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When it comes to good long-term health outcomes, success depends heavily on patients seeking and receiving the services they need, including annual checkups. Unfortunately, in the post-pandemic era, health care systems across the U.S. are reporting a rise in the number of missed appointments.
A Medical Group Management Association survey found that about 49% of medical groups reported that their patient no-show rates increased since 2021, compared to about 39% who said the rate stayed the same and 12% who noticed a decline.
Patients who fail to keep just one appointment with their primary care doctor are also 70% more likely to overlook a return visit within 18 months, an Athenahealth study found. Additionally, only about 50% of patients with chronic conditions take their medications, according to research published in U.S. Pharmacist.
Given the ongoing need to encourage patients to keep up with their health care routines, providers are using text messages to improve engagement for both primary care and preventative screenings, along with mental health services.
Traditionally, the health care industry has relied largely upon a combination of phone calls and letters for this type of outreach.
However, phone calls are no longer a reliable way to reach people, with 8-in-10 Americans saying they generally won’t answer calls from unknown numbers, according to the Pew Research Center. Meanwhile, letters are expensive and can be slow to reach patients.
Additionally, for large hospital networks, either outreach method requires significant staff time. So, the sector has been working to figure out how to get patients to book appointments for care gaps by figuring out what types of reminders are most effective.
When it comes to no-show rates that have increased (or stayed the same), the top drivers cited in MGMA’s poll were patient concern over cost, lack of transportation to appointments and patient forgetfulness or apathy.
Among respondents with no-show rates on the decline, the main reasons given were implementation of online patient check-in options, reminders by phone, text or email ahead of appointments and limiting patients with a history of no-shows to same-day-only appointments.
Text me
A growing body of research has also shown that text messages can also lead to better patient outcomes.
One such study conducted by Englewood Health found that texting can positively affect compliance when it comes to screenings.
As part of its research, the Bergen County health care network conducted a campaign last year that sought to close care gaps with two-way text message reminders for women overdue for their mammography screenings.
“In the wake of the COVID-19 pandemic, health systems across the country saw patients delay their recommended screenings. Here at Englewood Health, we observed a group of patients who were overdue for their annual mammograms,” said Helene Wolk, chief operating officer of Englewood Health. “The text message campaign was born of a need to close this care gap and get women back in for this lifesaving screening.”
As the second most prevalent and lethal cancer among U.S. women, breast cancer requires effective screening strategies for early detection and better prognosis for treatment. In the U.S., 1-in-every-8 women are affected by breast cancer and one in six cases occurs in women in their 40s.
Despite the fact that mammography has helped reduce breast cancer mortality by nearly 40% since 1990, many women remain overdue for their screening. Almost 60% of women over the age of 40 skip annual mammograms and almost a quarter (23%) say they’ve never had one, an October 2023 survey by MedStar Health said.
These results come as breast cancer diagnoses continue to increase by about 0.5% every year, according to the American Cancer Society, including a nearly 3% increase in younger women under age 40.
Englewood’s research indicates that digital outreach can enhance early diagnosis and patient outcomes in conditions like breast cancer. The campaign, conducted every four to six weeks between June 2023 and December 2023, consisted of texting reminders about screenings and a link to self-schedule an appointment, according to Wolk.
Altogether, 6,069 women were included in the study, which reached respondents at an average age of 59.6, according to the network. Of those women, close to 20% scheduled a breast imaging appointment. As a result of those screenings, breast cancer was detected in 0.5% of those patients, Englewood said.
Pilot’s success
Given the success of the pilot, the system has expanded the initiative to other screenings, such as lung cancer and colorectal cancer.
“It’s still too early to completely measure the outcomes of our new campaigns since we launched them just this year. So far within our lung screening campaign, we’re seeing an over 8% scheduling rate for patients, which is significant at this early stage,” Wolk said.
She went on to praise the program as a “team effort that required the expertise of clinicians, IT professionals, patient engagement specialists and support staff.”
“A campaign of this magnitude requires the leadership and involvement of various departments, both clinical and non-clinical,” Wolk stated.
She continued, “Our success with this campaign demonstrates that through effective digital outreach, by targeting and personalizing our efforts, we can effectively reengage patients in receiving the care they need.”
Patients through Englewood Health typically rely on notifications through the system’s patient portal or mailed letters as reminders for upcoming screenings. According to Wolk, the letters are sent around 30 days before patients are due for a screening.
“What distinguished our campaign’s outreach was not only our utilization of two-way text messaging but also our commitment to personalized engagement and prioritizing patient convenience. With just a few clicks from the text message, patients could easily schedule their mammograms at any of our nearby locations,” she said.
Prior research with similar findings includes a study by NYU School of Medicine that concluded text reminders for breast, cervical and colorectal cancer screenings increased screenings between 0.6% and 15%.
Using a text messaging campaign reduced missed appointments for patients who need primary or mental health care by 7% and 11%, respectively, Kaiser Permanente found. It also decreased same-day primary care cancellations by 6%.
Spreading the word
At Englewood, Wolk said, “When we saw the results of the campaign and the number of women we were able to get back in for their mammograms, we knew we had to share these findings with other leaders in the field of cancer care. Our aim in sharing these results is to contribute to best practices and improve outcomes, not just for our own patients, but for patients across the country.”
More work to be done:
New Jersey is among the best in the nation when it comes to treatment and survival of lung cancer; however, much like the rest of the country, gaps persist in who gets care, according to a report. Click here to read the findings.
In February, the findings were included as a poster presentation at the American College of Surgeons’ ACS Cancer Conference in Austin, Texas.
The conference drew nearly 500 surgeons, allied health providers, program directors and accreditation specialists. It included a special area of focus on quality improvement, using measures to drive those efforts and a step-wise approach to implementing such initiatives.
Centered on the theme “Improving Cancer Care for All,” attendees heard from more than 50 moderators and panelists who provided real-world examples of local and national quality improvement projects, as well as thematic discussions on incorporating health equity into the care of cancer patients, advocacy at both the state and national levels and ways to best engage with key stakeholders when designing a QI project.
Dr. James Gulley, clinical director of the National Cancer Institute and the conference’s keynote speaker, stressed to attendees that while overall survival rates of cancer have improved in recent decades, there remain significant gaps in cancer care. He also emphasized preventative efforts through screening and vaccination, as well as improving access to emerging treatments.
“If we can focus on prevention and early-detection strategies and better treatment for patients with metastatic disease, and we also focus on the efficiency of the system using tools such as AI, we can improve the clinical care for patients as well as the clinical outcomes for patients, and maybe decrease the rate of death,” he said.
