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Effectiveness of reminders in reducing non-attendance among out-patients

  • Mahesh Rajasuriya (a1), Varuni de Silva (a2) and Raveen Hanwella (a2)
Abstract
Aims and method

Non-attendance rates in a psychiatric out-patient clinic and the effectiveness of telephone or postal reminders in reducing non-attendance were evaluated. All patients who did not attend the clinic for their second appointment within 2 weeks were contacted by telephone or letter. Patients who failed to attend the clinic 6 weeks after the reminder were classified as non-attendees.

Results

Rate of non-attendance before the intervention was 31.3% (n = 61/195). After the intervention this was reduced to 23.1%, a relative risk reduction of 26.2%. Being male, not being prescribed medicines, having a diagnosis of psychoactive substance use or dementia were risk factors for non-attendance (odds ratio, OR>1). Risk of non-attendance was low for bipolar disorder, schizophrenia and depressive disorder (OR <1).

Clinical implications

A simple low-cost intervention in the form of a reminder reduced non-attendance rates. Routine implementation of this intervention should be considered in all psychiatry out-patient services in low- and middle-income countries.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Varuni de Silva (varunidesilva2@yahoo.co.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
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Effectiveness of reminders in reducing non-attendance among out-patients

  • Mahesh Rajasuriya (a1), Varuni de Silva (a2) and Raveen Hanwella (a2)
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eLetters

Can we infer that reminders are effective in reducing non-attendance?

MOHINDER KAPOOR, Specialty Registrar (ST5) in Old Age Psychaitry
10 January 2011

Rajasuriya et al highlight an important issue of non-attendance amongoutpatients and how to deal with this effectively.1

Their results show a reduction in non-attendance rates after using reminders in the form of letters and telephone calls. Their study identified several risk factors for non-attendance. However, they have overlooked so many other factors that might increase non-attendance rates.They have mentioned some of the factors like affordability, patient’s level of education and so on that can be responsible for non-attendance. The one big and important factor that they have failed to mention is the possibility of patients being admitted to hospital for either physical or mental health concerns. This could have led them to miss their outpatient appointments.

Another important aspect that they have mentioned is in relation to healthcare services in Sri Lanka. These are not based on geographically designated catchment areas. Therefore individuals can access the clinic oftheir choice in any part of the country. This means that some of the non-attendees might have attended another service. Unless we have more information in relation to this it would be difficult to make judgement about risk factors (male gender, substance use, bipolar disorder, schizophrenia, etc) of non-attendance with any certainty (increased or decreased risk) and the real impact of reminders. It is quite possible that people might have shopped around for doctors and were planning to attend their next appointment anyway (with or without reminders).

In order to evaluate the effectiveness of reminders in reducing non-attendance the design of the study should have been that of an intervention study i.e. randomising non-attendees to an intervention (reminders) and control (no reminders) group. This is the only way of dealing with so many characteristics or risk factors mentioned in the study. This is important because all baseline characteristics that affect risk of non- attendance and differ between the treatment groups could potentially confound the relationship between reminders and non-attendance. Also it takes care of unknown confounding factors that are notidentifiable, and these factors are distributed equally among treatment groups. Thus, randomisation can provide a degree of assurance about the comparability of the study groups that is simply not possible in any observational study design.2 I give credit to authors for mentioning the need of randomisation under the limitations of their study. I still feel that it is very difficult to draw any meaningful inferences from this study due to the drawbacks associated with the design of the study.

Declaration of interest: None

References:

1.Rajasuriya M et al. Effectiveness of reminders in reducing non-attendance among out-patients. Psychiatrist 2010; 34: 515-518.

2.Hennekens CH, Burning JE et al. Epidemiology in Medicine. Little, Brown and Company Boston/Toronto, 1987.
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Conflict of interest: None Declared

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