using the same terms, but found no additional relevant studies. All studies except one showed a positive effect from using reminders. The exception was the study by Satiani et al.30 This study also differed from the others because the patients themselves chose in advance whether they wished to receive a reminder or not. This may have introduced a bias in the intervention group. Further studies We recommend that rigorous health economics studies of the costs and savings of reminders should be carried out, preferably in the form of randomized controlled trials. Without such studies, it is not possible to know with certainty whether automated reminders such as SMS text messages are better than human-generated telephone calls (which are more expensive, but produce bigger improvements in DNA rates). Future research should also be carried out to investigate the beneﬁts of sending multiple reminders, and whether that leads to ‘reminder fatigue’ in the recipients. Some of the papers in the present review reported that the patients were not necessarily happy about the reminder they had received, despite stating that they would still like to be reminded about any future appointments. Most papers only provided numbers for attendance or non-attendance. Cancellations and rescheduling were not reported in enough papers to be considered in the analysis, but this is an important aspect of how reminders may contribute to a better and more efﬁcient use of the resources and it is possible that the time of the reminder may have a more interesting effect on cancellations than on non-attendance. Conclusions Sending appointment reminders from hospitals to patients can be seen as a form of telemedicine since it involves distance and is an application of technology which contributes to the health-care process. The evidence is overwhelming that reminders have a positive effect on non-attendance rates. 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