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 Table of Contents  
Year : 2017  |  Volume : 51  |  Issue : 3  |  Page : 173-176

Implication of auto-generated message reminders system (software) and rate of absenteeism in orthodontic clinic: A randomized controlled trial

1 Reader, Department of Orthodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India
2 Associate Prof., Department of Oral Surgery, Government Dental College, Aurangabad, Maharashtra, India
3 Prof. Head, Department of Orthodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India
4 Senior Lecturer, Department of Orthodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India

Date of Submission15-Nov-2016
Date of Acceptance30-May-2017
Date of Web Publication17-Jul-2017

Correspondence Address:
Siddharth Sonwane
57B Empress Mill Colony, Rameshwari Road, Nagpur, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jios.jios_157_16

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Context: Absenteeism is a routine pattern of nonattendance from duty of responsibilities, nonattending to given appointment may have deleterious effect on treatment outcome and revenue generation. Very few studies have been done to know the effect of absenteeism on revenue generation and treatment outcome with the help of postcard, telephone, and text messages as reminder; however, these studies have concluded that there was statistically significant difference found in treatment outcome and revenue generation. Furthermore, our study is the almost first to present with the use of current available reminder tool (software reminder system). Aims: The aim of this study to implicate and evaluate effects of auto-generated message reminder (easy dental software application) and previous visit reminder system. Materials and Methods: The sum of 180 patients was selected and divided 90 patients in each group. (1) Study group (Auto-generated message reminder system), (2) control group (previous visit remainder). Auto-generated messages were sent to the study group. No formal information given to control group. Statistical Analysis Used: Student's t-tests were used to compare two groups, and logistic regression was obtained 0.044. Results: In control group, 20% of total sample found to be absent whereas only 10% found to be absent in study group. Student's t-test and logistic regression were seen (P = 0.044). Conclusion: The use of auto-generated message reminder system (easy dental software), reduces the rate of absenteeism and increases clinic economy, proper results with stipulated period, and protect both clinician and patients from unwanted complications.

Keywords: Auto-generation, missed absenteeism, reminders, revenue

How to cite this article:
Sonwane S, Shweta R K, Kumar B S, Rajput D. Implication of auto-generated message reminders system (software) and rate of absenteeism in orthodontic clinic: A randomized controlled trial. J Indian Orthod Soc 2017;51:173-6

How to cite this URL:
Sonwane S, Shweta R K, Kumar B S, Rajput D. Implication of auto-generated message reminders system (software) and rate of absenteeism in orthodontic clinic: A randomized controlled trial. J Indian Orthod Soc [serial online] 2017 [cited 2019 May 25];51:173-6. Available from: http://www.jios.in/text.asp?2017/51/3/173/210904

  Introduction Top

Absenteeism (is a routine pattern of nonattendance from duty of responsibilities), can be defined as gauge of insufficient individual performance, resulting in breach of contract between doctor and patient. Remain absentee during orthodontic treatment results in poor treatment outcome and reduce revenue generation.[1] The UK National Health Service survey on absenteeism reports that 15%–30% absenteeism may cost over ≤600 million per year.[2]

Various studies have been suggested that most acceptable etiology for absenteeism could be illness, forgetfulness, transport difficulties, and other commitments such as examination, field trips, and sports activities.[3] However, University of Belfast was first to investigate and confirm rationale suggested were true; furthermore, also suggested that rate of absenteeism can be reduced by means of rescheduling the appointments with vacant slots.[4]

Rescheduling of appointment with vacant slots may often increase waiting time, underutilization of equipment, reduced appointment availability, reduced patient satisfaction, may resulting into disruption of patients and doctor relationship.[5]

Various majors have been taken to reduce rate of absenteeism such as postal cards, telephone, e-mail reminder, and text messages were used. In this 4G era, these methods are outdated and to maintain separate hospital staff member has to be recruited, hence it is most common disadvantage likely to be forget to send reminders.[6]

The aim of this study is to evaluate and differentiate between telephony call reminder and computer-generated reminder system.

  Materials and Methods Top


Essay dental application is a computer-based application that automatically sends messages to patients on their upcoming appointments. This computerized scheduling system automatically saves patient data and appointment information. It uses an interactive messages response technology to send messages as a reminder to patients 4–7 days before their scheduled appointment. The message conveys the appointment time and instructions for the patient to call the clinic for confirmation or rescheduling or cancellation of appointment if required.

Patient population

The inclusion criteria for this study were the patients receiving their fixed orthodontic treatment, with at the end of leveling and alignment, retraction yet to start and new nonextraction cases.

Exclusion criteria

Whereas, fixed orthodontic cases at finishing and leveling stage, new cases with extractions treatment planning. We have shortlisted the patients undergoing orthodontic treatment from 15th June 2014 to 15th June 2016.

Sample selection

Totally, 90 patients into each group were registered. Patients were categorized into the study group and the control group. During randomization, alternating 1 month period, each patient to receive automated appointment reminders (“study” group) versus the patient informed on their previous visit, with no formal appointment reminder (“control” group). Patients were advised to confirm their time telephone, once computerized reminder appointment messages were delivered. During attendance in clinic, their confirmed telephone numbers were recorded.

The obtained data were analyzed with appropriate statistical analysis and the t-test applied to evaluate the influence of (i) computerized reminder appointment messages, (ii) the patient informed on their previous visit, as per [Flow Chart 1].

  Results Top

Among 200 registered appointments, 180 were appropriate for randomization: 90 in the previous visited day reminder and 90 in the auto-generated computer message reminder. Among the 180 analyzed appointments, 68% came from previous visited day reminder group and 89.6% auto-generated computer message reminder group. Both were comparable in term of patients' age and gender and of orthodontic treatment professionals' profile [Table 1]. During the interventions, the overall rate of missed appointments in the division was 20%, with higher rates in the substance abuse unit (20%) than in the general primary care (10%) clinic [Table 2].
Table 1: Basic categories in sample with mean age and gender

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Table 2: Rate of absentees and distribution as per gender

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The rate of missed appointments was significantly differentiable in previous visited day reminder group (20%) and in the auto-generated computer message reminder group (10%). It is found that auto generated computer message reminder method was more effective in reducing missed appointments than the previous visited day reminder method in the orthodontic clinic. The advantages of using auto-generated message reminders were observed over the entire duration of the study in the aspect of cost generation to clinician [Figure 1].
Figure 1: Overall comparison between Group I and II

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Similarly, the rate of cancelled or rescheduled appointments by previous visited day reminder method, the day before and the day of the appointment was 20% in which 17% cancelled appointments and 3% rescheduled their appointments. Whereas, in the auto-generated computer message reminder group, it was only 10% in which, 7% cancelled appointments and 3% rescheduled appointments.

In comparison, the rate cancellations were found to be more in previous visited day reminder group which was 17%, and 7% auto-generated computer message reminder group, statistically higher in previous visited day reminder group thus logistic regression value give (P = 0.044). The rates of rescheduled consultations were same in both settings and in both the telephone and text messaging groups (3%).

Auto-generated computer message reminder was more effective in reducing the rate of missed appointments with cost-effectiveness. However, in comparison income generated and usage of internet and operator cost, only days in a month was used which is always profitable than previous visit reminder where investment zero with the loss of cost.

In the time span of 1 year (14 visits), gradually patients were responding more towards auto-generated computer message reminder than previous visit reminder with the most common reason of missing appointment was forgetfulness.

  Discussion Top

In our study, duration most significant outcome was the increase patient's response to both modes of reminders. However, doubled response was seen in auto-generated message reminder system shown than previous visit reminder group.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10]

Obtained results confirmed that usage of auto-generation of message reminder acts as most effective tool in reducing absenteeism in orthodontic clinics, increase financial status of orthodontist; hence, our study recommends utilization of auto-generation of message reminder system. Furthermore, this system reminds 4–7 days before the appointment, hence, patients can easily remember and attend clinic.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16]

In both previous visit reminder system and auto-generated message reminder system, 20% and 10% patients were absent, respectively. Among these female patients were more in compare to male, and the reason was forgetfulness, examinations, illness, transport, rarely, and few non-receiving messages.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19]

The degree of rise in the reserved appointment rate was fairly less than as reported in other studies. In our study, all age group were included while most of the other studies were age specific. The most important reason of degree rise in reserved appointment was technical error which leads to failure of system to auto-generate and deliver messages other reasons were incorrect phone number or receptionist failed to re-schedule.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20]

Cost-effectiveness and net profit are more seen in auto-generation of message reminder system than previous visit reminder. Although previous visit reminder system is free of investment absenteeism was seen to be more in comparison with auto-generation of message reminder system group.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21]

After considering the causes of failure of auto-generation message reminder system, we found it act as effective mode of reminder communication system for drastically reducing the number of absenteeism in clinic. Quattlebaum et al. reported that with improved system function, familiarity, auto-generation of message reminder system highly effective in reducing outpatient absenteeism.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23]

Our study limitation was including all age groups undergoing orthodontic treatment as a diverse range of patients visited for orthodontic treatment. Only 90% of populations were approachable in network to connect through auto-generated message reminder system. Among 90% only 50% of patients were approachable every time. Furthermore, this studies can be applied over large population with specific age, gender, stage of treatment, are the future scope for the study.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24]

The use of auto-generation message reminder system in our study helped us in rescheduling the cancelled appointments, resulting into increase in net revenue generations. The verdict to execute such a system in our practice would have to be made area and site specific basis. The cost of executing this system in our study was not insignificant; about Rs 22,000/- initially and an expected Rs 8000/- a year for maintenance and upkeep. We generated net profit is Rs 22, 40,000/.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25]

  Conclusion Top

Absenteeism in orthodontic clinic has a deleterious effect on orthodontic treatment outcome and drastic reduction in orthodontist's revenues. Several studies have concluded that reminder through postal card, phone call, text messages have reduced rate of absenteeism in appointments.

The implication of auto-generated message reminder software system has modest effect on the rate of absenteeism and revenue generation.


The authors would like to thank Mr. Gaurav Tiwari, CEO, Mansarovar Institutes of Dental College, Bhopal, Madhya Pradesh, India

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1]

  [Table 1], [Table 2]


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