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Reminders for Health Maintenance Visits
Does some form of reminder increase the likelihood that a patient will go to their scheduled health maintenance appointment and/or their appointment for 1 or more preventive services such as immunization or cancer screening?
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The most common appointment reminders are mailed notices and telephone calls.1 Studies have shown that computer-generated telephone calls increased visits substantially for routine checkups at public health clinics2 and childhood immunization visits.3 A regular telephone call 1 day prior to a scheduled visit increased attendance by 15% in an adolescent clinic.4 Similarly, mailed reminders for breast and/or cervical cancer screening have been shown to have anywhere from no effect to as much as a 50% greater likelihood of obtaining the recommended screening.5-9 One study compared patient-specific letter reminders with postcards and found no notable difference between them. However, both mailed reminders resulted in significantly higher attendance at well-child examinations than the group receiving no reminders.10 Alternatively, 2 studies to improve adult immunization have shown that adding a targeted educational message significantly increased the effect of the mailed appointment reminder.11-12 One study that examined the effect alone and in combination with automated telephone messages and letter reminders found that a letter followed by a telephone message was significantly better than either alone and resulted in 58% of underimmunized children getting an immunization compared with 36% of a comparison group receiving no reminders.13
In conclusion, reminders, whether by mail or telephone, have a modest effect on increasing health maintenance visits and the provision of preventive services.
Stuart J. Cohen, EdD;
William P. Moran, MD, MS;
James L. Wofford, MD, MS;
John S. Preisser, PhD
Winston-Salem, NC
1. Cohen SJ, Moran WP, Wofford JL, Prisser JS. Physician and patient predictors of health maintenance vistis. Arch Fam Med. 1998;7:346-351.
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2. Dini EF, Linkins RW, Chaney M. Effectiveness of computer-generated telephone messages in increasing clinic visits. Arch Pediatr Adolesc Med. 1995;149:902-905.
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3. Linkins RW, Dini EF, Watson G, Patriarca PA. A randomized trial of the effectiveness of computer-generated telephone messages in increasing immunization visits among preschool children. Arch Pediatr Adolesc Med. 1994;148:908-914.
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4. O'Brien G, Lazebnik R. Telephone call reminders and attendance in an adolescent clinic. Pediatrics. 1998;101:E6.
5. Burack RC, Gmotty PA, McBride GJ, et al. How reminders given to patients and physician affected Pap smear use in a health maintenance organization: results of a randomized controlled trial. Cancer. 1998;82:2391-2400.
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6. O'Connor AM, Griffiths CJ, Underwood MR, Eldridge S. Can postal prompts from general practitioners improve the uptake of breast screening? a randomized controlled trial in one east London general practice. J Med Screen. 1998;5:49-52.
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7. Margolis KL, Menart TC. A test of two interventions to improve compliance with scheduled mammography appointments. J Gen Intern Med. 1996;11:539-541.
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8. Wagner TH. The effectiveness of mailed patient reminders on mammography screening: a meta-analysis. Am J Prev Med. 1998;14:64-70.
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9. Somkin CP, Hiatt RA, Hurley LB, Gruskin E, Ackerson L, Larson P. The effect of patient and provider reminders on mammography and Papanicolaou smear screening in a large health maintenance organization. Arch Intern Med. 1997;157:1658-1664.
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10. Campbell JR, Szilagyi PG, Rodewald LE, Doane C, Roghmann KJ. Patient-specific reminder letters and pediatric well-child-care show rates. Clin Pediatr. 1994;33:268-272.
11. Carter WB, Beach LR, Inui TS. The flu shot study: using multi-attribute utility theory to design a vaccination intervention. Organ Behav Hum Decis Process. 1986;38:378-391.
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12. Moran WP, Nelson K, Wofford JL, Velez R, Case LD. Increasing influenza immunization among high-risk patients: education or financial incentive? Am J Med. 1996;101:612-620.
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13. Lieu TA, Capra AM, Makol J, Black SB, Shinefield HR. Effectiveness and cost-effectiveness of letters, automated telephone messages, or both for underimmunized children in a health maintenance organization. Pediatrics. 1998;101:E3.
Arch Fam Med. 1999;8:295-296.
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