Behaviourally informed, patient-led interventions to reduce missed appointments in general practice: a 12-month implementation study

Abstract

Abstract Background Scalable, positive, behaviourally informed interventions may help people remember to attend their primary care appointment or cancel in good time, but have not yet been implemented long term. Aim To examine effects of social norms and making active commitments on missed and cancelled appointments in primary care over 12 months and explore implementation factors. Design and setting A mixed-methods design evaluation and implementation study led by a Patient Participation Group (PPG) member in a large GP practice in the West Midlands. Methods Following a 6-month baseline, waiting room notices were redesigned to emphasise positive social norms for desired behaviours. When booking appointments, receptionists were trained to invite patients to (i) verbally actively commit to cancelling if needed; (ii) write down their own appointment details. Monthly missed appointments (MAs) and cancellations were statistically compared with baseline averages and seasonally equivalent months. To explore implementation, reception staff completed a knowledge, attitude, and behaviour questionnaire at 9 months, analysed descriptively. Study team field notes were thematically analysed. Results Across 12 intervention months there was a mean of 37.67 fewer MAs per month (20% reduction) and 102.66 more cancellations (21.07% increase) compared with 6-month baseline means [MAs t(11) = −6.15, P < 0.001; cancellations t(11) = 3.637, P = 0.004] with statistically significant differences in seasonally equivalent months [MAs t(5) = −4.65, P = 0.006; cancellations t(5) = 3.263, P = 0.022]. Receptionists (n = 12) reported implementing the strategies except when facing pressures; knowledge and attitudes varied. Conclusions Behaviourally informed interventions reduced primary care MAs longer term; PPGs and practice teams can work together on quality improvement projects with support from leaders to prioritise and embed new practices.