title: Text-messaging versus telephone reminders to reduce missed appointments in an academic primary care clinic: a randomized controlled trial.
abstract: BACKGROUND
  Telephone or text-message reminders have been shown to significantly reduce the rate of missed appointments in different medical settings. Since text-messaging is less resource-demanding, we tested the hypothesis that text-message reminders would be as effective as telephone reminders in an academic primary care clinic.
  
  
  METHODS
  A randomized controlled non-inferiority trial was conducted in the academic primary care division of the Geneva University Hospitals between November 2010 and April 2011. Patients registered for an appointment at the clinic, and for whom a cell phone number was available, were randomly selected to receive a text-message or a telephone call reminder 24 hours before the planned appointment. Patients were included each time they had an appointment. The main outcome was the rate of unexplained missed appointments. Appointments were not missed if they were cancelled or re-scheduled before or independently from the intervention. We defined non-inferiority as a difference below 2% in the rate of missed appointments and powered the study accordingly. A satisfaction survey was conducted among a random sample of 900 patients (response rate 41%).
  
  
  RESULTS
  6450 patients were included, 3285 in the text-message group and 3165 in the telephone group. The rate of missed appointments was similar in the text-message group (11.7%, 95% CI: 10.6-12.8) and in the telephone group (10.2%, 95% CI: 9.2-11.3 p = 0.07). However, only text message reminders were cost-effective. No patient reported any disturbance by any type of reminder in the satisfaction survey. Three quarters of surveyed patients recommended its regular implementation in the clinic.
  
  
  CONCLUSIONS
  Text-message reminders are equivalent to telephone reminders in reducing the proportion of missed appointments in an academic primary care clinic and are more cost-effective. Both types of reminders are well accepted by patients.
authors.affiliation: Division of primary care medicine, Department of community medicine, primary care and emergency medicine, Geneva University Hospitals, 4 rue Gabrielle Perret-Gentil, Geneva 14, 1211, Switzerland. noelle.junod@hcuge.ch
authors.forename: Noelle
authors.initials: N
authors.lastname: Junod Perron
authors.forename: Melissa Dominicé
authors.initials: MD
authors.lastname: Dao
authors.forename: Nadia Camparini
authors.initials: NC
authors.lastname: Righini
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Humair
authors.forename: Barbara
authors.initials: B
authors.lastname: Broers
authors.forename: Françoise
authors.initials: F
authors.lastname: Narring
authors.forename: Dagmar M
authors.initials: DM
authors.lastname: Haller
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gaspoz
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001071:Appointments and Schedules; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D017060:Patient Satisfaction; D011320:Primary Health Care; D017010:Reminder Systems / Q000295:instrumentation*; D011795:Surveys and Questionnaires; D013557:Switzerland; D013689:Telephone; D060145:Text Messaging
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