Digital health solutions for reducing the impact of non-attendance: A scoping review

Abstract

Objectives: Non-attendance is a significant source of waste in contemporary healthcare systems and can contribute to lengthened waiting lists, and limited appointment accessibility for patients. This scoping review aimed to systematically examine the scope of evidence regarding digital health interventions that have the potential to reduce the impact of non-attendance at scheduled outpatient appointments. Methods: Four databases were searched from 01 January 2010 to 15 February 2023. This review included studies that report on implementing one or more digital solutions to reduce the impact of non-attendance in the outpatient setting. Data was extracted on whether the implementation of the digital solution led to a reduction in non-attendance or improvement in a non-attendance metric, as well as the reported costs and cost-effectiveness of solutions where available. Results: Of the total of 3,730 records, 55 articles were included in the analysis. These papers reported on automated reminder systems (n=24), prediction models coupled with a targeted intervention (n=4), telehealth (n=21) and booking systems (n=6). The effectiveness of the digital health-related solution was seen across several studies: 12 reminder systems, 3 prediction models, 14 telehealth, and 6 booking systems. Only nine studies reported costs and one study reported cost-effectiveness. Conclusions: While reminder systems were the most commonly investigated intervention in the field, there is emerging evidence to support other digital health-related solutions that have the potential to reduce the impact of non-attendance across outpatient healthcare settings. Further investigations of these emergent technologies, including economic evaluations, are needed to provide appropriate policy and practice guidance. Public interest summary: Non-attendance (situations where a patient fails to attend scheduled appointments at the specified time without advanced cancellation or rescheduling) is considered a significant source of resource waste in healthcare systems. Several strategies have been trialled with varying degrees of success to address non-attendance, with some strategies being cost-inefficient, labour intensive, and resulting in poor patient experience. Digital health technologies are evolving at a rapid pace and providing new opportunities to reduce the impact of non-attendance at scheduled appointments. This review identifies digital health solutions for reducing the impact of non-attendance described in literature, research evidence on the effectiveness of these solutions, and the extent to which costs and cost-effectiveness of these solutions have been examined and reported. The study highlights the potential for emergent technologies to be used to reduce the impact of non-attendance and the need for further investigations to provide appropriate policy and practice guidance.