Trial reportJournal of general internal medicine2023
Using Nudges to Reduce Missed Appointments in Primary Care and Mental Health: a Pragmatic Trial.
Trial report in Journal of general internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03850431 (Using Behavioral Economics to Enhance Appointment Reminders and Reduce Missed Visits), which is not on this map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Using Behavioral Economics to Enhance Appointment Reminders and Reduce Missed Visits
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.
- A systematic review and meta-analysis of the effectiveness of social norms messaging approaches for improving health behaviours in developed countries.Nature human behaviour · 2025Pooled it
- Preferences for Personalized Text Message Appointment Reminders Among Outpatients in a Universal Health System: Cross-Sectional Study.Journal of medical Internet research · 2026Article
- Novel Strategies to Reduce Patient No-Show Rates: Single Institutional Study at Jane H. Booker Family Health Center.Cureus · 2026Article
- What are we missing? Reflections on the 'problem' of missed appointments in the UK.NIHR open research · 2026Article
- Using a cash transfer plus SMS nudge package to improve the wellbeing among caregivers of adolescents living with HIV during the COVID-19 epidemic in South Africa: A pilot randomised controlled trial.PLOS global public health · 2025Article
- Understanding the causes of missingness in primary care: a realist review.BMC medicine · 2024Review
- Cross-sectional analysis of primary care clinics' policies, practices, and availability of patient support services during the COVID-19 pandemic.BMC health services research · 2024Article
- Causes of Patient Nonattendance at Medical Appointments: Protocol for a Mixed Methods Study.JMIR research protocols · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMissed appointments ("no-shows") are a persistent and costly problem in healthcare. Appointment reminders are widely used but usually do not include messages specifically designed to nudge patients to attend appointments.
objectiveTo determine the effect of incorporating nudges into appointment reminder letters on measures of appointment attendance.
designCluster randomized controlled pragmatic trial. PATIENTS: There were 27,540 patients with 49,598 primary care appointments, and 9420 patients with 38,945 mental health appointments, between October 15, 2020, and October 14, 2021, at one VA medical center and its satellite clinics that were eligible for analysis.
interventionsPrimary care (n = 231) and mental health (n = 215) providers were randomized to one of five study arms (four nudge arms and usual care as a control) using equal allocation. The nudge arms included varying combinations of brief messages developed with veteran input and based on concepts in behavioral science, including social norms, specific behavioral instructions, and consequences of missing appointments. MAIN MEASURES: Primary and secondary outcomes were missed appointments and canceled appointments, respectively. STATISTICAL ANALYSIS: Results are based on logistic regression models adjusting for demographic and clinical characteristics, and clustering for clinics and patients. KEY
resultsMissed appointment rates in study arms ranged from 10.5 to 12.1% in primary care clinics and 18.0 to 21.9% in mental health clinics. There was no effect of nudges on missed appointment rate in primary care (OR = 1.14, 95%CI = 0.96-1.36, p = 0.15) or mental health (OR = 1.20, 95%CI = 0.90-1.60, p = 0.21) clinics, when comparing the nudge arms to the control arm. When comparing individual nudge arms, no differences in missed appointment rates nor cancellation rates were observed.
conclusionsAppointment reminder letters incorporating brief behavioral nudges were ineffective in improving appointment attendance in VA primary care or mental health clinics. More complex or intensive interventions may be necessary to significantly reduce missed appointments below their current rates. TRIAL NUMBER: ClinicalTrials.gov, Trial number NCT03850431.
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