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Introduction and objectivesMissed clinic appointments are a huge financial burden on the NHS, with an average of 6.9 million outpatient appointments being missed each year.1 The difficult asthma clinic at our inner city hospital is no exception to this trend. Many factors are likely to contribute to missed appointments, which can be summarised in with in socioeconomic deprivation indices. We wanted to confirm whether there is an association between missed appointments and socio-economic deprivation. We hypothesised that non-attenders lived in areas with worse deprivation scores.MethodWe compared deprivation scores of English postcodes of clinic attenders and non-attenders of a ‘difficult asthma clinic’ between 2011–2014 inclusive. Indices of multiple deprivation scores were using census related data and Townsend Index via UK data service ©University of Essex and University of Manchester. This provides a validated, relative measure of deprivation across small localities in England to enable comparison. A higher score represents an area with worse socio-economic deprivation, maximum score = 100. Mann-Whitney two-tailed tests to compare non-paired non-parametric data were performed in Prism version 6 (GraphPad).Abstract P250 Figure 1Indices of multiple deprivation Non-attenders and Attenders at a Difficult Asthma Clinic between 2011–2014ResultsThe median deprivation score of postcodes of non-attenders (n = 458) was 60.69, whereas for attenders it was 51.12 (n = 505), with a p value of <0.0001.ConclusionThese results strongly suggest socioeconomic deprivation has a negative impact on attendance rates at this specific clinic. Challenging socio-economic conditions are detrimental to healthcare in multiple ways and it can be difficult for patients to access resources needed to manage their healthcare need effectively. However, we hope to assess the effect of deprivation in a control medical clinic to explore the specificity of this result to asthma clinics. It would also be valuable to investigate if these DNA rates are reflected in community clinics, as this may be an alternative way to deliver this service in order to reduce overall DNA rates in deprived areas.Reference1

and August 17, 2012 were obtained to determine what types of tests were ordered for patients with heart murmurs, in what proportions, and their final diagnoses. Costs of the different strategies were calculated using multiple hospital resources, the public physician billing manual and other publically available online resources. Descriptive statistics were used to describe observed and estimated costs and a Wilcoxon matched-pairs signed rank test assessed the significance of pair-wise differences in cost between the two approaches. RESULTS: Strategy 2, which requires performing echocardiograms on all patients, resulted in a $77.30 increase in median total costs per patient over the current Strategy 1, which required all patients to be first examined by a pediatric cardiologist before any specialized tests could be performed. The difference was significant (p<0.001). CONCLUSION: The cost of initial referral to a pediatric specialist is less costly than direct referral of patients with murmurs for echocardiography in the patient group and caregiver group studied. The percentage of echoes ordered for innocent murmurs at which the "crossover point" in cost occurs, remains to be determined. CIHR