Purpose: Between 23% and 34% of outpatient appointments are missed annually. Patients who frequently miss medical appointments have poorer health outcomes and are less likely to use preventive health care services. Missed appointments result in unnecessary costs and organizational inefficiencies. Appointment reminders may help reduce missed appointments; particular types may be more effective than other types. We used a survey with a discrete choice experiment (DCE) to learn why individuals miss appointments and to assess appointment reminder preferences.
Methods: We enrolled a national sample of adults from an online survey panel to complete demographic and appointment habit questions as well as a 16-task DCE designed in Sawtooth Software's Discover tool. We assessed preferences for four reminder attributes - initial reminder type, arrival of initial reminder, reminder content, and number of reminders. We derived utilities and importance scores.
Results: We surveyed 251 adults nationally, with a mean age of 43 (range 18-83) years: 51% female, 84% White, and 8% African American. Twenty-three percent of individuals missed one or more appointments in the past 12 months. Two primary reasons given for missing an appointment include transportation problems (28%) and forgetfulness (26%). Participants indicated the initial reminder type (21%) was the most important attribute, followed by the number of reminders (10%). Overall, individuals indicated a preference for a single reminder, arriving via email, phone call, or text message, delivered less than 2 weeks prior to an appointment. Preferences for reminder content were less clear.
Conclusion: The number of missed appointments and reasons for missing appointments are consistent with prior research. Patient-centered appointment reminders may improve appointment attendance by addressing some of the reasons individuals report missing appointments and by meeting patients' needs. Future research is necessary to determine if preferred reminders used in practice will result in improved appointment attendance in clinical settings.
Keywords: DNAs; appointment attendance; conjoint analysis; discrete choice experiment; no-show rates; preferences; reminders; survey; text messaging.