Does an encouraging letter encourage attendance at psychiatric out-patient clinics? The Leeds PROMPTS randomized study

Talbott, J. A. MD

Kitcheman J, Adams CE, Pervaiz A, et al (Univ of Leeds, UK; Univ of Nottingham, Duncan MacMillan House, Nottingham; St. Luke's Hosp, Huddersfield; et al) Psychol Med 38:717-723, 2008

Year Book of Psychiatry & Applied Mental Health 2009:p 163-164, 2009.

Background.

The aim was to reduce non-attendance for first-time consultations at psychiatric out-patient clinics.

Method.

The study was a pragmatic randomized controlled trial; the setting was seven inner-city UK out-patient clinics in Leeds. The participants were 764 subjects of working age with an appointment to attend a psychiatric out-patient clinic for the first time. The intervention was an ‘orientation statement’ letter delivered 24–48 h before the first appointment compared with standard care. The primary outcome measure was attendance at the first appointment; secondary outcomes included hospitalization, transfer of care, continuing attendance, discharge, presentation at accident and emergency and death by 1 year.

Results.

Follow-up was for 763 out of 764 subjects (>99%) for primary and for 755 out of 764 subjects (98.8%) of secondary outcome data. The orientation statement significantly reduced the numbers of people failing to attend [79 out of 388 v. 101 out of 376 subjects, relative risk 0.76, 95% confidence interval (CI) 0.59–0.98, number needed to treat 16, 95% CI 10–187].

Conclusions.

Prompting people to go to psychiatric out-patient clinics for the first time encourages them to attend. Pragmatic trials within a busy working environment are possible and informative.