Alternatives
The use of technology and clinical support staff (e.g., nurses, physician assistants) to communicate with patients, allows a variety of interactions to be substituted for the traditional individual, in-person clinic visit with a physician. Here are a few of them with links to clinical literature that further describes the method.
- Telephone consulting: many physicians already do this, but many should consider transitioning these telephone consults to a nurse, or instruct the patient during a previous office visit to follow-up by phone in lieu of scheduling an appointment.
- For patients who may need a follow-up appointment, develop a system where the nurse or physician’s assistant checks in with the patient by phone two weeks prior to the follow-up. If the patient’s condition still warrants a follow-up visit, keep it on schedule. If not, schedule another follow-up call.
- Offer patients an alternative method for refilling medications or to receive lab results (e.g., nurse calls patients with results). According to research published in the Journal of the American Board of Family Medicine, a good prescription refill management process requires accuracy, efficiency and acceptability for patients and office staff.
- Email, telemedicine, and Internet communication between physicians or nurses and patients can be used to manage patients with chronic conditions such as diabetes, depression, chronic pain, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF).
- For patients with chronic conditions, implement Group visits in which several patients meet together with a provider and/or the care team. Group visits have been shown to be effective in reducing demand as well as for providing increased continuity of care and a supportive social network for patients. In a group visit, the physician might meet briefly with the group, but the patient receives all the services of a traditional visit by utilizing other members of the care team.
Monitor & Reduce No-Shows
Healthcare practices that periodically monitor no-show appointments, can develop a strategy to reduce them. Look for patterns in the types of visits for which patients do not keep appointments.
Analyze re-check visits; some practices find re-checks have the highest rates of no-show. If the follow-up appointment is crucial to the continuation of care, be sure to help the patient understand its importance, otherwise the patient is less likely to keep the appointment. Additionally, look for ways to either eliminate unnecessary appointments or to find alternative ways to check in with patients, such as phone follow-ups, email care, or consults with other appropriate clinical staff, as described in the previous section.
The following approaches can further reduce no-show appointments:
- Minimize the time between the appointment request and the day the appointment is scheduled. Look for ways to effectively match patients and specific providers. These two approaches address patient satisfaction (e.g., patient receives appointment on or near desired date/time and with practitioner with whom they are comfortable).
- If your practice no-show rate is relatively small compared to the total number of patients in the practice, find out what factors contribute to no-shows. When a patient fails to show, set aside time for a staff member to call and inquire what happened—some factors will be within the control of the practice, while others will not (e.g., they “forgot,” had a problem with transportation or child care). The simple act of calling to determine why the patient failed to show may prove invaluable to future efficiency as well as to patient perception of the practice. In one study, 3 types of issues were found related to missing appointments without notifying the clinic staff: emotions, perceived disrespect, and not understanding the scheduling system. Although patients mentioned logistical issues of appointment keeping, participants did not identify these issues as key reasons for nonattendance.
- Examine "bump" rates. Often no-show rates are highly correlated with the number of appointments that are canceled by the practice. If the practice sends the message that the patient appointment is valued by reducing the number of practice-initiated cancellations, then this can have an impact on patient behavior in meeting appointments.
Further Reading
Group Visits: A Qualitative Review of Current Research
It's no-show time! How leaders at one practice tackled the no-show problem--and how you can, too. MGMA Connex. 2007 Jul;7(6):44-9, 1. Quinn K.
University of California-San Francisco, Department of Orthopaedics, USA. This email address is being protected from spambots. You need JavaScript enabled to view it.
Why we don't come: patient perceptions on no-shows. Ann Fam Med. 2004 Nov-Dec;2(6):541-5. Lacy NL, Paulman A, Reuter MD, Lovejoy B.
University of Nebraska Medical Center Department of Family Medicine, 983075 Nebraska Medical Center, Omaha, NE 68198-3075, USA. This email address is being protected from spambots. You need JavaScript enabled to view it.
Writer’s Bio
Karen M. Rider, M.A. is a freelance writer who specializes in wellness, health psychology and healthcare news. In addition to writing for print and digital publications, Karen writes marketing content for healthcare and wellness practitioners across a variety of specialties.
