The Effectiveness of Outpatient Appointment Reminder Systems in Reducing No-Show Rates



      Patients who do not keep physician appointments (no-shows) represent a significant loss to healthcare providers. For patients, the cost includes their dissatisfaction and reduced quality of care. An automated telephone appointment reminder system may decrease the no-show rate. Understanding characteristics of patients who miss their appointments will aid in the formulation of interventions to reduce no-show rates.


      In an academic outpatient practice, we studied patient acceptance and no-show rates among patients receiving a clinic staff reminder (STAFF), an automated appointment reminder (AUTO), and no reminder (NONE). Patients scheduled for appointments in the spring of 2007 were assigned randomly to 1 of 3 groups: STAFF (n=3266), AUTO (n=3219), or NONE (n=3350). Patients in the STAFF group were called 3 days in advance by front desk personnel. Patients in the AUTO group were reminded of their appointments 3 days in advance by an automated, standardized message. To evaluate patient satisfaction with the STAFF and AUTO, we surveyed patients who arrived at the clinic (n=10,546).


      The no-show rates for patients in the STAFF, AUTO, and NONE groups were 13.6%, 17.3%, and 23.1%, respectively (pairwise, P<.01 by analysis of variance for all comparisons). Cancellation rates in the AUTO and STAFF groups were significantly higher than in the NONE group (P<.004). Appointment reminder group, age, visit type, wait time, division specialty, and insurance type were significant predictors of no-show rates. Patients found appointment reminders helpful, but they could not accurately remember whether they received a clinic staff reminder or an automated appointment reminder.


      A clinic staff reminder was significantly more effective in lowering the no-show rate compared with an automated appointment reminder system.


      To read this article in full you will need to make a payment


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Anonymous
        New statistics on outpatients' care confirm millions of missed appointments.
        New J (Inst Health Rec Inf Manag). 2006; 47: 17
        • Capko J.
        • Capko J.
        The price you pay for missed appointments.
        J Med Pract Manage. 2007; 22: 368
        • Husain-Gambles M.
        • Neal R.D.
        • Dempsey O.
        • et al.
        Missed appointments in primary care: questionnaire and focus group study of health professionals. [see comment].
        Br J Gen Pract. 2004; 54: 108-113
        • Reekie D.
        • Devlin H.
        Preventing failed appointments in general dental practice: a comparison of reminder methods.
        Br Dent J. 1998; 185: 472-474
        • Shepard D.S.
        • Moseley 3rd, T.A.
        Mailed versus telephoned appointment reminders to reduce broken appointments in a hospital outpatient department.
        Med Care. 1976; 14: 268-273
        • Hashim M.J.
        • Franks P.
        • Fiscella K.
        Effectiveness of telephone reminders in improving rate of appointments kept at an outpatient clinic: a randomized controlled trial.
        J Am Board Fam Pract. 2001; 14: 193-196
        • Alemi F.
        • Alemagno S.A.
        • Goldhagen J.
        • et al.
        Computer reminders improve on-time immunization rates.
        Med Care. 1996; 34: OS45-OS51
        • Irigoyen M.M.
        • Findley S.
        • Earle B.
        • et al.
        Impact of appointment reminders on vaccination coverage at an urban clinic.
        Pediatrics. 2000; 106: 919-923
        • Lambert T.
        ([Webpage]) TeleVox Software, Inc, Mobile, AL2008 ([cited 2008]) (Accessed January 22, 2008)
        • Macharia W.M.
        • Leon G.
        • Rowe B.H.
        • et al.
        An overview of interventions to improve compliance with appointment keeping for medical services.
        JAMA. 1992; 267: 1813-1817
        • Lehmann T.N.O.
        • Aebi A.
        • Lehmann D.
        • et al.
        Missed appointments at a Swiss university outpatient clinic.
        Public Health. 2007; 121: 790-799
        • Goldman L.
        • Freidin R.
        • Cook E.F.
        • et al.
        A multivariate approach to the prediction of no-show behavior in a primary care center.
        Arch Intern Med. 1982; 142 (537): 563
        • Neal R.D.
        • Lawlor D.A.
        • Allgar V.
        • et al.
        Missed appointments in general practice: retrospective data analysis from four practices. [see comment].
        Br J Gen Pract. 2001; 51: 830-832
        • Barron W.M.
        Failed appointments.
        Prim Care. 1980; 7: 563-574
        • Yehia B.R.
        • Gebo K.A.
        • Hicks P.B.
        • et al.
        Structures of care in the clinics of the HIV Research Network.
        AIDS Patient Care STDS. 2008; 22: 1007-1013
        • Lacy N.L.
        • Paulman A.
        • Reuter M.D.
        • et al.
        Why we don't come: patient perceptions on no-shows.
        Ann Fam Med. 2004; 2: 541-545
        • Oppenheim G.L.
        • Bergman J.J.
        • English E.C.
        Failed appointments: a review.
        J Fam Pract. 1979; 8: 789-796
        • O'Connor M.E.
        • Matthews B.S.
        • Gao D.
        • et al.
        Effect of open access scheduling on missed appointments, immunizations, and continuity of care for infant well-child care visits.
        Arch Pediatr Adolesc Med. 2006; 160: 889-893
        • Kopach R.
        • DeLaurentis P.C.
        • Lawley M.
        • et al.
        Effects of clinical characteristics on successful open access scheduling.
        Health Care Manag Sci. 2007; 10: 111-124
        • Murray M.
        • Berwick D.M.
        Advanced access: reducing waiting and delays in primary care.
        JAMA. 2003; 289: 1035-1040