What Will Reduce the No-Show Rate for Addiction Intakes?

By BRENDA J. WRIGHT, NANCY J. SMYTH and ELAINE M. MACCIO

Published September 2000

A study conducted at the Research Institute on Addictions by Paul Stasiewicz, Ph.D. and Robert Stalker, CSW(1) found that: 

• More than 70 percent of clients scheduled within 48 hours of initial call will keep their appointments. 
• Only 53 percent of clients scheduled outside of 48 hours of initial call will keep their appointments. 
• Reminder phone calls or mailings do not improve adherence rates if appointment is not within 48 hours.

What Does This Suggest for Practice? Optimally, intakes should be scheduled within 48 hours of the client's initial phone call. Reminder phone calls and letters are probably not the best use of your resources. However, this is only one study and it's possible that additional research might come up with some different findings. If you're a true skeptic, you can also try carrying this study at your own clinic (great project for a student intern) to see if the results apply. 

Study Summary: Individuals who were scheduled for their first appointments within 48 hours of the initial telephone call (Group 1) were more likely to keep their appointments than those who had to wait more than 48 hours. Those who had to wait longer than 48 hours were provided with reminders via phone call (Group 2) or mailed brochures and appointment card (Group 3). These latter two groups fared no better than those who received no reminders (Group 4). See attached Research In Brief from the Research Institute on Addictions. 

What Others Have Said about Pretreatment Dropout.

From their review of the literature, the authors found that few articles addressed factors beyond socioeconomic variables, such as age or race. The few studies tracking treatment system factors found that fewer days between initial phone intake and first visit lead to higher adherence rates. 

What Makes This Study Different?

The unique approach of the present study is its inclusion of a reminder mailing (Group 3) to the client, an intervention never before examined. In addition, phone call reminders (Group 2) and no-contact control (Group 4) groups were also compared with appointments set within 48 hours (Group 1). 

The Nuts and Bolts of It.

Who: One hundred twenty-eight persons called the Clinical Research Center (CRC), the outpatient alcohol and substance abuse treatment facility of the Research Institute on Addictions (RIA) seeking counseling. Most participants were male, white and employed, and almost half had undergone previous substance abuse outpatient treatment. 

What: Participants were randomly assigned to one of the four groups (see designations above) following a brief telephone intake interview. 

How: Number of hours between initial phone intake and time of first appointment were recorded for participants in each group. Then, appointment adherence was noted and compared with the corresponding time difference. 

And What Were the Results?

Clients scheduled within the first 48 hours of the initial phone intake were significantly more likely to show up for their appointments than any other group. For clients scheduled after more than the 48 hours, those in the no-contact control kept their appointments almost as often as their mailing and phone reminder counterparts. 

Therefore, there was very little difference in adherence whether the client received a brochure or appointment card reminder, a reminder phone call, or no reminder at all. 

Why No Difference?

While not addressed in the article, one possibility is that clients only stay in a "readiness to change" state for a short while. Once they are beyond that point, they may revert to a state where they are more ambivalent about addressing their addiction. 

Another possibility, although less likely, may be that the reminders, whether the phone call or the mailing, never reached the client for whom they were intended. Mail may be overlooked or left unopened, phone messages may not be forwarded, or clients otherwise are not reached. 

What if Our Clinic Can't Schedule Intakes Within 48 Hours?

If the hypothesis about the "readiness to change" window is correct, then a couple of interventions might be worth exploring when it's impossible to schedule intakes within 48 hours: 

• Train receptionists to explore briefly what happened that precipitated the call for help; then include a brief reminder of these circumstances in an appointment reminder letter, perhaps with mention that while the problem may not feel as urgent, it hasn't gone away. 
• Have counselors conduct a brief phone motivational enhancement session within a few hours of the initial call. These phone sessions can be scheduled in the initial call. (2)

Ultimately, it will take further research to determine if these interventions would decrease the no show rate. But there's nothing to stop your clinic from exploring some solutions now.  

Stasiewicz, P. R., & Stalker, R. (1999). A comparison of three "interventions" on pretreatment dropout rates in an outpatient substance abuse clinic. Addictive Behaviors, 24, 579-582.

This summary has been made possible by the Northeastern States Addiction Technology Transfer Center (NSATTC), partnered with the University at Buffalo School of Social Work, 685 Baldy Hall, Buffalo, NY, 14260. Additional copies can be requested from the NSATTC office at 716-645-3381 x243. In part, the mission of the NSATTC is to increase the knowledge and skills of addiction treatment practitioners from multiple disciplines by facilitating access to state-of-the-art research, education and best practices.