Reducing non‐attendance at specialist clinics: an evaluation of the effectiveness and cost of patient‐focussed booking and SMS reminders at a Scottish health board

The aim of the paper is to test the effectiveness of patient‐focussed booking and last minute reminders using short message service (SMS) messages to reduce non‐attendance at consultant outpatient clinics, and to estimate their cost to the service provider per non‐attendance [did not attend (DNA)] avoided. Non‐attendance is modelled in terms of patient‐focussed booking, reminders and a variety of control variables on new and return appointments at one health board in Scotland over a 14‐month period. Patient‐focussed booking and last minute reminders reduced non‐attendance. We find patient‐focussed booking demonstrated the importance of booking appointments no more than 6 weeks in advance, and would incur recurrent costs of £6 ($9.15, €6.73) compared with the status quo , assuming the DNA rate with neither initiative were 10%. Requiring patients also to opt in would cost an additional £200 ($305, €224). Coverage in terms of SMS reminders was limited both in respect to contact details and spread of cellphone ownership, but incurs no recurrent costs when the in‐house network, NHSmail, is used. Interactive voice response is an alternative to SMS reminders: it could achieve wide coverage, but at a cost of £5.50 ($8.39, €6.17) per DNA avoided. We conclude that SMS reminders and booking appointments no more than 6 weeks in advance can be effective and low‐cost ways to reduce non‐attendance. It is questionable whether patients should be required to opt in, unless this is by far the best way to obtain cellphone contact details. Otherwise. interactive voice response might be considered as the preferred method to send last minute reminders.