RESEARCH Systematic review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Q Use of telephone and SMS reminders to improve attendance at hospital appointments: a systematic review Per E Hasvold and Richard Wootton Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway Summary Patients failing to attend hospital appointments contribute to inefﬁcient use of resources. We conducted a systematic review of studies providing a reminder to patients by phone, short message service (SMS) or automated phone calls. A PubMed search was conducted to identify articles published after 1999, describing studies of non-attendance at hospital appointments. In addition, we searched the references in the included papers. In total, 29 studies were included in the review. Four had two intervention arms which were treated as independent studies, giving a total of 33 estimates. The papers were analysed by two observers independently. A study quality score was developed and used to weight the data. Weighted means of the absolute and the relative changes in non-attendance were calculated. All studies except one reported a beneﬁt from sending reminders to patients prior to their appointment. The synthesis suggests that the weighted mean relative change in non-attendance was 34% of the baseline non-attendance rate. Automated reminders were less effective than manual phone calls (29% vs 39% of baseline value). There appeared to be no difference in non-attendance rate, whether the reminder was sent the day before the appointment or the week before. Cost and savings were not measured formally in any of the papers, but almost half of them included cost estimates. The average cost of using either SMS, automated phone calls or phone calls was E0.41 per reminder. Although formal evidence of cost-effectiveness is lacking, the implication of the review is that all hospitals should consider using automated reminders to reduce non-attendance at appointments. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non-attendance for appointments in health care results in wasted resources and disturbs the planned work-schedules. Cancellations and rescheduling of appointments are usually dealt with administratively and vacant slots are often ﬁlled by other patients, which reduces the loss in overall efﬁciency for the health-care staff concerned. In hospitals, the problem of non-attendance can be met by a number of different strategies, such as overbooking the appointment list or sending some kind of reminder in advance of the appointment. However, overbooking may not be considered an appropriate method in modern health-care delivery. On the other hand, reminders directly to the patient from a hospital are generally acceptable. This can be viewed as a form of telemedicine, since it is an application of technology to the health-care process which involves distance. It seems reasonable to expect that sending reminders would decrease the no-show rate at hospital appointments. Accepted 1 August 2011 Correspondence: Per E Hasvold, Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, PO Box 6060, 9038 Tromsø, Norway (Fax: þ47 77 75 40 98; Email: per.hasvold@telemed.no) Journal of Telemedicine and Telecare 2011; 17: 358–364 However, there is little information about the magnitude of this effect and we are only aware of one previous review of the effect of reminders on non-attendance at hospital appointments.1 This was a narrative review of telephone and postal reminders, which concluded that reminders can improve attendance and reduce non-attendance qualitatively. We have therefore conducted a systematic review. The research questions were: (1) What is the best estimate of the effect of sending reminders on non-attendance rates? (2) Are there any differences in non-attendance when using reminders sent manually (i.e. from phones operated by a human) or automatically (i.e. by SMS text messages or by automated voice recordings)? (3) Does the time at which the reminder is sent inﬂuence the effect on non-attendance rates? (4) What are the costs and beneﬁts of using reminders? Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Papers were selected following the PRISMA methodology.2 A search of the PubMed database was DOI: 10.1258/jtt.2011.110707