In 2015 and 2016 around 7.5m NHS outpatient appointments were missed in England (6.6% of the total 113m). Missed appointments can lead to worse care for patients, inefficient use of staff and increased waiting times. While it is difficult to establish the exact financial cost of missed appointments, an estimate by the National Audit Office in 2014 suggests that missed first outpatient appointments cost the NHS up to £225m between 2012 and 2013. Hospitals often put in place coping measures, such as overbooking, but these can introduce further problems, and are not a sustainable solution.
Message Dynamics has a well-established Telecare system that uses simple voice and text messages to patients to enhance treatment adherence. It is an Outpatient Monitor Service (OMS), supported by two separate elements: an automated telephone follows up call using interactive voice response and a smartphone survey. The rationale behind the OMS is to use tailored patient feedback to monitor patients’ conditions remotely and to inform the decision as to whether a physical outpatient appointment is likely to be required.
This study explored the impact of the OMS on clinical and economic outcomes compared with standard care (i.e. historical patients who did not have access to the OMS). The evaluation focused on three gynaecological procedures at Gynaecology Department at the Royal Free Hospital, including gynaecology intervention (i.e. definitive interventions leading to discharge back to the patient’s GP); hysteroscopy; and ongoing treatment of vulval disease.
The objectives of the projects were:
- To identify if the OMS reduces the number of follow-up appointments and if so, by how much. In addition, the evaluation assessed the impact of the MS on DNA rates.
- To identify if the OMS reduces the costs for follow-up visits and missed appointments.
Clinical and economic outcomes data were triangulated with patient perception and satisfaction data to collaborate trends in results and assess whether reduced numbers of (i) follow-up appointments (ii) DNA rates and (iii) costs were accompanied by patient perception of, and satisfaction with, the OMS.