Targeted Messaging Boosts Re-engagement by Telemedicine During Pandemic

Close up of a senior couple having a video call with their doctor
Researchers conducted a randomized clinical trial to determine whether targeted messaging could improve the return to in-person visits during the COVID-19 pandemic.

A targeted-messaging program that encouraged patients who had canceled appointments due to the COVID-19 pandemic to return for medical services was found to modestly reinvigorate patient engagement. These findings from a randomized clinical trial were published in JAMA Network Open.

Patients who had canceled visits, procedures, or surgery between March and June of 2020 at 3 hospitals in the University of Pennsylvania Health System were randomly assigned in a 9:1 ratio to receive a letter or to not between June and July. Among the contact cohort, patients were randomly assigned in a 1:1 ratio to receive a tailored or standardized letter and in a 1:1 ratio to receive the letter in the mail or electronically.

Out of the 38,493 cancellations that occurred during the study period, 11,120 visits were not rescheduled. Patients had a median age of 59.7 (range, 18-100) years, 55% were women, and 61% were White.

Within 1 month of letter receipt, patients who did and did not receive a letter returned for an in-person visit at similar rates (5.0% vs 4.1%; P =.18). Letter recipients were more likely to attend a telemedicine visit (1.3% vs 0.4%; P =.006) or schedule a future visit (14.4% vs 11.7%; P =.02), respectively.

Personalized letters were more effective than standardized letters at encouraging patients to schedule a visit (15.3% vs 13.4%; P =.006), especially among patients scheduling orthopedic appointments (14.9% vs 10.9%; P <.001), patients younger than 65 years (13.7% vs 11.0%; P =.002), patients covered with commercial insurance (13.7% vs 11.0%; P =.005), women (15.7% vs 13.5%; P =.02), and those below the median income of $72,157 (15.7% vs 13.5%; P =.03), respectively.

Letters received through the mail were more effective than electronic messages for patients at or above the median income of $77,695 (16.6% vs 13.0%; P =.008).

It remains unclear whether these findings are generalizable to other regions or in nonpandemic situations.

The study authors concluded that targeted messaging of patients who were lost due to the COVID-19 pandemic did not effectively encourage face-to-face re-engagement but modestly increased telemedicine and the scheduling of future visits.


Cappola AR, Schriver ER, Mowery DL, et al. Effect of targeted messaging on return to in-person visits during the COVID-19 pandemic: a randomized clinical trial. JAMA Netw Open. 2021;4(6):e2115211. doi:10.1001/jamanetworkopen.2021.15211