Background/Purpose: Missed appointments in rheumatology are reported to be up to 40%. Non-adherence to outpatient visits is contributing to poor outcomes and low income population is considered especially vulnerable. In New York City, Bronx borough is the poorest neighborhood that is disproportionately affected by health disparities. Incorporating reminder letters, phone calls, text messaging and enhancing the access to health portals into rheumatology practices is thought to provide effective strategies for combatting non-adherence.
Our study examined the impact of these strategies in underserved population in the large academic center.

Methods: In our institution, Jacobi Medical Center, electronic medical record Epic and MyChart patient portals were implemented in 2019. Slicer-dicer tool extracted de-identified patient data. We compared Epic to pre-Epic data (collected between 2013-15), when reminder letters and phone calls were only used. Text messages to the patients were added mid 2023. Patients who adopted MyChart were deemed active users versus pending or inactivated users. Visits were classified as completed, cancelled or no-show. We performed t-tests for statistical analysis.

Results: From 1/2020-12/2023 there were 22.529 outpatient visits scheduled (5632±595 visits/year). Each year MyChart activation status significantly increased (from 69% in 2020 vs 76% in 2023:p< 0.05). Yearly, there was 180 temporary users who inactivated MyChart (3±1%) and the reminder of patients had pending activation status. Baseline demographic was similar between groups in a terms of age, sex and ethnicity with predominant African American and Latino population. Historical, pre-Epic non-adherence rate to outpatient visits was 48% (data from 2013-15, previously published). Average missed appointment rate during 2020-22 was 46% (in 2020 was 41%; in 2022 was 50%). With text message reminders in 2023 combined cancelled and no-show appointment rate was 49% (p >0.05). We compared missed appointment rates between patients with active vs pending vs inactivated MyChart. There was no statistical difference between active vs pending groups. There was statistically significant difference between active MyChart users and inactivated portal group (44±4% vs 59±11%; p< 0.05). Of note, number of patients in inactivated groups was small, as above. 

Conclusion: Appointment reminders delivered by text messaging, letters, phone calls or access to MyChart had no impact on visit adherence in underserved population. Of note, our study coincided with the peak of Covid-19 pandemic. This study identified targets for intervention such as increasing MyChart activation rate, assuring that patients received the reminders (calls or letters) or sending personalized text messages. Additionally, we are planning on contacting the patients soon after missed appointment through MyChart patient portal in order to reduce the risk of loss to follow-up and to promote appointment re-attendance within one month of the missed visit.

« Back to ACR Convergence 2024

ACR Meeting Abstracts - https://acrabstracts.org/abstract/appointment-adherence-impact-of-health-portal-access-letters-phone-calls-and-text-message-reminders-in-underserved-population/