Most conversations about patient reminders are built on intuition: it seems reasonable that reaching out to patients would improve follow-up. An Australian trial actually measured it and the gap between clinics that reached out proactively and clinics that didn’t was far larger than intuition alone would suggest.
Between 2011 and 2014, a controlled trial across five general practices in urban, regional, and rural Australia tested a structured, proactive follow-up approach for diabetic retinopathy screening, a routine but easily deferred check that’s critical for catching diabetes-related eye damage before it becomes serious. These intervention practices were compared against control practices that continued with their usual, largely patient-initiated approach to screening.
The results were stark. Screening completion reached 100% across the intervention practices that used structured, proactive follow-up. In the control practices, relying on standard care rather than active outreach, screening rates ranged from just 22% to 53%.
The gap widened further at the next step. Among patients who were found to have early-stage retinopathy, 95% received appropriate follow-up in the proactive-outreach practices, compared with 29% in the control group.
A separate national study using Australian general practice data (the MedicineInsight database, covering over 1.5 million patients) found that only 55.2% of people at high risk of diabetes had been screened within the recommended three-year window. Close to half of a high-risk population, precisely the group screening exists to protect, simply hadn’t been reached in time.
Neither of these findings suggests patients were refusing care. The gap wasn’t willingness. It was whether anyone proactively followed up before the window closed.
The pattern across both studies points to the same underlying mechanism: when follow-up depends on the patient remembering to book, act, and prioritise a check that doesn’t feel urgent, a large share of that population simply doesn’t get there, not out of neglect, but because nothing prompted the action at the right moment. When a clinic takes on that prompting itself, proactively identifying who’s due and reaching out, rather than waiting for the patient to initiate The completion rate stops depending on individual patient behaviour and starts depending on whether the clinic’s own system is reliable.
That’s a meaningful shift in where the responsibility and the leverage actually sits. A passive system puts the burden entirely on the patient to remember something that isn’t top of mind. A proactive one puts the burden on the clinic to have a reliable process, which is a far more solvable problem.
The 100% vs. 22–53% gap didn’t come from a different patient population or a different condition, it came from a different process. That’s a useful thing to know, because it means the improvement is available to any clinic willing to build proactive outreach into its regular workflow, not something limited to clinics with unusually engaged patients.
In practice, this means treating reminders as a standing, proactive process rather than a passive fallback, identifying who’s due for a check based on the clinic’s own criteria, reaching out before the window closes, and following up rather than waiting to see who responds on their own. Coda is built around exactly this shift: it connects to Best Practice, identifies patients who are overdue or high-risk based on the conditions a clinic defines, and reaches out to them proactively with follow-up for anyone who doesn’t respond rather than leaving that initiative to the patient.
The data suggests this isn’t a marginal improvement. It’s the difference between a fifth of a population being reached and effectively all of it.
The infrastructure layer that turns GP clinics from passive waiters into active carers.
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