Cancelled Primary Care Appointments: A Prospective Cohort Study of Diabetic Patients

Abstract

Patients scheduled for primary care appointments often cancel or no show. For diabetic patients, nonattendance can affect continuity of care and result in higher emergency department (ED) and hospital use. Nonattendance also impacts appointment scheduling, patient access, and clinic work load. While no show has received significant attention, little research has addressed the prevalence and impact of appointment cancellation. Data on 46,710 appointments for 7586 adult diabetic patients was used to conduct a prospective cohort study examining primary care appointment behavior. The independent variable was the status of the INDEX appointment, which was attended, cancelled, or no showed. Dependent variables included the dates of (1) the last attended appointment, (2) scheduling the NEXT appointment, (3) the next attended follow-up appointment, and (4) ED visits and hospitalizations within six months of the INDEX. Cancellation was more prevalent than no show (17.7% vs 12.2%). Of those who cancelled and scheduled a next appointment, 28.8% experienced over 30 days delay between the INDEX and NEXT appointment dates, and 59.9% delayed rescheduling until on or after the cancelled appointment date. Delay in rescheduling was associated with an 18.6% increase in days between attended appointments and a 26.0% increase in ED visits. For diabetic patients, cancellation with late rescheduling is a prevalent and unhealthy behavior. Although more work is necessary to address the health, intervention, and cost issues, this work suggests that cancellation, like no show, may be problematic for many clinics and patients.

Non‐attendance at diabetes outpatient appointments: a systematic review

“…Thirty‐four studies of varying designs were identified (15 observational, 1 randomized control trial, 9 qualitative, 5 surveys, 4 service improvements). Sixteen were studies from the UK , four from Europe , six from North America and eight from the rest of the world . Six studies specifically focused on young adults in transition from paediatric to adult services, each of which had a mean participant age of >18 years (age range 15–30 years) .…”

“…Reported baseline non‐attendance rates at diabetes appointments were mostly between 10 and 30% , but the extreme ranges were 8.3 and 76% . The means of quantifying non‐attendance varied; some studies calculated the number of missed appointments as a percentage of total booked appointments .…”

“…The means of quantifying non‐attendance varied; some studies calculated the number of missed appointments as a percentage of total booked appointments . Non‐attendance was also determined as the number of people missing more than one appointment in a defined period or when there was no record of HbA 1c measurement in primary or secondary care in the previous 12–15 months . Re‐referred ‘lapsers’ made up 19% of the ‘new patient’ clinic load at one UK diabetes service and appointment cancellations were only defined as a separate entity in one study where they occurred more frequently than non‐attendance (18 vs. 12%) .…”

“…These criteria may have excluded studies reporting non‐attendance when this was not a clear endpoint. Repeated appointment cancellation has been associated with more frequent emergency department attendances but was not explored in this review, and is often overlooked in papers reporting on non‐attendance.…”

Improving healthcare access management by predicting patient no-show behaviour

“…To understand the impact of a particular feature on no-show rates, several studies have been conducted using large datasets. McComb et al [20] find that the impact of lead time on no-show rates is greater among patients who cancel and were rescheduled. Ellis, Luther & Jenkins [21] conclude that reduced sleep consequence of the spring daylight savings change, increased no-show rates, suggesting seasonality on the patterns.…”