Background/Purpose: ‘No-shows’ (NS) to ambulatory care reduce the quality and efficiency of healthcare delivery.  We sought to identify patient, provider, and system factors associated with NS to 5 rheumatology clinics at an academic teaching hospital. We hypothesized that an online patient portal could have a role in reducing NS through electronic reminders.   

Methods: We conducted a 6-month prospective chart review of consecutive NS to the clinics of 5 rheumatologists at Sunnybrook Health Sciences Centre (SHSC). A sample of NS patients participated in semi-structured telephone interviews and qualitative themes were identified. Clinic processes were studied with administrative staff participation. Patients were encouraged to enroll in MyChart^TM, the online patient portal at SHSC. In one clinic, an email appointment reminder was implemented for portal users. Clinic attendees were surveyed for their portal enrollment, receipt of the reminder, and satisfaction; NS occurrences were monitored.

Results: Over 6 months there were 110 NS; rates varied among providers (2.5% – 6.8%) with a total estimated cost of >10 000$. Eighty-six (78.2%) were follow-ups, of which 57 (66%) had systemic autoimmune conditions and 51 (59.3%) were on DMARD and/or biologic therapy; 24 (28%) had active disease or severe symptoms at last visit; 22 (26%) had portal accounts. Among 28 follow-up NS interviewed, 14 (50%) forgot or were unaware of the appointment and 7 (25%) had the wrong date. The most common theme was the request for a reminder (57%). During the intervention, 120/274 (44%) surveyed patients had portal accounts. Of these, 73 (61%) received the email reminder and 72 (99%) found the email helpful. Twenty-two patients learned of the appointment from the email alone. Ninety-six percent of email recipients wanted future reminders compared with 90% of all portal users and 42% of non-portal users. Health portal enrollment did not increase, nor was an overall improvement in appointment attendance observed 4 months into the intervention.

Conclusion: Many NS are patients with systemic autoimmune conditions taking medications that require regular monitoring. Forgetfulness and date mix-ups were the most common reasons for NS. A simple email reminder has demonstrated high patient interest and satisfaction. Patients already enrolled in the portal were more receptive to email reminders, which may relate to increased comfort levels with Internet use. Future interventions could focus on improving patient portal access and addressing new patient NS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-health-portal-enrollment-and-electronic-appointment-reminders-to-improve-appointment-attendance-at-an-academic-rheumatology-clinic/