January 11, 2013
Reply by Authors to Mullen on Improving Communication with Low-Income Women Using Today’s Technology, by Nancy J. Cibulka, PhD, RN, WHNP-BC, FNP-BC; Harry W. Fischer, MA; Anna J. Fischer, BFA (March 26, 2012)
Reply to Ms. Mullen:
The authors wish to thank Ms. Mullen for her thoughtful comments and for sharing a strategy to address missed appointments that has been adopted by the state of Arizona. We share her concern about the financial ramifications of missed appointments on clinic systems and the need to look for solutions that will encourage rather than dissuade individuals from attending appointments. Ongoing changes in state Medicaid programs and their contractual agreements with providers present new fiscal challenges on an ongoing basis. As a provider (NJC) of prenatal and well-woman care, we are acutely aware that insufficient or absent care sometimes results in harmful outcomes for mothers, infants, and families that could have been avoided. Newer communication technologies and other solutions will need to be helpful, not punitive, to effectively reduce missed appointments.
In our inner city OB-GYN clinic in Missouri, hospital administration has supported continuation of the text message appointment reminder program, based on the authors’ experience. Pricing for the set-up and continuation of text messaging is becoming more competitive as healthcare systems seek to adopt this innovation, and we are in the process of changing vendors at a substantial cost-savings. Long-range plans include enrolling other clinics (e.g. Medicine, Surgery, Dermatology) and developing the ability for patients to text back if needing to cancel or reschedule an appointment.
Besides effective reminders, we agree that flexibility in scheduling is crucial to appointment attendance. To address this need, the OB-GYN clinic offers a few early appointments for women who wish to be seen before work and a majority of mid-day appointments that are compatible with dropping a child off for school and being home in time to meet the bus. We also offer later appointments for those who need them and for the teen clinic to accommodate those who need to be seen after work or school. Even so, on a daily basis, some women need to cancel an appointment at the last minute and wish to re-schedule the very next day while others call in and ask for an appointment right away. Experience has shown that patients are more likely to keep an appointment if the time from scheduling is short. We are currently developing a strategy to offer same-day appointments, which will help with urgent needs and will also fill the gaps where patients cancelled without much notice. We hope that our new same-day scheduling along with the text-messaging reminders will better meet the needs of our population, encourage attendance at appointments, and improve revenues. Additionally, we intend to continue to monitor the effectiveness of our text-messaging program and look forward to networking with others to develop best practices for implementing new communication technologies to improve healthcare.
Nancy Cibulka, PhD, RN, WHNP-BC, FNP-BC, FAANP
Harry W. Fischer, MA
Anna J. Fischer, BFA, M.P.P