Out-patient appointments: a necessary evil? a literature review and survey of patient attendance records

Aims and MethodTo describe the effect of a postal reminder system on UK adult psychiatry clinic attendance. A literature review was completed and a serial cross-sectional survey of patient attendance records in an inner-city psychiatric hospital during 2006 and 2007 was undertaken.ResultsA simple postal prompt reduces non-attendance by up to 50% and data from the serial cross-sectional survey of attendance records (n=36) powered at 77% supported this finding. Postal prompts in the survey accounted for 30% improvement in the variance (r2).Clinical ImplicationsA simple postal prompt that takes less than 30 s to read, sent up to 2 weeks prior to the appointment improves attendance by up to 50% and is useful for maintaining standards of excellence.

Screening for Colorectal Cancer by Once Only Sigmoidoscopy: A Feasibility Study in Turin, Italy

Objectives –To assess the impact on compliance of three invitation methods, as well as the acceptability and efficacy of two bowel preparation regimens, for endoscopic screening in the general population. Methods –1170 subjects (men and women aged 55 to 59, in the rosters of a sample of general practitioners (GPs) in Turin), were randomly allocated to one of three invitation groups (A: personal letter, signed by GP, with a pre-fixed appointment; B: same as for A + letter supporting the study by a well known scientist; C: letter signed by the study coordinator, NS) and two preparation regimens (i: one enema, self administered at home two hours before the test; ii: two enemas, administered the night before and two hours before the test). A postal reminder was mailed to non-attenders. A sample of non-responders was contacted for a telephone interview by a trained nurse. Written consent was obtained from all subjects undergoing the test. Results –A total of 278 subjects attended for sigmoidoscope screening. An invitation from the GP alone produced the highest response rate (compliance: A = 29.3%; B = 24.9%; C = 26.8%). A single enema was as effective as two enemas in achieving satisfactory preparation for the test: the proportion of subjects invited to repeat the test was 8.1% in the single enema group, and 9.6% in the group receiving two enemas. Conclusions –Compliance with this screening procedure tends to be low. One enema, self administered two hours before sigmoidoscopy, can ensure a satisfactory bowel preparation.