Telephone Reminders to Increase Kept Intake and Therapy Appointments in a Rural Community Mental Health Clinic: Findings from Two Pilot Studies

Background and Purpose:

A common problem in community mental health centers is missed appointments. Findings about the effectiveness of phone reminder calls to decrease missed appointments are mixed. Some studies report phone reminders increase kept appointments and others cast doubt about their effectiveness and efficiency. This poster will report findings from two small studies that examined whether reminder calls increased attendance at intake and therapy appointments at a mental health center in rural Appalachia. It builds on prior studies by examining whether there were differences in appointment keeping based on whether therapists or staff members made the call.

Methods:

In the first study, one of three conditions (no reminder calls, therapist calls, or staff calls) was randomly assigned to each week of the nine week study. One therapist in each of two small rural clinics participated. There were 381 scheduled appointments (254 therapy,127 intake) for 238 clients across the two therapists. Calls were classified as no contact, therapist direct contact (talked with client), therapist indirect contact (left message), staff direct contact, and staff indirect contact. In the second study, all therapists (n=10) in all agency clinics (n=4) called and reminded clients who were scheduled for intake appointments. During the ten week study period there were 283 intake appointments for 259 clients. Calls were classified as no contact (clients could not be reached or therapist did not have time to call), direct contact, or indirect contact.

Mixed effects ordinal regression, using MIXOR, was used for data analysis. Independent variables for the first study were clinic site, appointment type (intake or therapy), and four dummy variables representing phone call condition. Interactions between type of contact and type of appointment were tested. Type of appointment was not applicable to the second study.

Results:

Findings from the first study include a significant interaction between type of contact and type of appointment (z=1.95, p=.05). The rate of appointment keeping for therapy when therapists directly contacted their clients was 89%, compared to 80% with no contact. Only 43% of the intake appointments were kept when there was no contact, compared to 94% when therapists talked with clients. For intake, but not for therapy, the rate of appointment keeping decreased sharply when clients were not contacted directly by their therapists. Findings from the second study reinforce those from the first study. Direct contact resulted in more kept appointments (74%) than no contact (37%) (z=2.03, p=.02). Indirect contact resulted in 49% kept appointments, not significantly different from no contact.

Conclusions and Implications:

Other studies have not examined whether who makes reminder calls makes a difference, but these findings suggest that it does, at least for intakes. An explanation for this is that early contact with the therapist begins to build the helping relationship, though this needs to be subjected to empirical testing. Phone reminders were less efficient for therapy appointments. Agencies struggling with high rates of missed appointments may want to give therapists time for intake reminder calls and document the results.