Did Not Attend, Could Not Attend: An Audit of the Impact of Text Message Reminders in Integrated Care

Abstract Background Non-attendance at clinic appointments contributes to inefficiencies and delays in care. We completed an audit to evaluate the impact of introducing text message reminders on appointment attendance within an ICPOP service operating across both rural and urban settings. Methods An audit cycle was completed across two five-week periods: before and after the implementation of automated text message reminders. All scheduled appointments with medical or nursing ICPOP team members were included. Attendance outcomes were categorised as attended, did not attend (DNA, no reason provided), or could not attend (CNA, reason provided). Subgroup analyses were conducted by appointment type (new CGA versus follow-up) and location (urban versus rural clinic setting). Results A total of 380 scheduled appointments were analysed (192 pre-intervention, 188 post-intervention). Overall attendance improved slightly from 63% to 68%, primarily due to a reduction in the DNA rate from 20% to 15%, though not statistically significant (p = 0.39). A larger improvement was observed in rural clinics (attendance increased from 56% to 73%) compared to urban clinics (64% to 62%), but the difference was also not statistically significant (p-interaction = 0.15). Attendance was significantly higher for follow up appointments (69%) compared to initial CGA appointments (57%), with DNA rates of 14% vs 25% respectively (p = 0.02). The most common CNA reason given was that the appointment didn’t suit (n = 26) followed by the patient being medically unwell and not able to attend (n = 15). Conclusion While text message reminders alone did not significantly improve attendance, the observed trends suggest potential benefits, especially in rural populations. Higher DNA rates for new CGA appointments highlights the need for improved engagement at first contact, including more flexible scheduling options to reduce avoidable CNAs.