./tpl/new_commands Effectiveness of Email Reminders to Reduce Outpatient Non-attendance: A Quasi-Experimental Study in a Urology Department

Introduction Non-attendance at scheduled medical appointments implies negative consequences for both healthcare systems and individual patient health. An email reminder system that includes a link to easily cancel appointments was implemented. The objective of this study is to evaluate the effectiveness of this tool to reduce non-attendance. Methods We conducted a retrospective, quasi-experimental before-and-after study using two complementary analytical approaches: an individual-level analysis of scheduled appointments and an aggregated interrupted time series (ITS) analysis by epidemiological weeks. All consecutive adult urology appointments from twelve months before the implementation (July 2021) to twelve months after (March 2024) were included. Appointments scheduled before the intervention were considered unexposed, while those scheduled afterward were considered exposed. We used logistic regression for individual-level and segmented Poisson regression for aggregated ITS analysis. Results A total of 272,331 appointments corresponding to 73,387 individuals were analyzed over 144 epidemiological weeks. In the main individual-level analysis, the non-attendance percentage was nearly 3% lower in the exposed group. The adjusted odds ratio for the effect of the reminder on non-attendance was 0.76 (95% CI 0.73 - 0.81). In the ITS analysis, segmented regression confirmed an immediate 13% drop at intervention (Relative Risk 0.868, RR), and a post-intervention decline of 0.4% per week (RR 0.996). Sensitivity and subgroup analyses yielded similar results. Conclusions We observed a consistent association between the reminders and the reduction in non-attendance percentages for urology appointments, both in the individual-level and aggregated analyses.