To attend or not attend? A critical review of the factors impacting on initial appointment attendance from an approach–avoidance perspective

Paige, Louise; Mansell, Warren

doi:10.3109/09638237.2012.705924

Cited by 26 publications

(41 citation statements)

References 67 publications

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“…217 This tension neatly captures some of the ambiguities encountered in the course of the review informed by realist principles whereby an appointment can be seen as both a positive and a negative event leading to markedly alternative 'futures'.…”

Section: Voting With Their Feetmentioning

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

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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.

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Section: Voting With Their Feetmentioning

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

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show abstract

“…Nonattendance rates in mental health settings have been found to be as high as 60%, with an average of approximately a third of all scheduled appointments not kept [6][7][8]. Nonattendance is also often the first step towards dropout.…”

Section: Non-attendance and Dropoutmentioning

confidence: 99%

The Therapy Attitudes and Process Questionnaire: A Brief Measure of Factors Related to Psychotherapy Appointment Attendance

Clough

Nazareth

Casey

2016

Patient

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Objectives: Patient non-attendance and dropout remains problematic in mental health settings [1,2]. The Theory of Planned Behaviour (TPB) has proved useful in understanding such challenges in a variety of healthcare settings, but the absence of an adequate measure has hampered research in mental health. The aim of the current study was to develop and conduct an initial psychometric investigation of a brief measure, the Therapy Attitudes and Process (TAP) Questionnaire, utilising the TPB to understand factors associated with attendance in mental health settings.Design: A quantitative survey based design was utilised. Methods:The TAP was administered to 178 adult participants, who were engaged in individual or group psychotherapy. A subsample also provided data to assess validity and reliability.Results: A four-factor solution was revealed through Exploratory Factor Analysis and accounted for approximately 75% of the variance in scores. Factors corresponded to those predicted by the TPB. Analyses supported the reliability, validity, and internal consistency of the measure. Conclusions:Results suggest that the TAP may provide a useful measure for examining patients' attitudes and beliefs about attending psychotherapy appointments. The TAP can be used to better understand patients' intentions, attitudes, perceptions of behavioural control, and subjective norms relating to psychotherapy attendance. This understanding may facilitate improved outcomes for patients and clinicians. Key Points for Decision Makers:DEVELOPMENT OF THE TAP 3  Non-attendance and dropout is a substantial problem in psychotherapy settings. There is a need to better understand and tailor interventions in accordance with the individual patient barriers. The TAP was developed based on the Theory of Planned Behaviour, and is designed to assess attitudes, subjective norms, perceived behavioural control, and behavioural intentions regarding appointment attendance. Initial investigation of the TAP indicates it has sound psychometric properties and can be used to increase the delivery of patient centered services

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“…Numerous empirical studies have reported that when a patient fails to keep scheduled clinical appointments, it leads to severe consequences for the patient's health. In addition, missing appointments jeopardizes all types of medical practices, ranging from maternal practice clinics to general practice clinics [1][2][3] . In some medical settings, such as obstetrics, which encompasses pregnancy planning as well as prenatal and postnatal care, missed appointments pose severe health consequences for women both pre-and post-pregnancy.…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, a notable gap remains in the available literature related to why women miss their appointments or which categories of women are more likely to miss appointments [1][2][3][4][5][6][7][8][9][10] . Researchers have critically debated a wide range of explanations, including socio-demographic characteristics, where by certain groups have been deemed vulnerable due to the presence of multiple health problems, and economic difficulties as reasons for missed appointments at a maternal healthcare clinic [1-5, 9, 10] .…”

Section: Introductionmentioning

confidence: 99%

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

Almalki

2014

JHA

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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.

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To attend or not attend? A critical review of the factors impacting on initial appointment attendance from an approach–avoidance perspective

Cited by 26 publications

References 67 publications

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

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

The Therapy Attitudes and Process Questionnaire: A Brief Measure of Factors Related to Psychotherapy Appointment Attendance

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

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