Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic

Abstract

SUMMARYUnkept outpatient appointments are a drain on resources. In a prospective study we asked non-attenders at a gastroenterology clinic why they had missed their appointment.103 patients missed their appointment (14% of the total invited); 3 had died. The remaining 100 were asked to complete questionnaires, 68 by mail (43 returned) and 32 by telephone (30 successful); the response rate was thus 73%. 49 of the respondents were new patients, 6 of them with urgent referrals. The explanations for non-attendance by the 73 patients were: forgot to attend or to cancel (30%); no reason (26%); clerical errors (10%); felt better (8%), fearful of being seen by junior doctor (3%); inpatient in another hospital (3%); miscellaneous other (20%). 13 (27%) of the review patients had not kept one or more previous appointments. The non-attendance rates for different clinics ranged from 10% to 25% (average 14%).A substantial number of non-attenders claimed to have forgotten their appointment or to cancel it. If, as we surmise, this re¯ects apathy, no strategy to improve attendance is likely to have great impact. Since the nonattendance rate is reasonably constant, it can be taken into account when patients are booked.

Appointment reminder systems are effective but not optimal: Results of a systematic review and evidence synthesis employing realist principles

“…7 In 2009, non-attendance was estimated to cost over £600 million (around US$970 million). 10,11 underutilization of equipment and personnel, 10 reduced appointment availability, 6,11 reduced patient satisfaction, 12,13 and negative relationships between patients and staff. 6,9 Missed appointments may delay presentation at health services, resulting in a lack of follow-up of chronic conditions which may ultimately lead to complications, unnecessary suffering, and costly hospital admission.…”

“…6,9 Missed appointments may delay presentation at health services, resulting in a lack of follow-up of chronic conditions which may ultimately lead to complications, unnecessary suffering, and costly hospital admission. 10,14 Pressures from referring agents to manage waiting lists, can potentially increase staff stress, anxiety, and fatigue levels. 15 Reducing the number of missed appointments may be a relatively inexpensive way to increase health care efficiency, effectiveness, and quality.…”

Factors associated with patient absenteeism for scheduled endoscopy

“…There has been limited research into the explanations or reasons for patient absenteeism for scheduled gastroenterology appointments [12] . If patients could be identified as "high-risk" for absenteeism, then specific targeted efforts could be developed to ensure their appropriate appearance at their procedure.…”

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

“…Chapter 11,12 In addition to the costs identified above, non-attendance may lead to increased waiting times for appointments, 5,13 increased cost of care delivery, 11,12 under-utilisation of equipment and personnel, 12 reduced numbers of appointments available for all patients, 5,11 reduced patient satisfaction 14,15 and negative relationships between the patient and staff. 5,13 The delay in presentation at health-care departments and consequent lack of monitoring of chronic conditions may predispose patients to exacerbations of their condition and its related complications, leading to unnecessary suffering and possible costly hospital admission.…”