Date of Award

Spring 5-25-2019

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Michael Terry, DNP, PMHNP, FNP


Background/Objectives: Missed appointments (MAs) are correlated with reduced treatment efficacy, increased financial burden on medical institutions, and early treatment terminations for therapy (DeFife, Conklin, Smith, & Poole, 2010). MAs occur for a variety of reasons including, but not limited to severity of illness, financial/geographic constraints, and forgetting the appointment (Filippidou, Lingwood, & Mirza, 2014). Appointment compliance within outpatient mental health clinics has a wide variance with some clinics reporting MAs ranging from 15% to 50% (Car, Gurol-Urganci, de Jongh, Vodopivec-Jamsek, & Atun, 2013).

With decreasing costs and a subsequent massive increase in mobile phone technology use by the general population, Short Message Services (SMS) has become a new mainstay for direct communication (Brown et al., 2018). Availability of SMS in America is so high that traditionally at-risk populations such as the homeless have access to SMS through the use public outreach programs and prefer SMS reminders (Moczygemba, et al., 2017). These appointment reminders have been implemented in a large variety of clinical settings including, but not limited to outpatient mental health, radiology, physical therapy, and dentistry with each setting experiencing a significant decrease in MAs (Boksmati, Butler-Henderson, Anderson, & Sahama, 2016).

Design: The Iowa model is optimal for this project with interventions tailored to best suite an organization with multiple departments invovled.

Setting: At Outpatient Psychiatric Services-Hillcrest (OPS-H), the MAs rate is 18% among Mental Health Nurse Practitioners (MHNPs) and 33% with therapy appointments. OPS-H uses the Voicevox automatic phone call service reminder for appointments and on September 2018 began mailing patient orientation packets to new patients with driving directions, policy details, and procedure information.

Participants: OPS-H patients seen by PMHNPs and their students for medication management and therapy with both initial intakes and follow-up appointments.

Intervention: University of California San Diego (UCSD) and University of San Diego (USD) Institutional Review Board (IRB) approval were obtained and qualitative statements from PMHNPs and staff regarding attitudes and barriers regarding SMS were gathered. Pre-data collection surveying MAs rates and SMS sign up among PMHNP patients for the previous 8 weeks was conducted.

After pre-data collection was complete, 15 to 30-minute teaching sessions took place with PMHNP, PMHNP students, and front desk staff. Flyers informing about SMS services were posted in patient waiting rooms. Data was collected weekly for a minimum of 8 weeks with an examination of SMS sign up rates and MAs, along with provider/staff SMS compliance with offering SMS to patients. At the end of the data collection, qualitative statements regarding attitudes and responses to SMS were gathered from PMHNP, PMHNP students, and front desk staff. Throughout the project, data was continually collected on secured cloud and local hard drives with continual tallies on Excel spreadsheets. Case identifiers were limited to alpha numeric codes with no personal information attached.

Measurements: PMHNP and PMHNP student patient no show and SMS sign up rates were collected from August to November 2019.

Results: SMS sign ups increased from 23% to 61%, attaining statistical significance. MA rates decreased from 15% to 11%, while approaching statistical significance.

Conclusion: SMS appointment reminders are favorable to the majority of OPS-H patients. SMS is a cost effective and efficient tool to hep prevent MAs or no-shows. SMS can be beneficial toward decreasing MAs or no-shows.

Key Words: SMS, Text-messages, Appointment-reminders, No-shows, Missed Appointments, mobile phones, smart phones.

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