The Effects of Negative Reinforcement on Increasing Patient Adherence to Appointments at King Abdullah University Hospital in Jordan

Abstract

Appointment nonadherence is a health behavior that represents a burden to health care systems. On March 1, 2015, a new negative reinforcement intervention involving “service fees” for a visit without appointment was implemented at King Abdullah University Hospital in Jordan. To evaluate the effect of this intervention in improving patient adherence to medical appointment, a retrospective preintervention and postintervention analysis was used, including all patients (n = 65 535) who had scheduled appointments at 39 outpatient clinics. A repeated-measures analysis of variance was first performed. Then, a multivariate linear regression model was used to identify factors that might predict individuals who are likely to attend or miss their appointments and those who have a greater tendency to visit the hospital with or without appointments. Although the average percentage of appointments attended was more than missed preintervention and postintervention, the decrease in percentage of missed appointments was more pronounced postintervention. Also, the average percentage of visits without appointments was less than visits with appointments in both times, but the decrease in the percentage of visits without appointments was more prominent after. The regression analysis revealed that younger, married and male patients were more likely to miss their appointment before and after the intervention. Also, younger patients had a tendency to attend without appointments. Conversely, patients with the lower copayment rate had a tendency to adhere to appointment times. In conclusion, negative reinforcement interventions could improve patient appointment adherence rates. Accordingly, interventions designed that consider evidence and are theory-based are needed to change patient behavior.

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“…Level of education has a role to play as one of the nurses stated. This has also been reported in literature 19,42,43. Lower levels of education are usually associated with unemployment and lower paying jobs.…”

Nonattendance rates of scheduled outpatient appointments in a university general hospital

“…Probably within the highest reported nonattendance rates examples are Singapore 18.5% and 35.9% as part of the Predicting Appoint Misses (PAM) project, 18.6% in dermatology clinics in the United States, 18.8% in the United Sates over a 12‐year period, 19% outpatient neurology consultations in Spain, 28% in programmed chronic medication distribution centers in South Africa, and 45.12% in Jordan .…”

“…Costs associated with nonattendance in our setting are unknown and we need additional studies focusing on this topic. Nonattendance generates the loss of screening opportunities, comorbidities control, recommendations of known effectiveness, implies a discontinuity in health care and disrupts doctor‐patient relationship . The loss of opportunities could have a direct individual deleterious effect over individual health.…”

“…1 Also, nonattendance rate was 7.6% in primary care in Australia, 12 10% in Aragón considering all the specialties together in a high immigration proportion population and a high proportion of rural origin in the Aragonés High Resolution Sanitary Consortium (CASAR), 9 12.5% in preventive medicine consultations in Zaragoza, 13,14 13.8% in diabetes clinic in Singapore, 15 13% and 16% in allergy consultations in Murcia, 16,17 and 14.6% in Albacete. 18 Probably within the highest reported nonattendance rates examples are Singapore 18.5% and 35.9% as part of the Predicting Appoint Misses (PAM) project, 19 18.6% in dermatology clinics in the United States, 20 18.8% in the United Sates over a 12-year period, 21 19% outpatient neurology consultations in Spain, 22 28% in programmed chronic medication distribution centers in South Africa, 23 and 45.12% in Jordan 24 .…”

Missed Appointments: Factors Contributing to Patient No-Show in Outpatient Hospital Clinics in Tehran, Iran

“…In a review study, the mean no-show prevalence is estimated at 23.8%. The high-est rate was in North America (27.1%) and the lowest in Europe (14.9%), while it was 24.3% in Asia (7,8).…”