Behavioural Interventions to Improve Equity in Outpatient Access

NCT06163222 | Completed

• 1 other identifier: 23IC8361
• Study Type: interventional
• Target: 13,389
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this clinical trial is to improve health equity within outpatient service access. This is through design and behavioural science-informed interventions that aim to improve rates of first outpatient appointment attendance. Health equity refers to the avoidable and unfair differences in health access, outcomes and experience between groups or populations. Outpatient services are those appointments where advice from a specialised medical professional is provided to a patient in a clinic setting. This clinical trial aims to test different ways of supporting people to attend their first outpatient appointments at five clinical specialties (ophthalmology, gastroenterology, colorectal surgery, cardiology and plastic surgery) at Imperial College Healthcare NHS Trust (ICHT). It is specifically focused on improving attendance for people who are most likely to miss their appointment based on ICHT data, which includes people from minority ethnic backgrounds and people living in the most deprived postcodes. The main question this clinical trial aims to answer is:

• Do behavioural science-informed message interventions improve rates of first outpatient appointment attendance in patients facing inequity of access based on ethnicity and deprivation? The secondary questions this clinical trial aims to answer include:
• Do behavioural science-informed message interventions improve rates of first outpatient appointment attendance across all patient groups?
• Do behavioural science-informed message interventions increase the number of patients who "self-cancel" their appointment if they need to?
• In which patient groups did the message interventions have most impact, e.g., a certain age range?
• Which factors were associated with improved outpatient attendance rates specifically in participants from minority ethnic groups or living in area with highest level of deprivation?
• What was the overall outcome of all first outpatient appointments included in the clinical trial?
• What was the overall successful message delivery rate for the messages sent as part of the study? Were there particular participant groups that were more likely to have an undelivered message?
• What was the overall outcome of appointment attendance for people who received a text message intervention compared with receiving a text message and/or email intervention?
• How well did participants engage with the message interventions e.g. did they click the link provided in the message?

Conditions

Behavioural Science Interventions to Improve Health Equity

Outcome Measures

Primary Outcomes (1)

• Change in Did Not Attend (DNA) rate for first outpatient appointment across five clinical specialties with an emphasis on participants' ethnicity and the deprivation level of their address (Index of Multiple Deprivation quintiles)

  Did Not Attend (DNA) rate is the change over time in the number of people who do not attend their outpatient appointment without cancelling or rescheduling. This rate will be analysed for the clinics included in the study and to see if it changes over time with our interventions. While this change in DNA rate over time will be analysed for all patients, the research team will focus particularly on how this changes with a patient's ethnicity and the deprivation of where they live. Deprivation is currently recorded by ICHT using the Index of Multiple Deprivation (IMD) which assigns a score to a patient's postcode to indicate its level of deprivation based on multiple factors.

  End of study period (12 months)

Secondary Outcomes (8)

• Change in DNA rate at first outpatient appointment across all five clinical specialties for all participant groups

  End of study period (12 months)

• Change in Patient-Initiated Cancellation (PIC) rate for first outpatient appointment across all five clinical specialties.

  End of study period (12 months)

• Change in DNA rate at first outpatient appointment across all five clinical specialties for population subgroups, controlling for variables such as ethnicity, participant demographics, clinic specialty and IMD

  End of study period (12 months)

• Change in the rate of appointment outcomes (attended, DNA, PIC, Hospital-Initiated Cancellation) for first outpatient appointments across all five clinical specialties

  End of study period (12 months)

• Differences between message delivery rate for study interventions across all five clinical specialties for different population subgroups

  End of study period (12 months)

Study Arms (4)

Getting to your appointment

EXPERIMENTAL

Additional 14-day message reminder that includes link to new transport index web page

Behavioral: Additional message with behavioural science-informed content and associated web pages

Help with travel costs

EXPERIMENTAL

Additional 14-day message reminder that includes link to new 'help with travel costs' web page

Behavioral: Additional message with behavioural science-informed content and associated web pages

What to expect

EXPERIMENTAL

Additional 14-day message reminder that includes link to 'what to expect' web page

Behavioral: Additional message with behavioural science-informed content and associated web pages

Usual communications

ACTIVE COMPARATOR

Existing communication strategy used for each of the five clinical specialties e.g. reminder messages 3 and 7 days prior to outpatient appointment

Other: Usual communication strategy

Interventions

Additional message with behavioural science-informed content and associated web pages BEHAVIORAL

Behavioural science-informed messages sent 14-days prior to outpatient appointment which include links to re-designed web pages

Getting to your appointment; Help with travel costs; What to expect

Usual communication strategy OTHER

Usual communications sent from outpatient services to remind participants about their appointments

Usual communications

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• All patients who have been referred to their first outpatient appointment at one of five ICHT adult clinical specialties - Cardiology, Colorectal Surgery, Gastroenterology, Ophthalmology and Plastic Surgery.

You may not qualify if:

• Phone or video appointments
• Diagnostics appointments
• Two-week wait appointments
• Saturday or Sunday appointments
• Appointments without message reminders switched on in DrDoctor
• Patients who re-enter the study and receive \>1 intervention
• Patients who received email message reminders about their appointment (until 23rd May 2024, after which they will be included due to change in ICHT communications approach)

Sponsors & Collaborators

• Imperial College London: lead
• Imperial College Healthcare NHS Trust: collaborator

Study Sites (1)

Imperial College Healthcare NHS Trust

London, United Kingdom

Location

Related Publications (3)

• Huf S, Kerrison RS, King D, Chadborn T, Richmond A, Cunningham D, Friedman E, Shukla H, Tseng FM, Judah G, Darzi A, Vlaev I. Behavioral economics informed message content in text message reminders to improve cervical screening participation: Two pragmatic randomized controlled trials. Prev Med. 2020 Oct;139:106170. doi: 10.1016/j.ypmed.2020.106170. Epub 2020 Jun 29.

  PMID: 32610059 BACKGROUND

• Acharya A, Ashrafian H, Cunningham D, Ruwende J, Darzi A, Judah G. Evaluating the impact of a novel behavioural science informed animation upon breast cancer screening uptake: protocol for a randomised controlled trial. BMC Public Health. 2022 Jul 19;22(1):1388. doi: 10.1186/s12889-022-13781-x.

  PMID: 35854267 BACKGROUND

• Hallsworth M, Berry D, Sanders M, Sallis A, King D, Vlaev I, Darzi A. Stating Appointment Costs in SMS Reminders Reduces Missed Hospital Appointments: Findings from Two Randomised Controlled Trials. PLoS One. 2015 Sep 14;10(9):e0137306. doi: 10.1371/journal.pone.0137306. eCollection 2015.

  PMID: 26366885 BACKGROUND

Related Links

• NHS England. Core20PLUS5 (adults) - an approach to reducing healthcare inequalities \[Internet\]. 2023 \[cited 2023 Nov 17\].

Study Officials

• Sarah Huf

  Imperial College London

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 21, 2023
• First Posted: December 8, 2023
• Study Start: January 8, 2024
• Primary Completion: November 20, 2024
• Study Completion: November 20, 2024
• Last Updated: April 9, 2025

Record last verified: 2025-04

Data Sharing

• IPD Sharing: Will not share

Locations

GB (1)