Understanding repeated non-attendance in health services: a pilot analysis of administrative data and full study protocol for a national retrospective cohort

Abstract

IntroductionUnderstanding the causes of low engagement in healthcare is a pre-requisite for improving health services’ contribution to tackling health inequalities. Low engagement includes missing healthcare appointments. Serially (having a pattern of) missing general practice (GP) appointments may provide a risk marker for vulnerability and poorer health outcomes.Methods and analysisA proof of concept pilot using GP appointment data and a focus group with GPs informed the development of missed appointment categories: patients can be classified based on the number of appointments missed each year. The full study, using a retrospective cohort design, will link routine health service and education data to determine the relationship between GP appointment attendance, health outcomes, healthcare usage, preventive health activity and social circumstances taking a life course approach and using data from the whole journey in the National Health Service (NHS) healthcare. 172 practices will be recruited (∼900 000 patients) across Scotland. The statistical analysis will focus on 2 key areas: factors that predict patients who serially miss appointments, and serial missed appointments as a predictor of future patient outcomes. Regression models will help understand how missed appointment patterns are associated with patient and practice characteristics. We shall identify key factors associated with serial missed appointments and potential interactions that might predict them.Ethics and disseminationThe results of the project will inform debates concerning how best to reduce non-attendance and increase patient engagement within healthcare systems. Significant non-academic beneficiaries include governments, policymakers and medical practitioners. Results will be disseminated via a combination of academic outputs (papers, conferences), social media and through collaborative public health/policy fora.

Factors associated with appointment non‐attendance at a medical imaging department in regional Australia: a retrospective cohort analysis

“…Medical imaging departments provide a vital role in patient care and can provide accurate diagnostic information, reducing the need for investigative surgery or other risky and more costly interventions . Poor attendance rates may have flow on effects in other departments and lead to poorer health and economic outcomes . Therefore, there is value in understanding the rates of non‐attendance in the medical imaging department context and investigating factors that are likely associated.…”

“…5,6 Poor attendance rates may have flow on effects in other departments and lead to poorer health and economic outcomes. 7,8 Therefore, there is value in understanding the rates of nonattendance in the medical imaging department context and investigating factors that are likely associated.…”

Missed Appointments in Health Care Systems: A National Retrospective Data Linkage Project

“…Therefore, we undertook some preliminary research, which confirmed that a small core group of patients who miss multiple appointments did indeed exist. In addition, the odds of missing a subsequent appointment increase among patients who had missed at least one appointment in the previous 12 months (Waller & Hodgkin, 2000;Williamson et al, 2017). This was confirmed in later work (Figure 1), which already has significant implications for patients, practitioners, and service managers.…”

Why Don't Patients Referred by a Family PhysicianVisit a Specialist? A Study in Golestan Province in Northern Iran

“…The study was conducted in 15 megacities with the highest physician-population ratios in the United States, and concluded that despite the large number of physicians in each megacity, a large number of patients had to wait 14 days or more to see their physician [20][21]. Williamson et al have also stated that one of the main reasons for not visiting a specialist wasthe large distance between medical centers and patients' place of residence [29].…”