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Do Appointment Reminders Reduce Missed Dental Visits? What the Evidence Says

Introduction

Every missed appointment leaves an empty chair, a disrupted treatment sequence and, for the patient, delayed care. The Cochrane review discussed below notes that missed appointments are a major cause of inefficiency in healthcare delivery, that patients' forgetfulness is one of the main reasons for them, and that reminders may help [PMID 24310741]. For clinic owners and dentists in India seeking to reduce patient no-shows, the practical question is whether appointment reminders, and SMS reminders in particular, change attendance, and by how much.

This article summarises a Cochrane systematic review on mobile phone messaging reminders and four dental studies, including one conducted in India, and sets out what they mean for a dental clinic's scheduling practice.

The broad evidence: a Cochrane systematic review

Gurol-Urganci and colleagues updated their Cochrane review of mobile phone messaging reminders in 2013, including only randomised controlled trials in which the effect of messaging could be separated from other interventions [PMID 24310741]. Eight trials involving 6615 participants were included. The principal findings reported in the abstract are as follows [PMID 24310741].

  • Text reminders versus no reminder. Moderate quality evidence from seven studies (5841 participants) showed that text message reminders improved attendance compared with no reminders (RR 1.14, 95% CI 1.03 to 1.26).
  • Text reminders versus phone calls. Moderate quality evidence from three studies (2509 participants) showed a similar effect for text and phone call reminders (RR 0.99, 95% CI 0.95 to 1.02).
  • Text added to postal reminders. Low quality evidence from one study (291 participants) suggested that adding text reminders to postal reminders improved attendance (RR 1.10, 95% CI 1.02 to 1.19).
  • Attendance rates. Overall attendance was 67.8% with no reminder, 78.6% with text message reminders and 80.3% with phone call reminders.
  • Cost. Two studies reported that costs per text message per attendance were 55% and 65% lower than costs per phone call reminder.

The authors cautioned that the included studies were heterogeneous, that evidence quality was low to moderate, and that information on harms, user evaluation and health outcomes was lacking [PMID 24310741].

What dental studies have found

The dental literature is smaller and less consistent.

  • An Indian dental teaching hospital. At the ITS Centre for Dental Studies and Research, Ghaziabad, 206 patients in prosthodontic, endodontic, orthodontic and paedodontic departments were studied; on-time attendance was 79.2% in the SMS reminder group versus 35.5% in the control group [PMID 22251033].
  • A paediatric dental clinic in Seattle. In a randomised study of 318 caregiver–child pairs, the no-show rate was 8.2% with voice message reminders and 17.7% with SMS text reminders (P = .01); the authors concluded that text messages were not as effective as voice reminders in that setting [PMID 21454845].
  • Recall for tooth scaling in Taiwan. Among 389 outpatients, those reminded by postcard, text message or telephone were 2.6 (95% CI 1.3–5.4) to 2.9 (95% CI 1.1–7.8) times more likely to revisit for scaling than those not reminded; reminders were accompanied by short health education messages [PMID 23512651].
  • An orthodontic clinic in Amsterdam. In a randomised trial comparing telephone, mail and SMS reminders sent one day before the appointment with no reminder, the hypothesis that reminders would reduce failed attendance was not confirmed, and no differences were found between the four groups [PMID 15775951].

Interpreting the evidence

In our reading, the overall direction of evidence favours sending reminders: the Cochrane review shows a modest but consistent improvement in attendance compared with no reminder [PMID 24310741], and two of the four dental studies show substantial benefit [PMID 22251033][PMID 23512651]. The Amsterdam trial [PMID 15775951] and the Seattle trial [PMID 21454845] are important correctives, however. They suggest that the benefit of a reminder depends on the setting, the baseline attendance of the patient population and the reminder channel, and that SMS is not universally superior to a voice call.

In our reading, the Indian study [PMID 22251033] is particularly relevant to clinics in India, although its abstract does not describe how patients were allocated to groups, and it was conducted in a teaching hospital; its large difference in attendance should not be assumed to transfer to private practice.

Practical steps for a dental clinic

The following steps are our interpretation of the evidence, not protocols tested in the studies above.

  1. Measure your baseline. Record the no-show rate by appointment type before changing anything, so that any effect can be judged locally, as the mixed dental findings suggest [PMID 15775951][PMID 21454845].
  2. Send reminders by default. Given the Cochrane findings [PMID 24310741], a routine reminder for every booked appointment is a reasonable default.
  3. Offer more than one channel. Patient preferences vary [PMID 15775951], and voice reminders outperformed text in one paediatric setting [PMID 21454845]; consider a phone call for patients with a history of missed visits.
  4. Use recalls with a purpose. Pairing recall reminders with a short health message was associated with higher return for scaling [PMID 23512651].
  5. Respect patients who opt out. At least 20% of interviewed patients in the Amsterdam study felt negative about reminders [PMID 15775951].

D4dent's appointments workspace supports online booking and email/SMS reminders, which can make a routine reminder step easier to apply consistently. Clinic owners can see how this fits a multi-doctor practice on the D4dent for clinics page.

Frequently asked questions

Do SMS reminders reduce missed appointments?

Across healthcare settings, a Cochrane review of randomised trials found moderate quality evidence that mobile text message reminders improved attendance compared with no reminder (RR 1.14, 95% CI 1.03 to 1.26). Dental studies have been mixed, so results in an individual clinic may differ.

Are text reminders as effective as phone calls?

In the Cochrane review, text reminders had a similar effect to phone call reminders (RR 0.99, 95% CI 0.95 to 1.02), and two studies reported lower cost per attendance for text messages. In one paediatric dental trial, however, voice reminders produced fewer no-shows than text messages.

Does every patient want a reminder?

Not necessarily. In an Amsterdam orthodontic clinic most interviewed patients felt positive about reminders, but at least 20% felt negative, and preferences differed between mail, telephone and SMS.

Limitations to keep in mind

The Cochrane review predates more recent trials and was not dental-specific [PMID 24310741]. The dental studies are single-centre, use different designs and outcome definitions, and some report only limited methodological detail in their abstracts [PMID 22251033][PMID 23512651]. Figures here are taken from the published abstracts; clinicians should read the full texts before citing specific effect sizes.

Conclusion

Text message reminders improve attendance at healthcare appointments compared with no reminder and perform similarly to phone calls at lower cost, although the evidence is of low to moderate quality [PMID 24310741]. Dental studies range from large benefit [PMID 22251033] to no measurable effect [PMID 15775951], and in one paediatric clinic voice reminders outperformed text [PMID 21454845]. In our reading, the most defensible approach for a clinic aiming to reduce patient no-shows is to send reminders routinely, offer a choice of channel, and audit its own attendance data.

More in this series

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References

  1. Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R, Car J. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev. 2013 Dec 5;2013(12):CD007458. PMID: 24310741
  2. Prasad S, Anand R. Use of mobile telephone short message service as a reminder: the effect on patient attendance. Int Dent J. 2012 Feb;62(1):21-6. PMID: 22251033
  3. Nelson TM, Berg JH, Bell JF, Leggott PJ, Seminario AL. Assessing the effectiveness of text messages as appointment reminders in a pediatric dental setting. J Am Dent Assoc. 2011 Apr;142(4):397-405. PMID: 21454845
  4. Cheng CC, Li CY, Hu YJ, Shen HC, Huang SM. Effects of tooth scaling reminders for dental outpatients. J Telemed Telecare. 2013 Jun;19(4):184-9. PMID: 23512651
  5. Bos A, Hoogstraten J, Prahl-Andersen B. Failed appointments in an orthodontic clinic. Am J Orthod Dentofacial Orthop. 2005 Mar;127(3):355-7. PMID: 15775951