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Am Fam Physician. 2013;88(1):20-21

Author disclosure: No relevant financial affiliations.

Clinical Question

Do text message reminders improve attendance at health care appointments?

Evidence-Based Answer

Text message reminders increase attendance at health care appointments compared with no reminders or postal reminders. They are as effective as telephone call reminders but are less expensive. (Strength of Recommendation: C, based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series.)

Practice Pointers

Missed appointments are a significant problem for patients and physicians. They delay needed health care and increase medical costs. Common reasons for missing health care appointments include forgetting the appointment (49%), having an inconvenient appointment time (30%), and attempting to cancel an appointment (30%).1 Telephone calls and postal mail have been used to send reminders to patients about appointments.

The advantages of text messaging include low cost, immediate transmission, relatively high privacy, and less intrusiveness.2 Text messaging could represent an effective, low-cost medium for sending appointment reminders.

In a meta-analysis of four randomized controlled trials involving 3,547 participants (mean age range = 33 to 57 years), the authors of this Cochrane review found that text message reminders increased attendance at health care appointments compared with no reminders (risk ratio = 1.10; 95% confidence interval, 1.03 to 1.17). One study showed that adding text message reminders to postal reminders increased attendance compared with using postal reminders alone (risk ratio = 1.10; 95% confidence interval, 1.02 to 1.19). Text message and telephone call reminders had a similar impact on attendance, although the cost per text message reminder was lower. In two studies, the relative cost of text message reminders per attended appointment was only 55% to 65% of the cost of telephone call reminders.

Limitations of the review included the small number of studies and their low to moderate methodologic quality. None of the studies measured harms or adverse effects of text messaging, such as loss of confidentiality and security of medical information. In addition, no evaluation of health outcomes or user satisfaction was performed.

This Cochrane review shows that text message reminders can improve appointment attendance at a lower cost than postal and telephone call reminders. High rates of text messaging across all socioeconomic groups suggest that most patients have access to this communication modality.2 However, there is a significant age disparity in text messaging use; adults 18 to 29 years of age use text messaging 23 times more often per day than those older than 65 years.3 Text messages sent to the wrong patient based on incorrect or outdated contact information could create confidentiality problems.4 Further high-quality studies that address the concerns about text message reminders are needed.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at

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