***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To test the effectiveness of different systems of reminding patients about their appointments in order to reduce the rate of failed attendance . The expense in implementing a reminder system for patients was also estimated . Design : A clinical study in a single-h and ed dental practice .Subjects : Patients were reminded about their appointment using either postal , manual telephone or automated telephone reminders ( or all three combined ) . A control group received no reminders .  500 patient attendances were recorded in each group . Results : Patients failed to attend  for 130 of the 2500 appointments considered in the study . There was a significant reduction in the failed attendance rate from 9.4 % ( with no reminder ) to a minimum of 3 % when a reminder was given to the patient before the appointment . However , there was no significant difference among the four reminder test groups , indicating that the form of the reminder made no difference to the failure rate . Conclusions : Reminding patients using postal or manual telephone techniques is effective at improving attendance . All of the reminder methods , telephone and postal , provided net cost savings rather than additional The new-patient no-show rate reached 55 percent in an urban , university-based family practice center in mid-1981 . A prospect i ve descriptive study revealed that the no-show rates varied significantly with hour of appointment , patient age , source of referral , delay in appointment date , and chronicity of illness . Study findings led to alterations in the scheduling system , with a subsequent drop in the new-patient no-show rate to 40 percent BACKGROUND The dem and for anticoagulation management is increasing . This has led to care being provided in non-hospital setting s. While clinical studies have similarly demonstrated good clinical care in these setting s , it is still unclear as to which alternative is the most efficient . AIM To determine the costs borne by patients when attending an anticoagulation management clinic in either primary or secondary care and to use this information to consider the cost-effectiveness of anticoagulation management in primary and secondary care , both from the National Health Service and patient perspectives . DESIGN OF STUDY Observational study comparing two cohorts of patients currently attending anticoagulation management clinics .  SETTING Four primary care clinics in Birmingham and one in Warwickshire , and the haematology clinics at the University of Birmingham Hospitals Trust and the City Hospital NHS Trust . METHOD The survey of patients attending the clinics was used to ascertain patient costs . This information was then used in conjunction with the findings of a recent r and omised controlled trial to establish cost-effectiveness . RESULTS Patient costs were lower in primary care than in secondary care setting s ; the mean ( st and ard deviation ) costs per visit were Pound Sterling6.78 ( Pound Sterling5.04 ) versus Pound Sterling14.58 ( Pound Sterling9.08 ) . While a previous cost-effectiveness analysis from a health sector perspective alone found a higher cost for primary care , the adoption of the societal perspective lead to a marked change in the result : a similar total cost per patient in both sectors . CONCLUSION There are significantly higher costs borne by patients attending secondary care anticoagulation management clinics  than similar patients attending primary care clinics . This study also demonstrates that the perspective adopted in an economic evaluation can influence the final result OBJECTIVE --To ascertain which social and psychological characteristics are associated with patients attending surgeries without appointments .  DESIGN -- Prospect i ve study of patients attending an urban centre group practice . SETTING --Urban health centre group practice with five doctors and 12,000 patients in an area of high ( greater than 20 % ) unemployment and social deprivation . PATIENTS --All attenders at the open access surgery and one in four consecutive attenders by appointment , selected sequentially from the first three appointments , during 10 days in January 1989 . Patients participating in the pilot study , reattending during the study period , or attending antenatal clinics were excluded . MAIN OUTCOME MEASURES -- Patients ' attitude to making appointments and reasons for attending , including perception of urgency , with respect to sociodemographic and psychosocial data obtained from a self completed question naire before the consultation . Doctors ' diagnosis and perception of urgency obtained from a separate question naire . RESULTS --86 % ( 141/172 ) Of patients attending without appointments and 96 % ( 139/145 ) with appointments responded to the question naire . The need for consultation was considered to be " very urgent " or " fairly urgent " in significantly more of the open access group than the appointments group ( 89 % , 124/139 v 66 % , 91/138 ; chi 2 = 27.04 , df = 3 ; p less than 0.001 ) , although the doctors did not share the same views . Significantly more patients had self limiting conditions of recent onset in the open access than in the appointments group ( 75 % , 101/135 v 48 % , 59/123 : p less than 0.001 ) . Overall , open access attendance was significantly linked with social support ( 39 % , 48/124 v 26 % , 32/123 ; p less than 0.05 ) and with marital separations or intentions to separate ( 10 % , 9/87 v 0/92 ; 47 % , 32/87 v 22 % , 20/92 respectively ; both p less than 0.001 ) , but the doctors recorded significantly fewer psychological and social problems in these patients ( p less than 0.05 ) . Although almost half those in the appointments group considered that making appointments was inconvenient , more of those in the open access group agreed with this view ( 47 % , 60/129 v 61 % , 80/131 ) . CONCLUSIONS --There was an important link between social support problems and a negative attitude to making appointments . In our previous experience encouraging patients to make appointments has been unsuccessful ; practice s serving areas with a high prevalence of social deprivation providing a mixed open access and appointments system may better serve patients ' needs 
    Output:
    
RESULTS AND CONCLUSIONS The epidemiology of non-attendance has been well described , but there is little work on the reasons for non-attendance .