No-show rates lowest when patients called by human being

A recent study suggests that patients may be more likely to show up for their appointments if they get a telephone call from the office -- a call from an actual person, not a machine.

"Connecting to a live person, they may feel more of a responsibility to show up," said Amay Parikh, MD, a fellow at Columbia University's College of Physicians and Surgeons in New York.

Dr. Parikh was the lead author on a study in the June American Journal of Medicine on the subject. For three months in 2007, he and fellow researchers tracked no-shows at Robert Wood Johnson University Medical Group, an outpatient multispecialty clinic, which has several locations in New Jersey. Dr. Parikh was a resident there at the time.

Approximately 23.1% of patients who received no reminder call missed their appointments. The number went down to 17.3% if patients were contacted by the HouseCalls automated appointment reminder system offered by TeleVox Software Inc. in Mobile, Ala., the system used for the study. But the no-show figure went down further to almost 13.6% if an actual staff member made the call.

Patients were not asked their reminder preference but were randomized to one of the three groups.

Experts said that the study does not prove that one way of reminding patients is necessarily better than others in every situation, and those that are automated may have other advantages.

Practice managers say busy medical offices frequently have a hard time fitting in these calls, which means that sometimes they don't happen at all, although the study did find that they were important. Of those who received a call from a staff member, 78% said it helped them keep their appointments. This was true for 72% of those who received the call from the automated system.

"The biggest advantage of the automated system is that calls always get done," said Rosemarie Nelson, a principal consultant with the Medical Group Management Assn. "Sometimes a day can get so hectic that staff don't get all the calls made."

There also is the question of the cost effectiveness of no-show prevention strategies. The price of automated communication services varies. HouseCalls, the system in the study, is offered by subscription. Each transaction costs an average of 20 cents. In the study, automated reminders had less of an impact on the no-show rate, but having staff members make these calls tended to be more expensive. More studies are planned to explore the question further.

Those who work on the issue also wonder how other factors such as age or socioeconomic status may affect how patients respond to various appointment reminders. For instance, Tamarah Duperval, MD, MPH, a family physician at the Mile Square Health Center in Chicago, prefers to receive automated calls from her own physician. But she has not found the strategy successful with her patient population, which tends to be poor.

"They don't want to pay for cell phone minutes and use them up on calls from an automated system," Dr. Duperval said. "They definitely want a human touch." She is also a board member of the Illinois Academy of Family Physicians, although she was speaking personally.

Officials with TeleVox, said they have collected numerous case reports of institutions reducing no-shows significantly and increasing revenue with their service. But they added that it is important to allow patients to choose how they want to be reminded. Some may better respond to text messages or e-mail, or want frequent phone calls. Others may need just one.

"Allowing patients to choose their communication preferences goes a long way toward providing a personal touch to each and every patient, in turn creating a stronger connection with the office," said Scott Zimmerman, TeleVox's president.

E-mail and text message reminders were not part of the study.