The effect of reminder calls in reducing non-attendance rates at care of the elderly clinics

BACKGROUND DNA (“did not attend”) at outpatient clinics is an important problem costing the NHS an estimated £266 million annually. The national DNA rate for 1996–1997 for all clinics was 12%. The DNA rate at Hammersmith Hospital for the same year in the care of the elderly specialty was 21%. The aim of this study was to establish why this was so, and to test the efficacy of a reminder call in increasing attendance rates at care of the elderly clinics. METHODS 23 DNAs from seven clinics were contacted to ascertain the reasons for non-attendance (group I). For seven further clinics, 84 patients were contacted in advance to reconfirm their appointment (group II). RESULTS From group II 12 patients were identified who were unaware of their appointment (14%), six of whom agreed to attend; thus six potential DNAs were prevented. Eleven vacant appointments were identified in advance. Theunexpected DNA rate was reduced to 5% from a potential 21% as a result of this exercise. The DNA rate for all patients with dementia (both groups) was 44%, whereas the DNA rate for all patients without this diagnosis (both groups) was 16% (p < 0.001). CONCLUSIONS A preclinic phone call reminder to elderly patients is feasible, increases attendance rates, and identifies vacant appointments. Patients with dementia are more likely to miss clinic appointments; therefore they and their carers need specific reminders about appointment dates. Key points Clinic non-attendance is an important problem in the elderly. Surveys show that up to 50% of non-attenders say they forgot about their appointment, and reminder letters/calls are effective for other specialties. Reminder calls to the elderly are well received, and very effective in increasing attendance rates. Vacant appointments can be identified in advance, allowing urgent referrals at short notice. Patients with dementia are significantly more likely to be non-attenders, and they and their carers need to be specially targeted for reminders.