using neuropsychological assessment and a clinical interview. Semistructured interviews, co-developed with community members living with HIV, focused on how cognitive difficulties manifested and progressed, impacted well-being, and were discussed with others. We analyzed interview transcripts using a team-based, thematic approach. Participants described concentration, memory, and multitasking difficulties that fluctuated over time, as well as potential risk factors, management strategies, and psychosocial consequences. They reported they seldom discussed cognitive impairment with health care professionals, and that receiving a HAND diagnosis was validating, informative, yet somewhat disconcerting. Conversations between health care professionals and people living with HIV about HAND may provide opportunities for education, assessment, and support.

When open access might not work: Understanding patient attitudes in appointment scheduling

BACKGROUND

Open-access (OA) systems aim to reduce delays to care. However, recent evidence suggests that OA systems might reduce patient satisfaction and result in poorer patient experiences due to patients' inability to obtain appointments with their usual care provider. We conducted a series of experiments to explore the role of risk attitudes, an individual difference variable that measures preferences for risky options, in patients' perception of OA systems.

PURPOSE

The aim of the study was to investigate the relationship between patient's risk attitudes and attitudes toward OA systems and demonstrate whether patients' attitudes toward OA systems will vary as a function of their risk attitudes.

METHODOLOGY

Three separate experiments were conducted to assess the relationship between patient risk attitudes and their attitudes about OA systems. Study 1 (patient population) explored the aforementioned relationship. We explored two potential moderators for this effect: how salient the tradeoff is between delays to care and quality of care (Study 2; online population) and the severity of the patient's health condition (Study 3; patient population).

RESULTS

Compared to risk-averse patients, risk-seeking patients have more favorable attitudes toward OA systems (a 1-point increase in risk attitudes on a 7-point scale resulted in a 0.44-point boost in attitudes toward OA systems on a 7-point scale). This relationship holds even when the tradeoff between access to care and quality of care is made salient (e.g., a practice informs patients they can have a same-day appointment but are unlikely to see their regular provider) and when people consider having a minor health condition. This relationship is attenuated when patients imagine having a serious medical condition because speedy access to care becomes a top priority.

CONCLUSION

Risk-seeking patients have more favorable attitudes toward OA systems.

PRACTICE IMPLICATIONS

Risk-seeking patients are primarily driven by speed to access at the potential expense of continuity of care. Organizations that better understand patient motives in scheduling medical appointments can introduce more effective interventions and positively impact patient experiences of care.

Getting patients in the door: medical appointment reminder preferences

PURPOSE

Between 23% and 34% of outpatient appointments are missed annually. Patients who frequently miss medical appointments have poorer health outcomes and are less likely to use preventive health care services. Missed appointments result in unnecessary costs and organizational inefficiencies. Appointment reminders may help reduce missed appointments; particular types may be more effective than other types. We used a survey with a discrete choice experiment (DCE) to learn why individuals miss appointments and to assess appointment reminder preferences.

METHODS

We enrolled a national sample of adults from an online survey panel to complete demographic and appointment habit questions as well as a 16-task DCE designed in Sawtooth Software's Discover tool. We assessed preferences for four reminder attributes - initial reminder type, arrival of initial reminder, reminder content, and number of reminders. We derived utilities and importance scores.

RESULTS

We surveyed 251 adults nationally, with a mean age of 43 (range 18-83) years: 51% female, 84% White, and 8% African American. Twenty-three percent of individuals missed one or more appointments in the past 12 months. Two primary reasons given for missing an appointment include transportation problems (28%) and forgetfulness (26%). Participants indicated the initial reminder type (21%) was the most important attribute, followed by the number of reminders (10%). Overall, individuals indicated a preference for a single reminder, arriving via email, phone call, or text message, delivered less than 2 weeks prior to an appointment. Preferences for reminder content were less clear.

CONCLUSION

The number of missed appointments and reasons for missing appointments are consistent with prior research. Patient-centered appointment reminders may improve appointment attendance by addressing some of the reasons individuals report missing appointments and by meeting patients' needs. Future research is necessary to determine if preferred reminders used in practice will result in improved appointment attendance in clinical settings.

Patients' Online Access to Their Primary Care Electronic Health Records and Linked Online Services: Implications for Research and Practice

Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1) Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2) Whether online access to records improves patient safety and health outcomes; (3) Whether record access increases disparities across social classes and between genders; and (4) Improving efficiency. The challenges for practice are: (1) How to incorporate online access into clinical workflow; (2) The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems.

Crafting Appealing Text Messages to Encourage Colorectal Cancer Screening Test Completion: A Qualitative Study

Background

mHealth interventions that incorporate text messages have great potential to increase receipt of preventive health services such as colorectal cancer screening. However, little is known about older adult perspectives regarding the receipt of text messages from their health care providers.

Objective

To assess whether older adults would value and access text messages from their physician’s practice regarding colorectal cancer screening.

Methods

We conducted four focus groups with 26 adults, aged 50 to 75 years, who had either recently completed or were overdue for colorectal cancer screening. A trained moderator followed a semistructured interview guide covering participant knowledge and attitudes regarding colorectal cancer screening, potential barriers to colorectal cancer screening, attitudes about receiving electronic communications from a doctor’s office, and reactions to sample text messages.

Results

Participant responses to three primary research questions were examined: (1) facilitators and barriers to colorectal cancer screening, (2) attitudes toward receiving text messages from providers, and (3) characteristics of appealing text messages. Two themes related to facilitators of colorectal cancer screening were perceived benefits/need and family experiences and encouragement. Themes related to barriers included unpleasantness, discomfort, knowledge gaps, fear of complications, and system factors. Four themes emerged regarding receipt of text messages from health care providers: (1) comfort and familiarity with technology, (2) privacy concerns/potential for errors, (3) impact on patient-provider relationship, and (4) perceived helpfulness. Many participants expressed initial reluctance to receiving text messages but responded favorably when shown sample messages. Participants preferred messages that contained content that was important to them and were positive and reassuring, personalized, and friendly to novice texters (eg, avoided the use of texting shorthand phrases and complicated replies); they did not want messages that contain bad news or test results. They wanted the ability to choose alternative options such as email or phone calls.

Conclusions

Older adults are receptive to receiving cancer screening text messages from health care providers. Sharing sample messages with patients may increase acceptance of this tool in the clinic setting. Supportive tailored text messaging reminders could enhance uptake of colorectal cancer screening by enhancing patient self-efficacy and providing cues to action to complete colonoscopy or fecal occult blood testing.

The Prevalence and Characteristics of Emergency Medicine Patient Use of New Media

Background

Little is known about “new media” use, defined as media content created or consumed on demand on an electronic device, by patients in emergency department (ED) settings. The application of this technology has the potential to enhance health care beyond the index visit.

Objective

The objectives are to determine the prevalence and characteristics of ED patients’ use of new media and to then define and identify the potential of new media to transcend health care barriers and improve the public’s health.

Methods

Face-to-face, cross-sectional surveys in Spanish and English were given to 5,994 patients who were sequentially enrolled from July 12 to August 30, 2012. Data were collected from across a Southern Connecticut health care system’s 3 high-volume EDs for 24 hours a day, 7 days a week for 6 weeks. The EDs were part of an urban academic teaching hospital, an urban community hospital, and an academic affiliate hospital.

Results

A total of 5,994 (89% response rate) ED patients reported identical ownership of cell phones (85%, P<.001) and smartphones (51%, P<.001) that were used for calling (99%, P<.001). The older the patient, however, the less likely it was that the patient used the phone for texting (96% vs 16%, P<.001). Income was positively associated with smartphone ownership (P<.001) and the use of health apps (P>.05) and personal health records (P<.001). Ownership of iPhones compared to Android phones were similar (44% vs 45%, P<.05). Race and ethnicity played a significant role in texting and smartphone ownership, with Hispanics reporting the highest rates of 79% and 56%, respectively, followed by black non-Hispanics at 77% and 54%, respectively, and white non-Hispanics at 65% and 42%, respectively (P<.05).

Conclusions

There is a critical mass of ED patients who use new media. Older persons are less comfortable texting and using smartphone apps. Income status has a positive relationship with smartphone ownership and use of smartphone apps. Regardless of income, however, texting and ownership of smartphones was highest for Latinos and black non-Latinos. These findings have implications for expanding health care beyond the ED visit through the use of cell phones, smartphones, texting, the Internet, and health care apps to improve the health of the public.