Enhancing Usability of Appointment Reminders: Qualitative Interviews of Patients Receiving Care in the Veterans Health A
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VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA; 2Department of Psychiatry, Oregon Health & Science University, Portland, USA; 3School of Public Health, Oregon Health & Science University and Portland State University, Portland, USA; 4Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, USA; 5Comprehensive Access and Delivery Research and Evaluation Center, Iowa City Veterans Affairs Healthcare System, Iowa City, USA; 6Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, USA.
BACKGROUND: No-shows are a persistent and costly problem in all healthcare systems. Because forgetting is a common cause of no-shows, appointment reminders are widely used. However, qualitative research examining appointment reminders and how to improve them is lacking. OBJECTIVE: To understand how patients experience appointment reminders as part of intervention development for a pragmatic trial of enhanced appointment reminders. DESIGN: Qualitative content analysis PARTICIPANTS: Twenty-seven patients at a single Department of Veterans Affairs hospital and its satellite clinics APPROACH: We conducted five waves of interviews using rapid qualitative analysis, in each wave continuing to ask veterans about their experience of reminders. We doublecoded all interviews, used deductive and inductive content analysis to identify themes, and selected quotations that exemplified three themes (limitations, strategies, recommendations). KEY RESULTS: Interviews showed four limitations on the usability of current appointment reminders which may contribute to no-shows: (1) excessive information within reminders; (2) frustrating telephone systems when calling in response to an appointment reminder; (3) missing or cryptic information about clinic logistics; and (4) reminder fatigue. Patients who were successful at keeping appointments often used specific strategies to optimize the usability of reminders, including (1) using a calendar; (2) heightening visibility; (3) piggybacking; and (4) combining strategies. Our recommendations to enhance reminders are as follows: (1) mix up their content and format; (2) keep them short and simple; (3) add a personal touch; (4) include specifics on clinic location and contact information; (5) time reminders based on the mode of delivery; and (6) hand over control of reminders to patients. CONCLUSIONS: Appointment reminders are vital to prevent no-shows, but their usability is not optimized for Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06183-5) contains supplementary material, which is available to authorized users. Received April 10, 2020 Accepted August 24, 2020
patients. There is potential for healthcare systems to modify several aspects of the content, timing, and delivery of appointment reminders to be more effective and patientcentered. KEY WORDS: access to care; no-shows;
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