Review question:

What is the effect of using email for the coordination of appointments and attendance reminders on healthcare providers, patients and carers?

Nursing Implications:

Email can be used to remind patients about healthcare appointments and to schedule, reschedule or cancel an attendance. Non-attendance for an appointment may result in a patient becoming delayed in starting or changing a healthcare intervention. It can also increase healthcare provider costs, lead to larger patient waiting lists and reduce productivity. A patient may not attend an appointment for many reasons including that an inconvenient schedule was offered or the arrangement was forgotten. Enabling patients to self-select an appointment date or asking patients to confirm attendance can increase attendance rates. There are benefits to undertaking these communications by email: email is cheaper than postal reminders, it can offer a written confirmation that the communication has been read and is retainable for future patient reference. Nonetheless, there are concerns about the confidentiality and reliability of email communications. In addition, some patients or carers may not access their email accounts regularly and older service users or low income families may not have access to email. Thus, a systematic review of email appointment and attendance reminders was required to ascertain the effectiveness and harms associated with this form of communication.

Study Characteristics:

This summary is based on the results of a Cochrane systematic review. Seven health-related databases and 7 ‘grey literature’ sources were searched in January 2010. The review authors searched for any randomised or quasi-randomised controlled trial, controlled ‘before and after’ and interrupted time series study. Any healthcare provider, patient, or carer in any healthcare setting was considered, although routine preventative screening communications were excluded (considered in another review). Unsecured, secured/encrypted emails and web messaging interventions versus ‘no intervention’ or any other form of communication were to be included in the review. Primary outcomes considered were whether email correspondence was understood and acted upon appropriately from the perspectives of healthcare organisations (e.g. attendance rates), professionals (e.g. knowledge and understanding, behaviour), and patients or carers (e.g. understanding, patient health status), as well as harms (e.g. missed diagnoses, privacy or technological failures). Secondary outcomes considered the effect of the email reminder on: professional-patient/carer knowledge and understanding, communication, relationships and evaluations of care; health providers’ costs, referrals, admissions and time.

Summary of Key Evidence:

No relevant study was identified for this review. The review authors hypothesised this may be because email appointments are integrated within patient communication and management systems and are not separately evaluated. It may also be that other methods of communication (such as text messaging) are now being used. Therefore, the authors concluded that high-quality studies of the effect of email healthcare appointment and attendance reminders should be undertaken. Such research should consider the security, workload and costs associated with email and its use by different types of patients.

Best Practice Recommendations:

No recommendations can currently be made regarding the use of email for the coordination of healthcare appointments and attendance reminders.

The full text of the review can be found at:http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007981.pub2/abstract

Summary Author

Janice Christie, PhD, RN
City University London
School of Health Sciences
20 Bartholomew Close
London, EC1A 7QN

A member of the Cochrane Nursing Care Field (CNCF)