Interventions for reducing missed initial appointments at a community mental health center. Does an encouraging letter encourage attendance at psychiatric out-patient clinics? The Leeds PROMPTS randomized study. Strategies for reducing missed initial appointments in a community mental health center.
The present study attempted to reduce the initial appointment no-show rates at a CMHC through the use of several intervention techniques. One hundred-fifty individuals who called for an intake appointment were randomly assigned to either a control group or one of the following experimental groups: letter prompt received one day before appointment, letter prompt received three days before appointment, orientation letter received one day before appointment or orientation letter received three days before appointment. Individuals assigned to the one day orientation group had significantly lower no-show rates than individuals assigned to the control group (17% vs. 43%). The other groups were not significantly different from the control group. The effectiveness of the one day orientation letter for reducing no-show rates and its application at a CMHC was discussed. The aim was to reduce non-attendance for first-time consultations at psychiatric out-patient clinics.
                The study was a pragmatic randomized controlled trial; the setting was seven inner-city UK out-patient clinics in Leeds. The participants were 764 subjects of working age with an appointment to attend a psychiatric out-patient clinic for the first time. The intervention was an 'orientation statement' letter delivered 24-48 h before the first appointment compared with standard care. The primary outcome measure was attendance at the first appointment; secondary outcomes included hospitalization, transfer of care, continuing attendance, discharge, presentation at accident and emergency and death by 1 year.
                Follow-up was for 763 out of 764 subjects (>99%) for primary and for 755 out of 764 subjects (98.8%) of secondary outcome data. The orientation statement significantly reduced the numbers of people failing to attend [79 out of 388 v. 101 out of 376 subjects, relative risk 0.76, 95% confidence interval (CI) 0.59-0.98, number needed to treat 16, 95% CI 10-187].
                Prompting people to go to psychiatric out-patient clinics for the first time encourages them to attend. Pragmatic trials within a busy working environment are possible and informative. The present study attempted to reduce the missed initial appointment rate of an urban CMHC through the use of several intervention strategies. Individuals who called for an intake appointment were randomly assigned to either a control group or one of the following treatment conditions: orientation statement at the time the appointment was made, orientation statement plus phone prompt, or phone prompt only. The orientation statement only group had significantly fewer missed initial appointments than the control group (28% vs. 56%). A client reachability factor also played a role in predicting missed initial appointments.