The economics of non-attendance and the expected effect of charging a fine on non-attendees

Bech, Mickael

doi:10.1016/j.healthpol.2005.01.001

Cited by 106 publications

(107 citation statements)

References 59 publications

Supporting

Mentioning

104

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…Furthermore, Bech [16] suggested that there were significant insufficiencies in the training among the PHCC staff, which deterred women from appearing for their scheduled appointments or caused them to show up later on the same day when other staff was available. George and Rubin [16] proposed that providing training to the PHCC staff to address women would likely improve the women's satisfaction levels and correspondingly reduce the rates of missed appointments. Further, Gordon et al [17] highlighted that a lack of respect from the PHCC staff toward women receiving maternal healthcare indicated that the PHCC staff, including both doctors and nurses, was not properly trained to address women, which caused serious dissatisfaction among women and correspondingly reduced the likelihood of their adhering to appointments for maternal healthcare at PHCCs.…”

Section: Discussionmentioning

confidence: 99%

“…These reasons indicate that women with daily responsibilities such as child care might find it difficult to adhere to clinical appointments, suggesting that providing child care support to such women would improve their attendance of maternal healthcare appointments [15][16][17] . Visiting another healthcare facility and long waiting times are both relevant to the satisfaction of women.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Missed appointments at maternal healthcare clinics in primary healthcare centres in Riyadh city: reasons and associated factors

Almalki

2014

JHA

View full text Add to dashboard Cite

Background: The issue of missed appointments at maternal healthcare clinics in primary healthcare centers (PHCCs) has received increasing attention in recent years. The significant relationship between missed appointments and access to maternal healthcare has been recognized around the world. Missed appointments have serious health and economic consequences for women seeking maternal healthcare at PHCCs. Objectives:The objectives of this research were 1) to critically explore the reasons for and socio-demographic factors associated with missed appointments at maternal healthcare clinics at PHCCs; and 2) to provide recommendations for health policy that might help to eliminate the problem of "no-show" maternal patients. Methods:Descriptive statistics were used to analyze the responses of 250 women regarding demographics, as well as their reasons for missing appointments and their preferences regarding appointment confirmation at maternal healthcare clinics at five PHCCs in Riyadh, Saudi Arabia. Results:The most frequent reasons associated with missed appointments reported by women included a lack of supplies and medical equipment, such as ultrasound machines, the unavailability of transportation and a lack of respect from PHCC staff. Conclusion:Developing easily accessible, flexible, interactive appointment systems with reminder/recall, providing means of transportation, providing training courses to PHCC employees on how to address these women and the provision of necessary medical equipment and facilities, such as ultrasound machines to all PHCCs are highly recommended to reduce the occurrence of missed appointments at maternal healthcare clinics at PHCCs in Riyadh, Saudi Arabia.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Missed appointments at maternal healthcare clinics in primary healthcare centres in Riyadh city: reasons and associated factors

Almalki

2014

JHA

View full text Add to dashboard Cite

show abstract

“…Bech 215 suggests the following interventions to combat non-attendance: information given to patients before appointments, reminder letters, telephone reminders, punishing non-attendees by discharging them from the waiting list or by assigning them to the bottom of the waiting list, and charging non-attendees a monetary fine. Some of these suggestions have been examined in the systematic review section of this report.…”

Section: Current and Future Developments (Innovations)mentioning

confidence: 99%

Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis

McLean

Gee

Booth

et al. 2014

Health Services and Delivery Research

View full text Add to dashboard Cite

BackgroundMissed appointments are an avoidable cost and a resource inefficiency that impact on the health of the patient and treatment outcomes. Health-care services are increasingly utilising reminder systems to counter these negative effects.ObjectivesThis project explores the differential effect of reminder systems for different segments of the population for improving attendance, cancellation and rescheduling of appointments.DesignThree inter-related reviews of quantitative and qualitative evidence relating to theoretical explanations for appointment behaviour (review 1), the effectiveness of different approaches to reminding patients to attend health service appointments (review 2) and factors likely to influence non-attendance (review 3).Data sourcesDatabase searches were conducted on Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, The Cochrane Library, EMBASE (via NHS Evidence from 1 January 2000 to January/February 2012), Health Management Information Consortium database, Institute of Electrical and Electronics EngineersXplore, The King’s Fund Library Catalogue, Maternity and Infant Care, MEDLINE, Physiotherapy Evidence Database, PsycINFO, SPORTDiscus and Web of Science from 1 January 2000 to January/February 2012. Supplementary screening of references of included studies was conducted to identify additional potentially relevant studies. Conceptual papers were identified for review 1, randomised controlled trials (RCTs) and systematic reviews for review 2 and a range of quantitative and qualitative research designs for review 3.MethodsWe conducted three inter-related reviews of quantitative and qualitative evidence, involving a review of conceptual frameworks of reminder systems and adherence behaviours, a review of the reminder effectiveness literature and a review informed by realist principles to explain the contexts and mechanisms that explain reminder effectiveness. A preliminary conceptual framework was developed to show how reminder systems work, for whom they work and in which circumstances. Six themes emerged that potentially influence the effectiveness of the reminder or whether or not patients would attend their appointment, namely the reminder–patient interaction, reminder accessibility, health-care settings, wider social issues, cancellation and rebookings, and distal/proxy attributes. Standardised review methods were used to investigate the effectiveness of reminders to promote attendance, cancellation or rebooking across all outpatient settings. Finally, a review informed by realist principles was undertaken, using the conceptual framework to explain the context and mechanisms that influence how reminders support attendance, cancellation and rebooking.ResultsA total of 466 papers relating to 463 studies were identified for reviews 2 and 3. Findings from 31 RCTs and 11 separate systematic reviews (review 2 only) revealed that reminder systems are consistently effective at reducing non-attendance at appointments, regardless of health-care setting or patient subgroups. Simple reminders that provide details of timing and location of appointments are effective for increasing attendance at appointments. Reminders that provide additional information over and above the date, time and location of the appointment (‘reminder plus’) may be more effective than simple reminders at reducing non-attendance and may be particularly useful for first appointments and screening appointments; simple reminders may be appropriate thereafter for most patients the majority of the time. There was strong evidence that the timing of reminders, between 1 and 7 days prior to the appointment, has no effect on attendance; substantial numbers of patients do not receive their reminder; reminders promote cancellation of appointments; inadequate structural factors prevent patients from cancelling appointments; and few studies investigated factors that influence the effectiveness of reminder systems for population subgroups.LimitationsGenerally speaking, the systematic review method seeks to provide a precise answer to a tightly focused question, for which there is a high degree of homogeneity within the studies. A wide range of population types, intervention, comparison and outcomes is included within the RCTs we identified. However, use of this wider approach offers greater analytical capability in terms of understanding contextual and mechanistic factors that would not have been evident in a more narrowly focused review and increases confidence that the findings will have relevance in a wide range of service settings.ConclusionsSimple reminders or ‘reminder plus’ should be sent to all patients in the absence of any clear contraindication. Other reminder alternatives may be relevant for key groups of patients: those from a deprived background, ethnic minorities, substance abusers and those with comorbidities and/or illnesses. We are developing a practice guideline that may help managers to further tailor their reminder systems for their service and client groups. We recommend future research activities in three main areas. First, more studies should routinely consider the potential for differential effects of reminder systems between patient groups in order to identify any inequalities and remedies. Second, ‘reminder plus’ systems appear promising, but there is a need for further research to understand how they influence attendance behaviour. Third, further research is required to identify strategies to ‘optimise’ reminder systems and compare performance with current approaches.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

“…No-shows result in fragmented continuity of care, reduce access for other patients in the practice, and decrease provider productivity. [8][9][10][11][12][13][14][15][16] Studies in primary care and specialty clinics have demonstrated that staff phone calls are an effective intervention for reducing no-shows. [17][18][19][20][21][22][23][24][25][26][27][28][29][30] However, this convincing work is difficult to apply, because staff phone calls are timeconsuming and costly.…”

Section: Introductionmentioning

confidence: 99%

Targeted Reminder Phone Calls to Patients at High Risk of No-Show for Primary Care Appointment: A Randomized Trial

et al. 2016

View full text Add to dashboard Cite

BACKGROUND: No-shows, or missed appointments, are a problem for many medical practices. They result in fragmented care and reduce access for all patients. OBJECTIVE: To determine whether telephone reminder calls targeted to patients at high risk of no-show can reduce no-show rates. DESIGN: Single-center randomized controlled trial. PARTICIPANTS: A total of 2247 primary care patients in a hospital-based primary care clinic at high risk of no-show (>15 % risk) for their appointment in 7 days. INTERVENTION: Seven days prior to their appointment, intervention arm patients were placed in a calling queue to receive a reminder phone call from a patient service coordinator. Coordinators were trained to engage patients in concrete planning. All patients received an automated phone call (usual care). MAIN MEASURES: Primary outcome was no-show rate. Secondary outcomes included arrival rate, cancellation rate, reschedule rate, time to cancellation, and change in revenue. KEY RESULTS: The no-show rate in the intervention arm (22.8 %) was significantly lower (absolute risk difference −6.4 %, p < 0.01, 95 % CI [−9.8 to −3.0 %]) than that in the control arm (29.2 %). Arrival, cancellation, and reschedule rates did not differ significantly. In the intervention arm, rescheduling and cancellations occurred further in advance of the appointment (mean difference, 0.35 days; 95 % CI [0.07-0.64]; p = 0.01). Reimbursement did not differ significantly. CONCLUSIONS: A phone call 7 days prior to an appointment led to a significant reduction in no-shows and increased reimbursement among patients at high risk of noshow. The use of targeted interventions may be of interest to practices taking on increased accountability for population health.KEY WORDS: access to care; applied informatics; primary care redesign; behavior change; population health.

show abstract

The economics of non-attendance and the expected effect of charging a fine on non-attendees

Cited by 106 publications

References 59 publications

Missed appointments at maternal healthcare clinics in primary healthcare centres in Riyadh city: reasons and associated factors

Missed appointments at maternal healthcare clinics in primary healthcare centres in Riyadh city: reasons and associated factors

Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis

Targeted Reminder Phone Calls to Patients at High Risk of No-Show for Primary Care Appointment: A Randomized Trial

Contact Info

Product

Resources

About