An overview of interventions to improve compliance with appointment keeping for medical services.
OBJECTIVE
To determine, by a quantitative meta-analysis of randomized trials, the effectiveness of strategies to improve patient compliance with screening, referral, and clinic appointments for health services that are provided at the time of the visit.


METHODS
Computerized searches of MEDLINE (1966 through 1990) were done using two search strategies: (1) (Patient Compliance OR Adhere* OR Dropout*) AND (Appointment*) AND (Screen* OR Follow* OR Refer*); and (2) (Patient Compliance OR Adhere* OR Dropout*) AND (Attend* OR Screen*) OR (Appointment*). A computerized search of PSYCHLIT was done with the terms Compliance AND Appointment*. In addition, the reference list of each retrieved article was reviewed and relevant citations retrieved.


METHODS
Only randomized trials with quantitative data concerning the effect of interventions to improve attendance at appointments for supervised administration of care were considered for detailed review. Studies of appointment keeping for self-administered treatments or tests were excluded. Two independent reviewers assessed each article for inclusion (kappa, for agreement, 0.66 for MEDLINE; 0.95 for PSYCHLIT) and validity (kappa, 0.62) using a priori criteria. Twenty-three (26%) of 88 relevant articles met all criteria.


METHODS
Data on study populations, interventions, and outcomes were extracted and analyzed using pooled odds ratios (ORs).


RESULTS
The average rate of compliance with appointments was 58%. Mailed reminders and telephone prompts were consistently useful in reducing broken appointments (OR, 2.2; 95% confidence interval [CI], 1.7 to 2.9; and OR, 2.9, CI, 1.9 to 4.3, respectively). An "orientation statement" (OR, 2.9; CI, 1.5 to 5.6), "contracting" with patients (OR, 1.9; CI, 1.04 to 3.5), and prompts from physicians (OR, 1.6; CI, 1.4 to 2.0) showed positive effects as well.


CONCLUSIONS
In clinic settings where kept appointments can be an accurate measure of patient compliance with health care interventions, broken appointments can be reduced by mail, telephone, or physician reminders; orienting patients to the clinic; or contracting with patients.
Macharia
W M
WM
Design, Measurement, and Evaluation Program, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
Leon
G
G
Rowe
B H
BH
Stephenson
B J
BJ
Haynes
R B
RB
D001071:Appointments and Schedules; D005500:Follow-Up Studies; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D015201:Meta-Analysis as Topic; D016017:Odds Ratio; D010349:Patient Compliance; D010352:Patient Dropouts; D011613:Psychotherapy / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation