Texting is now an inherent part of everyday life, from contacting friends, receiving information from the bank, shopping deliveries to reminders about medical appointments. Text messaging is a fast, low cost and popular mode of communication and these advantages can be used in a variety of ways in the healthcare environment.
Given the huge range of specialities within the NHS and the number of different types of consultations, assessments and treatments that are conducted on a daily basis, it is hard to put a precise figure on the true cost of a missed appointment. Recent research conducted by a team at Warwick Business School recently put the average figure at £160. With nearly 10% of appointments missed in 2014-15 alone – that is a staggering £5.6 million. The annual cost is reported by the National Audit Office to be £225 million. In the challenging economic and demographic climate of today, reducing this is an issue of top priority. In addition to the financial impact, it is also important to consider that every missed appointment is also a lost opportunity for somebody else to be seen.
One NHS trust that tested the effect of SMS reminders fairly early on was the Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust. Prior to the trial they conducted, their outpatient clinics had seen a non-attendance rate of around 1 in 10 patients. This was costing the trust in the region of £2.2 million a year.
With the introduction of an SMS messaging trial across three specialities, they saw a significant reduction of 4% in missed appointments within the first three months.
Areas for Improvement
The NHS now sends as many as 5 million text message reminders to patients every month. Despite this, figures for non-attendance still remain high. Trials conducted by Vlaev and his colleagues from Imperial College London, the Department of Health and the ‘Nudge Unit’ (the UK Government’s Behavioural Insights Team), revealed, however, just how the content of a text message can reduce non-attendance for hospital appointments.
Whilst a simple text message giving the details of the appointment – time, day and hour – had good results, adding information about the cost of missed appointments saw a further reduction in missed appointments of 25% in comparison. The inferences of this are dramatic, with the potential to prevent a further 400,000 no-shows per year simply by amending the information contained within the text.
One observation worth noting is that the NHS is currently estimated to hold mobile phone numbers for just 20% of patients – despite Ofcom reporting that 93% of the UK’s adult population personally own or use a mobile phone.
The utilisation of information technology using text messaging could improve access to care. The healthcare user can have their needs met more quickly and at a lower cost, by communicating via text. Additionally, text message reminders can help the patient be more compliant, therefore decreasing the loss of revenue related to missed appointments, and the need for schedule changes for the provider.
Various research studies indicate that text messaging healthcare interventions are largely beneficial clinically, in public health related uses, and in terms of administrative processes. Sexual health services for example are using text to communicate between clinics and patients for contraception reminders, appointment reminders and sexual health promotion and education.
The widespread use of SMS, the least-expensive mobile phone function, offers a solution that could rapidly overcome weaknesses in communication, potentially leading to improved delivery of health services and better health outcomes. Text messaging is particularly attractive because it is available on most basic handsets without the need for additional applications. SMS functions on a lower bandwidth than voice, requires minimal skills in its use, offers automated delivery, and is personally convenient because of its easy character.
As interest in mobile health (mHealth) interventions increases worldwide, it is important to assess the cost-effectiveness of these types of interventions. While a cost-benefit analysis cannot always demonstrate the advantages seen, it is important to evaluate before making changes in policy and subsequent practice. The utilisation of mHealth using text messaging has the potential of making significant change with minimal financial investment.