Psychological Medicine

Original Articles

Does an encouraging letter encourage attendance at psychiatric out-patient clinics? The Leeds PROMPTS randomized study

J. Kitchemana1, C. E. Adamsa1a2 c1, A. Pervaiza3, I. Kadera4, D. Mohandasa5 and G. Brookesa6

a1 Academic Department of Psychiatry and Behavioural Sciences, University of Leeds, Leeds, UK

a2 Division of Psychiatry, University of Nottingham, Duncan MacMillan House, Nottingham, UK

a3 Calderdale and Huddersfield NHS Foundation Trust, St Luke's Hospital, Huddersfield, UK

a4 Leeds Mental Health Teaching NHS Trust, Bridge House, Leeds, UK

a5 Bradford District Care Trust, Bradford, UK

a6 Leeds Partnerships NHS Foundation Trust, Becklin Centre, Leeds, UK


Background The aim was to reduce non-attendance for first-time consultations at psychiatric out-patient clinics.

Method The study was a pragmatic randomized controlled trial; the setting was seven inner-city UK out-patient clinics in Leeds. The participants were 764 subjects of working age with an appointment to attend a psychiatric out-patient clinic for the first time. The intervention was an ‘orientation statement’ letter delivered 24–48 h before the first appointment compared with standard care. The primary outcome measure was attendance at the first appointment; secondary outcomes included hospitalization, transfer of care, continuing attendance, discharge, presentation at accident and emergency and death by 1 year.

Results Follow-up was for 763 out of 764 subjects (>99%) for primary and for 755 out of 764 subjects (98.8%) of secondary outcome data. The orientation statement significantly reduced the numbers of people failing to attend [79 out of 388 v. 101 out of 376 subjects, relative risk 0.76, 95% confidence interval (CI) 0.59–0.98, number needed to treat 16, 95% CI 10–187].

Conclusions Prompting people to go to psychiatric out-patient clinics for the first time encourages them to attend. Pragmatic trials within a busy working environment are possible and informative.

(Received November 20 2006)

(Revised July 17 2007)

(Accepted August 06 2007)

(Online publication October 15 2007)


c1 Address for correspondence: Dr C. E. Adams, Associate Professor, Division of Psychiatry, University of Nottingham, Duncan MacMillan House, Portchester Road, Nottingham NG3 6AA, UK. (Email: