Abstract
We read with interest the recent report by Farmer et al. 1 on using text reminders to reduce non-attendance (DNA) rates in sexual health (SH) and HIV clinic appointments.
In our service, the Archway Centre, a Sexual Health Clinic in North London, UK, routine SH appointments are bookable but despite being mostly compliant with 48 h access, our DNA rate averaged 21% in 2012. We reviewed the impact of 24 h and 48 h text reminders on DNA, cancelled and rescheduled appointments. The appointment outcomes were compared in three-month periods during 2013 with respective periods in 2012 with no text reminder. Statistical significance was determined using chi-square test.
In 2012, 18,413 patients attended, of which 15% booked less than 24 h in advance (DNA 5%), 44% between 24 and 48 h (DNA 22%) and 41% more than 48 h (DNA 26%) beforehand. There was non-significant variation in DNA rates by calendar month. During the period of 24 h text reminders in 2013, 85% of 4914 patients attended, booked more than 24 h in advance. DNA rates fell from 22% to 19% (p < 0.005) overall, and by 3% (p < 0.05) and 2% (p < 0.05) for females and males, respectively.
During the period of 48 h text reminder, 36% of 4521 patients attended, booked more than 48 h in advance. In comparison to the Patrick Clements Clinic (PCC) where 85% of appointments are unbooked walk-in appointments, walk-in appointments at our centre are in addition to our majority booked appointments. This is reflected in the total number of patients analysed by Farmer et al. compared to our analysis (984 in 2009 compared to 4521 over a three-month period in 2013, respectively). Our DNA rates fell by 4% from 22% to 18% (p < 0.005) and by 4% (p < 0.05) and 5% (p < 0.05) for females and males, respectively, compared to 4% (not significant) and 10% (p < 0.02) for females and males, respectively, at the PCC. Overall, our data show 24 h and 48 h text reminders resulted in a statistically significant reduction in DNA rates overall and for both females and males with a higher impact of 48 h reminders.
Forty-eight hours texts resulted in cancellation rates falling by 1% (7% to 6%, p < 0.05) unlike 24 h texts which showed no change (6%, p = 0.2344). Gender analysis showed a statistical significance with females, with cancellation rates falling by 1% and 2% for 24 h and 48 h texts, respectively (p < 0.05). The analysis at the PCC showed the opposite. Interestingly, both text reminders resulted in more appointments being rescheduled (p < 0.05), with a statistically significant impact on females only.
Further analysis to determine the timing of booking showed 15% booked less than 24 h, 44% within 24–48 h and 41% more than 48 h, in advance. Given that the majority of patients are booking less than 48 h, 24 h and 48 h reminders still significantly reduced DNA rates.
Patient feedback proved acceptability: 93% found it useful, 97% felt it was appropriate and 95% wanted to continue receiving reminders.
Text reminders are an acceptable, easy and cost-effective strategy to increase capacity, especially given NHS targets. Given the findings of our data, we have since successfully implemented 48 h text reminders to all patients who are informed when booking their appointments, with the option to opt-out.