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Does an encouraging letter encourage attendance at psychiatric out-patient clinics? The Leeds PROMPTS randomized study

  • J. Kitcheman (a1), C. E. Adams (a1) (a2), A. Pervaiz (a3), I. Kader (a4), D. Mohandas (a5) and G. Brookes (a6)
  • DOI:
  • Published online: 15 October 2007

The aim was to reduce non-attendance for first-time consultations at psychiatric out-patient clinics.


The study was a pragmatic randomized controlled trial; the setting was seven inner-city UK out-patient clinics in Leeds. The participants were 764 subjects of working age with an appointment to attend a psychiatric out-patient clinic for the first time. The intervention was an ‘orientation statement’ letter delivered 24–48 h before the first appointment compared with standard care. The primary outcome measure was attendance at the first appointment; secondary outcomes included hospitalization, transfer of care, continuing attendance, discharge, presentation at accident and emergency and death by 1 year.


Follow-up was for 763 out of 764 subjects (>99%) for primary and for 755 out of 764 subjects (98.8%) of secondary outcome data. The orientation statement significantly reduced the numbers of people failing to attend [79 out of 388 v. 101 out of 376 subjects, relative risk 0.76, 95% confidence interval (CI) 0.59–0.98, number needed to treat 16, 95% CI 10–187].


Prompting people to go to psychiatric out-patient clinics for the first time encourages them to attend. Pragmatic trials within a busy working environment are possible and informative.

Corresponding author
*Address for correspondence: Dr C. E. Adams, Associate Professor, Division of Psychiatry, University of Nottingham, Duncan MacMillan House, Portchester Road, Nottingham NG3 6AA, UK. (Email:
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MJ Commander , SP Dharan , SM Odell , PG Surtees (1997). Access to mental health care in an inner-city health district. I: Pathways into and within specialist psychiatric services. British Journal of Psychiatry 170, 312316.

W Hamilton , A Round , D Sharp (1999). Effect on hospital attendance rates of giving patients a copy of their referral letter: randomised controlled trial. British Medical Journal 318, 13921395.

M Hershorn (1993). The elusive population: characteristics of attenders versus non-attenders for community mental health center intakes. Community Mental Health Journal 29, 4957.

MP Kluger , A Karras (1983). Strategies for reducing missed initial appointments in a community mental health center. Community Mental Health Journal 19, 137143.

KJ McGlade , T Bradley , GJ Murphy , GP Lundy (1988). Referrals to hospital by general practitioners: a study of compliance and communication. British Medical Journal 297, 12461248.

E Rossi (1994). Effects of a simple strategy on attendance and satisfaction with medication clinic services in the chronically mentally ill. PhD dissertation, United States International University, USA.

JW Smoller , RY McLean , MW Otto , MH Pollak (1998). How do clinicians respond to patients who miss appointments? Journal of Clinical Psychiatry 59, 330338.

PR Stasiewicz , R Stalker (1999). A comparison of three ‘interventions’ on pretreatment dropout rates in an outpatient substance abuse clinic. Addictive Behaviour 24, 579582.

TR Swenson , G Pekarik (1988). Interventions for reducing missed initial appointments at a community mental health center. Community Mental Health Journal 24, 205218.

G Thornicroft , M Phelan , G Strathdee (1996). Needs assessment. In Mental Health Service Evaluation (ed. H. C. Knudsen and G. Thornicroft ), pp. 317338. Cambridge University Press: Cambridge.

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Psychological Medicine
  • ISSN: 0033-2917
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