Background: Globally, non-adherence to healthcare appointments (NAHA) remains a challenge in outpatient clinics. In pediatric outpatient settings in the United States and locally, NAHA presents a significant financial burden to the patient and clinician, exposes vulnerable children to huge health risk, and reduces clinic productivity and efficiency. It has been reported that the implementation of text message (TM) reminders has been shown to enhance scheduled appointments adherence rates in outpatient pediatric settings. Therefore, NAHA rates of 18% to 22% at Baybol pediatric warranted a need for a different appointment reminder from its routine telephone call reminders. Evidence-Based Frameworks: The use of TM reminders to reduce NAHA will be guided by an evidence-based practice (EBP) model and theory. For this project, the Iowa Model of EBP was used to introduce, develop, and evaluate the appointment reminder change, while the Health Belief Model explained changes in health-related behaviors. Methods: This was a quality improvement project (QIP) with two objectives: (A) reducing no-shows by 2% and (B) establishing a reminder system that was cost effective to the clinic. A review of current literature involving the use of TM reminders compared to other modes of reminders had shown improvements in NAHA rates and proven to be more cost effective. The process involved data collected during the first two weeks of implementation with TM reminders and the last two weeks of post-implementation with the clinic’s routine phone calls from November 13th to December 9th 2017, with both data compared to the pre-implementation data of the corresponding periods in 2016. A two-item questionnaire was used to evaluate the overall effect on adherence rate by understanding how helpful the text message reminder was and what time frames were preferenced by parents. The outcome was aimed at a reduction in NAHA rates. The results will be used as evidence that TM reminders decreased NAHA and are most preferable to phone call reminders. Results: Following the implementation of TM reminders, there was an overall reduction of NAHA rates by 5%. Conclusions/Recommendations: NAHA is a global issue. This QIP showed TM reminder can enhance appointment attendance to improve service delivery and to improve profitability for the clinic. Recommendations with opportunities to improve are focused on correctly entering phone data in scheduling database and used a good timeframe suitable for parents, before implementing an automated TM reminder system. The potential financial benefit realized can improve patient-provider relationship. Further studies involving a larger population over an extended time are needed.
