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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)...

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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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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