‘Simple reminder’ reduces telehealth no-shows among older adults by 33%
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New research suggests a letter may be all that it takes to lower the number of telehealth no-shows among older patients, even during a pandemic.
Sarah King, MD, a fellow at a geriatric clinic affiliated with Boston Medical Center, told Healio Primary Care that “despite the fact that patients did not have to physically come into the clinic, we still had a high proportion of telehealth visits for which we were unable to contact our patients.”
King and colleagues set a goal of reducing the number of telehealth no-shows at their clinic by 25% in 3 months. They interviewed patients about obstacles to telehealth and their “preferred method of visit reminders.”
According to the researchers, some common themes emerged, including the fact that patients often missed reminder phone calls, physicians did not call at the exact appointment time and that patients favored reminder letters. Thus, the clinic began a new policy of sending patients a reminder letter 2 weeks before a scheduled telehealth visit.
“The letter was a very simple reminder, stating ‘You have an upcoming telehealth visit with your doctor’ and included the date and a range of time that the provider would call, typically a 30-minute period,” King said in the interview.
According to the researchers, during the 8 weeks prior to the intervention, the clinic’s telehealth no-show rate was 13.6% compared with the in-person no-show rate of 7.8%. Six weeks into the intervention, the telehealth no-show rate dropped to 9.1%, and the in-person no-show rate declined to 7.3%. Overall, the researchers said their intervention was associated with a 33.1% drop in the telehealth no-show rate and an 8% drop in the no-show rate for in-person visits.
“The clinic staff for the most part were ok with this change and we were able to arrange the schedule so that they would print and mail all letters on Friday afternoons to all patients for the following week. I think that some have time set aside for this task made this a more accepted and sustainable change,” King continued. She was not aware of any negative feedback from patients about the reminder letters.
“It is important to evaluate ways to improve telehealth access moving forward, as this is an important tool to help reach out to patients who may have difficulty coming into the clinic and may not need to come in as frequently,” King said.
Some of the telehealth services that CMS allowed during the pandemic have become permanent fixtures. However, a review published in February pointed out that telehealth does not necessarily “cater to the needs of older people with specific physical and cognitive limitations,” and a JAMA study published in 2018 showed that 38% of all older adults in the United States were not ready to engage in telehealth visits.
References:
Doraiswamy S, et al. Int J Environ Res Public Health. 2021;doi:10.3390/ijerph18041755.
Lam K, et al. JAMA Intern Med. 2020;doi:10.1001/jamainternmed.2020.2671.
Perspective
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Andrea Wershof Schwartz, MD, MPH
Telehealth offers an incredibly important resource for older adults, particularly those with limited mobility or cognitive impairment for whom getting to the clinic could pose a challenge. Dr. King and colleagues’ abstract offers an important reminder that small interventions can improve continuity and access to care among geriatric clinic patients.
In my own clinic, we were able to greatly improve our no-show rate by offering telehealth to older adults for whom leaving the home is a difficult endeavor or are reliant on others for travel, and telehealth has provided an important option during the COVID-19 pandemic to avoid exposures. Nationwide, Veterans Affairs has a program called Digital Divide in which veterans who meet certain criteria are sent a broadband-enabled tablet device that will help them connect for their telehealth visits. Programs like this help overcome some of the social determinants of health that serve as barriers to engagement with telehealth among older adults.
There is a tremendous heterogeneity of telemedicine use among older adults, some of whom are using technology as part of their work or as part of their daily lives, and some of whom have more difficulty in using it. A recent study found that 13 million older adults — or 38% of all older adults in the United States – were not ready to engage in medicine visits in 2018, while another recent study found access and confidence were among the barriers to more older adults using telehealth.
What is so important about King and colleagues’ study is that it was really an attempt to make the telehealth experience parallel to the in-person clinical experience that patients have come to expect. The general idea of having a similar reminder structure to make sure that that the person is available when it is time for the appointment is really critical, especially for an older person with cognitive impairment. These patients may need that extra reminder for the telehealth appointment when there is no one showing up to pick them up to bring them to an in-person appointment.
Though there are some things that cannot yet be accomplished over telehealth, when used appropriately it is a valuable tool for increasing access to care among older adults. The study also shows that small patient-centered changes such as a structured reminder system can help telehealth be better integrated into regular care for older adults and improve access to health care.
References:
Hawley CH, et al. J Am Geriatr Soc. 2020;doi:10.1111/jgs.16845.
Lam K, et al. JAMA Intern Med. 2020;doi:10.1001/jamainternmed.2020.2671.
System Director, Aging and End of Life Theme, Harvard Medical School
Associate fellowship director, Harvard Multicampus Geriatrics Fellowship
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