What reduces missed appointments: the evidence
What a systematic review found about reminders, timing, fines and rewards for missed appointments, and how the Healthcare pack's e-mail reminders fit.
By Achekam · · 4 min read · For Healthcare businesses in South Africa, Nigeria, Kenya
Launching soon. The Industry CRM add-on described in this article is launching soon. This article describes it as it will work at launch.
Every practice has a theory about missed appointments. Some receptionists swear by a phone call the day before; some doctors want a fee for every no-show; some practice managers believe nothing works and simply overbook. Each theory has a cost, in staff time, in patient goodwill or in empty consulting rooms, and most are never tested.
There is, however, real evidence on what works. A 2023 systematic review published in BMC Health Services Research pulled together the research on interventions to reduce missed appointments. This article sets out what it found, in plain terms, and then explains how the reminders in the Healthcare pack of Achekam's Industry CRM fit with that evidence, including where they fall short of it.
What counts as a no-show
The review defines a no-show as when a patient does not present for a scheduled appointment and did not cancel ahead of time. The definition matters for a practice's own records: a patient who phones in the morning to cancel is not a no-show, even if the slot goes unused. If you want to know whether reminders are working, record no-shows and late cancellations separately.
Reminders work, across channels
The review looked at 61 studies and found significant evidence that appointment reminders, whether sent by SMS, telephone or mail, reduce no-shows across various outpatient care settings.
The detail is worth knowing:
- Mailed reminders increased kept appointments in all five studies that tested them.
- SMS reminders significantly reduced non-attendance in 15 studies, while four found no reduction.
- Telephone reminders come with a twist: the review notes one study finding that phone reminders may decrease no-show rates while at the same time increasing cancellations.
That last point is not necessarily bad news. A patient who cancels in advance frees a slot that can be offered to someone else; a patient who simply does not arrive wastes it.
Timing: a day or a few days ahead
The review reports that reminder timing in the studies ranged from two hours to two weeks before the appointment, with most studies sending reminders one to three days before. There is no single proven moment, but one to three days ahead is where most of the evidence sits. It is close enough that the patient remembers, and early enough to rearrange the day or to cancel in good time.
Naming the cost, and the thin evidence on fines and rewards
The review cites work by Hallsworth and colleagues finding that reminder messages are more effective when they state the specific cost of a missed appointment. A message that says a missed slot costs the practice, or another patient, something concrete gives the patient a reason to act, rather than just a date.
On penalties and incentives, the evidence is much thinner. The review reports one study finding that fining patients DKK250 (€34) for non-attendance did not appear to reduce non-attendance, and another finding that $15 gift-card incentives were associated with improved attendance (OR 1.94). It notes that the evidence on incentives and penalties rests on only two studies. A practice that introduces a missed-appointment fee should not assume, on this evidence, that the fee will cut no-shows; it may still be fair to charge one for the lost time.
The full review, behavioural economic interventions to reduce appointment non-attendance, sets out the studies, methods and findings on reminders, timing, fines and incentives.
How the Healthcare pack's reminders fit
The Healthcare pack in Achekam's Industry CRM reminds patients by e-mail, two days before an appointment. That timing sits within the one-to-three-day window where most of the studies placed their reminders.
The limits need saying just as clearly. Industry CRM reminders go by e-mail and in-app only, with no SMS or WhatsApp. E-mail is not one of the channels the review singles out: its evidence covers SMS, telephone and mail. A practice whose patients read e-mail reliably may do well with it; a practice whose patients mostly rely on SMS or WhatsApp should keep its existing SMS or phone reminders running alongside.
Two further points about how reminders behave:
- Off until switched on. Each customer reminder stays off until a workspace administrator switches it on. A practice that expects reminders to go out from day one needs to turn them on deliberately.
- Once only, with a daily cap. Each reminder is sent at most once, and reminders are limited by a daily cap. They will not pester a patient, and they will not flood the outbox on a heavy clinic day.
Because the review found that naming the cost of a missed appointment makes reminders more effective, it is worth writing the practice's own reminder wording with that in mind: a short line saying that a missed slot is one another patient could have used. Setting the e-mail reminders up is covered in appointment reminders by e-mail.
Charging for a missed appointment
Where the practice's policy is to charge for a missed appointment, the fee is billed with the invoices Achekam already provides. A business creates customer invoices as drafts it can change or delete, so a missed-appointment fee can be prepared and reviewed before it is sent; issuing one takes the next number in its sequence and posts it to the ledger. Whether to charge or waive the fee in a particular case is covered in charging a missed-appointment fee, or waiving it.
Testing it in your own practice
Count no-shows and late cancellations separately for a month before you change anything. Then switch on the reminders, add a line about the cost of a missed slot, and count again for the following month. Your own figures, set against the review's findings, will tell you whether e-mail is enough for your patients or whether SMS or phone calls need to stay.
General guidance only, not advice on your own circumstances. Tax and payroll rules change: check the current position with the authority or your adviser.
