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Velu P, Wilson C, Kariveda RR, Weber PC, Levi JR. Factors Associated With Follow-Up Appointment Attendance in Adults With Sensorineural Hearing Loss. Otol Neurotol 2025:00129492-990000000-00814. [PMID: 40423686 DOI: 10.1097/mao.0000000000004530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2025]
Abstract
OBJECTIVE Sensorineural hearing loss has a high disease burden and requires close follow-up to manage long-term sequelae of the disease. This study aims to identify patient- and appointment-related factors including demographic data and medical comorbities associated with sensorineural hearing loss follow-up appointment attendance in adults to better understand barriers to care. STUDY DESIGN Retrospective chart review. SETTING Tertiary-care, safety-net hospital. PATIENTS Adult patients seen in an otolaryngology clinic for sensorineural hearing loss between May 1, 2015, and December 31, 2021. INTERVENTIONS Analysis of patient demographic, medical comorbidity, and appointment factors. MAIN OUTCOME MEASURES Follow-up appointment attendance rates for otolaryngology and audiology appointments. RESULTS Of 5,632 patients, 54.9% attended, 28.7% canceled, and 16.3% were no-show at follow-up appointments. On univariate analysis, factors associated with appointment cancellation and no-show included sex, race, language, education, employment status, insurance, country of birth, housing insecurity, hypertension, smoking status, timing of appointments before or after the beginning of COVID-19, and having a physician within hospital network. In multivariate analysis, factors significantly associated with appointment nonattendance included age greater than 60 years old, higher education levels, unemployment, housing insecurity, having a primary care physician outside the hospital network, and residing outside a 5-mile radius of the hospital. CONCLUSIONS Patient and appointment characteristics such as age, education level, employment status, housing insecurity, and distance to appointment had an independent association with higher rates of missed follow-up appointments in sensorineural hearing loss. Accessibility of appointments and interventions such as telehealth and reminder systems may be key to ensuring equitable care.
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Affiliation(s)
- Preetha Velu
- Boston University Chobanian and Avedisian School of Medicine
| | - Carolyn Wilson
- Boston University Chobanian and Avedisian School of Medicine
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Yuhan BT, Yasuda MA, Joshi R, Charous S, Hurtuk A. No-Show Rates in an Academic Otolaryngology Practice Before and During the COVID-19 Pandemic. Cureus 2024; 16:e54015. [PMID: 38476808 PMCID: PMC10929764 DOI: 10.7759/cureus.54015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE Our objectives were to determine the no-show and nonattendance rate for an outpatient academic otolaryngology practice, to identify patient and systemic factors associated with nonattendance, and to evaluate the impact that the COVID-19 pandemic had on the rate of nonattendance. METHODS This is a retrospective review of the Epic practice management and billing reports from all scheduled outpatient visits at a multi-physician, academic, general, and sub-specialty otolaryngology practice from January 2019 to December 2021. RESULTS Over three years, 121,347 clinic visits were scheduled in the otolaryngology practice. The overall nonattendance rate was 18.3%. A statistically significant increase in nonattendance was noted during the COVID-19 pandemic (16.8% vs. 19.8%, p < 0.001). The rate of nonattendance in patients of younger age (under 18 years) (p <0.001), female gender (p=0.03), afternoon appointments (p=0.04), and extended time between the day of scheduling and the day of appointment (p <0.001) increased. Head and neck clinics were found to have the lowest nonattendance rates, while pediatric otolaryngology clinics had the highest (12.6% vs. 21.3%). On multivariate regression, younger age (p < 0.001), female gender (p=0.01), afternoon appointments (p< 0.001), and online self-scheduling (p< 0.001) were significantly associated with nonattendance. CONCLUSIONS Both patient and appointment-related factors were found to impact rates of nonattendance in this academic otolaryngology practice. In this study, young age, female gender, afternoon appointments, and online self-scheduling were associated with increased nonattendance. In addition, the COVID-19 pandemic significantly impacted no-show rates across all otolaryngologic subspecialties.
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Affiliation(s)
- Brian T Yuhan
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Mayuri A Yasuda
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Radhika Joshi
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Steven Charous
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Agnes Hurtuk
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
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Yılmaz H, Kocyigit B. Factors associated with non-attendance at appointments in the gastroenterology endoscopy unit: a retrospective cohort study. PeerJ 2022; 10:e13518. [PMID: 35910767 PMCID: PMC9332409 DOI: 10.7717/peerj.13518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/09/2022] [Indexed: 01/17/2023] Open
Abstract
Background and Aims Gastrointestinal (GI) endoscopy is a limited health resource because of a scarcity of qualified personnel and limited availability of equipment. Non-adherence to endoscopy appointments therefore wastes healthcare resources and may compromise the early detection and treatment of GI diseases. We aimed to identify factors affecting non-attendance at scheduled appointments for GI endoscopy and thus improve GI healthcare outcomes. Methods This was a single-center retrospective cohort study performed at a tertiary hospital gastroenterology endoscopy unit, 12 months before and 12 months after the start of the COVID-19 pandemic. We used multiple logistic regression analysis to identify variables associated with non-attendance at scheduled appointments. Results Overall, 5,938 appointments were analyzed, and the non-attendance rate was 18.3% (1,088). The non-attendance rate fell significantly during the pandemic (22.6% vs. 11.6%, p < 0.001). Multivariable regression analysis identified the absence of deep sedation (OR: 3.253, 95% CI [2.386-4.435]; p < 0.001), a referral from a physician other than a gastroenterologist (OR: 1.891, 95% CI [1.630-2.193]; p < 0.001), a longer lead time (OR: 1.006, 95% CI [1.004-1.008]; p < 0.001), and female gender (OR: 1.187, 95% CI [1.033-1.363]; p = 0.015) as associated with appointment non-attendance. Conclusions Female patients, those undergoing endoscopic procedures without deep sedation, those referred by physicians other than gastroenterologists, and with longer lead time were less likely to adhere to appointments. Precautions should be directed at patients with one or more of these risk factors, and for those scheduled for screening procedures during the COVID-19 pandemic.
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Affiliation(s)
- Hasan Yılmaz
- Department of Gastroenterology, Kocaeli University, İzmit, Kocaceli, Turkey
- Department of Internal Medicine, Kocaeli University, İzmit, Kocaceli, Turkey
| | - Burcu Kocyigit
- Department of Internal Medicine, Kocaeli University, İzmit, Kocaceli, Turkey
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Factors Affecting Voice Therapy Completion in Singers. J Voice 2018; 32:564-571. [DOI: 10.1016/j.jvoice.2017.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 11/18/2022]
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Faiz KW, Kristoffersen ES. Association between age and outpatient clinic arrival time: myth or reality? BMC Health Serv Res 2018; 18:235. [PMID: 29609612 PMCID: PMC5879733 DOI: 10.1186/s12913-018-3057-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/22/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Non-attendance and late arrivals diminish patient flow in outpatient clinics. On the other hand, patient earliness may also be undesirable. Physicians often experience that older patients are more punctual than younger patients, and often they come excessively early. The aim of this study was to determine whether an association between age and outpatient clinic arrival time could be established or not, i.e. to find out if it is a myth or a reality. METHODS Prospective descriptive study performed at a neurological outpatient clinic. Data were collected from all scheduled appointments during an eight-week period. Variables included were age, gender, appointment time, arrival time, no-shows, appointment type, need for assistance and if it was an early or late appointment. Outcomes were unpunctuality (early and late arrivals) and non-attendance. RESULTS Of 1353 appointments, non-attendance rate was 9.5 and 5.1% were late arrivals. Median age increased with increased patient earliness (p < 0.001). Younger age (p = 0.007) and new referrals (p = 0.025) were associated with non-attendance. CONCLUSIONS The intuition of an association between age and outpatient clinic arrival time was confirmed, thus it is a reality that older patients attend their appointments more frequently and have better punctuality than younger adults. This age effect in outpatient clinics should be considered when developing future simulation models and intervention studies.
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Affiliation(s)
- Kashif Waqar Faiz
- Department of Neurology, Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway
- Health Services Research Center, Akershus University Hospital, Lørenskog, Norway
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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McIvor R, Ek E, Carson J. Non-attendance rates among patients attending different grades of psychiatrist and a clinical psychologist within a community mental health clinic. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.28.1.5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo examine non-attendance rates in patients seen by psychiatrists of different grades and a consultant clinical psychologist. Rates were obtained from the patient administration system over a 21-month period.ResultsA planned linear contrast showed that the clinical psychologist's patients had the lowest rate of non-attendance (7.8%), followed in turn by those of consultant psychiatrists (18.6%), specialist registrars (34%) and senior house officers (37.5%).Clinical ImplicationsFactors such as continuity of care, perceived clinical competence and the provision of non-medical interventions might have an impact on attendance rates. These results indicate the difficulty in reconciling the training needs of junior doctors with the provision of continuity and quality of care for patients. Reminder systems for people seeing training doctors might be an effective way of reducing non-attendance rates.
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Killaspy H, Gledhill J, Banerjee S. Satisfaction of ottenders and non-attenders with their treatments at psychiatric out-patient clinics. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.22.10.612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodNon-attendance at psychiatric outpatient appointments has a substantial financial cost, and may also have clinical significance. To prevent non-attendance and formulate effective responses, its determinants need to be understood. Patient dissatisfaction with services has been suggested as a reason for non-attendance, we therefore investigated the role of patient satisfaction in attendance at psychiatric out-patients appointments. All patients booked for adult psychiatric out-patient follow-up appointments in a three-month period were studied using a brief, self-report questionnaire.ResultsSixty-three per cent (340/538) of offenders and 54% (118/219) of non-attenders responded. Responders expressed high levels of satisfaction with their treatment (92% offenders, 91% non-attenders) and with the service (96% attenders 92% non-attenders). Despite adequate statistical power, there were no statistically significant differences in satisfaction between the two groups.Clinical implicationsIn conclusion, patient satisfaction with psychiatric out-patient care was reported to be relatively high and did not seem to be an important determinant of non-attendance. Further work is needed to determine the impact of variables such as relapse and social disorganisation on attendance.
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Abstract
Psychiatric out-patient services originated in the early-20th century to enable triage of new referrals to the asylum in order to differentiate between treatable and untreatable cases. They evolved to provide community follow-up of patients discharged from hospital and assessment of those newly referred to psychiatric services. Non-attendance at out-patient appointments represents an enormous waste of clinical and administrative resources and has potentially serious clinical implications for those who are most psychiatrically unwell. The place of out-patient clinics in modern community mental health services is explored with reference to the reasons for, and clinical and cost implications of, missed appointments. An alternative model is described that incorporates recent UK government guidance on the roles and implementation of community mental health teams, liaison with primary care and new roles for consultant psychiatrists.
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Shrestha MP, Hu C, Taleban S. Appointment Wait Time, Primary Care Provider Status, and Patient Demographics are Associated With Nonattendance at Outpatient Gastroenterology Clinic. J Clin Gastroenterol 2017; 51:433-438. [PMID: 27661970 DOI: 10.1097/mcg.0000000000000706] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOALS We intended to identify the factors associated with missed appointments at a gastroenterology (GI) clinic in an academic setting. BACKGROUND Missed clinic appointments reduce clinic efficiency, waste resources, and increase costs. Limited data exist on subspecialty clinic attendance. STUDY We performed a case-control study using data from the electronic health record of patients scheduled for an appointment at the adult GI clinic at the Banner University Medical Center between March and October of 2014. Patients who missed their appointment during the study period served as cases. Controls were randomly selected from patients who completed their appointment during the study period. Analysis included univariate and multivariate logistic regression analysis. RESULTS Of 2331 scheduled clinic appointments, 195 (8.4%) were missed appointments. Longer waiting time from referral to scheduled appointment was significantly associated with missed appointment (AOR=1.014; 95% CI, 1.01-1.02; P<0.001). Patients with primary care providers (PCPs) were less likely to miss their appointment than those without PCPs (AOR=0.35; 95% CI, 0.18-0.66; P=0.001). Among patient demographic characteristics, ethnicity and marital status were associated with missed appointment. CONCLUSIONS Wait time, ethnicity, marital status, and PCP status were associated with missed GI clinic appointments. Further investigations are needed to assess the effects of intervention strategies directed at reducing appointment wait time and increasing PCP-based care.
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Affiliation(s)
- Manish P Shrestha
- *Department of Medicine, University of Arizona College of Medicine †Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, AZ
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Salisu AD, Jibril YN. Extending otology services to rural settings: Value of endoscopic ear surgery. Ann Afr Med 2017; 15:104-8. [PMID: 27549413 PMCID: PMC5402810 DOI: 10.4103/1596-3519.188888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Few centers, mainly located in urban settings offer otological surgical services, yet majority of patients requiring these services are rural based and are generally unable to access these centers with resulting disease chronicity and complications. This paper aims to describe the access of otological surgical services by a rural population. Methodology: This is a retrospective study of patients who accessed otological services at three secondary health institutions and one tertiary referral institution. All patients requiring ear surgery over a 4-year period were studied. The initial 2 years without ear endoscopic surgery was compared with the 2 years when ear endoscopic surgery was introduced. Hospital records were studied and relevant data were extracted. Results: Six hundred and nine ears required surgery over 4 years. Age ranged from 3 to 62 years, with a ratio of 1.4 males: 1 female. During the initial 2 years, all patients were referred from the three secondary health institutions to the urban-based tertiary institution for microscopic ear surgery, 94% failed to proceed on the referral. In the second 2 years, 34% were considered suitable for endoscopic ear surgery, of which 78% accepted and had surgery within the locality. Of the 66% referred, only 5% proceeded on the referral. Conclusion: With operator training and investment in portable ear endoscopy set, bulk of ear surgery needing magnification can be treated in the rural setting. This represents a most feasible means of extending the service to the targeted population.
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Affiliation(s)
- Abubakar Danjuma Salisu
- Department of Otolaryngology (ENT), Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
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Abstract
BACKGROUND Patients who miss scheduled appointments without notifying office staff--"no-shows"--disrupt practice workflow and decrease access for others, resulting in misuse of resources and lost revenue. The primary purpose of this study was to identify factors associated with no-shows in a hospital-based outpatient hand office. Secondarily, we studied factors associated with cancelations. METHODS Of the 14,793 new adult patient appointments to our outpatient hand surgery office scheduled between January 2011 and December 2013, 880 (5.9 %) were no-shows and 2715 (18 %) were cancelations. Data on patient demographics and timing of the visit were collected to construct a multinomial logistic regression model of determinants of appointment no-shows and cancelations. RESULTS Factors independently associated with no-shows included younger age, Hispanic or black race, unmarried status (single or divorced), appointment on a Monday or Tuesday, and residence near the office. Factors associated with cancelations were female sex, unmarried status (widowed or divorced), winter season, and appointment on a weekday other than Friday. CONCLUSIONS Non-attendees are more likely to be younger, unmarried, non-white, to have their appointments at the start of the week, and to live near the office. Knowledge of these factors might prove useful for implementation of tailored quality improvement initiatives to reduce non-attendance and maximize productivity in the hand surgery office setting. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Mariano E. Menendez
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
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Bottle A, Gaudoin R, Goudie R, Jones S, Aylin P. Can valid and practical risk-prediction or casemix adjustment models, including adjustment for comorbidity, be generated from English hospital administrative data (Hospital Episode Statistics)? A national observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02400] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BackgroundNHS hospitals collect a wealth of administrative data covering accident and emergency (A&E) department attendances, inpatient and day case activity, and outpatient appointments. Such data are increasingly being used to compare units and services, but adjusting for risk is difficult.ObjectivesTo derive robust risk-adjustment models for various patient groups, including those admitted for heart failure (HF), acute myocardial infarction, colorectal and orthopaedic surgery, and outcomes adjusting for available patient factors such as comorbidity, using England’s Hospital Episode Statistics (HES) data. To assess if more sophisticated statistical methods based on machine learning such as artificial neural networks (ANNs) outperform traditional logistic regression (LR) for risk prediction. To update and assess for the NHS the Charlson index for comorbidity. To assess the usefulness of outpatient data for these models.Main outcome measuresMortality, readmission, return to theatre, outpatient non-attendance. For HF patients we considered various readmission measures such as diagnosis-specific and total within a year.MethodsWe systematically reviewed studies comparing two or more comorbidity indices. Logistic regression, ANNs, support vector machines and random forests were compared for mortality and readmission. Models were assessed using discrimination and calibration statistics. Competing risks proportional hazards regression and various count models were used for future admissions and bed-days.ResultsOur systematic review and empirical analysis suggested that for general purposes comorbidity is currently best described by the set of 30 Elixhauser comorbidities plus dementia. Model discrimination was often high for mortality and poor, or at best moderate, for other outcomes, for examplec = 0.62 for readmission andc = 0.73 for death following stroke. Calibration was often good for procedure groups but poorer for diagnosis groups, with overprediction of low risk a common cause. The machine learning methods we investigated offered little beyond LR for their greater complexity and implementation difficulties. For HF, some patient-level predictors differed by primary diagnosis of readmission but not by length of follow-up. Prior non-attendance at outpatient appointments was a useful, strong predictor of readmission. Hospital-level readmission rates for HF did not correlate with readmission rates for non-HF; hospital performance on national audit process measures largely correlated only with HF readmission rates.ConclusionsMany practical risk-prediction or casemix adjustment models can be generated from HES data using LR, though an extra step is often required for accurate calibration. Including outpatient data in readmission models is useful. The three machine learning methods we assessed added little with these data. Readmission rates for HF patients should be divided by diagnosis on readmission when used for quality improvement.Future workAs HES data continue to develop and improve in scope and accuracy, they can be used more, for instance A&E records. The return to theatre metric appears promising and could be extended to other index procedures and specialties. While our data did not warrant the testing of a larger number of machine learning methods, databases augmented with physiological and pathology information, for example, might benefit from methods such as boosted trees. Finally, one could apply the HF readmissions analysis to other chronic conditions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alex Bottle
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Rene Gaudoin
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Rosalind Goudie
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Simon Jones
- Department of Health Care Management and Policy, University of Surrey, Surrey, UK
| | - Paul Aylin
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
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Gurol‐Urganci I, de Jongh T, Vodopivec‐Jamsek V, Atun R, Car J, Cochrane Consumers and Communication Group. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev 2013; 2013:CD007458. [PMID: 24310741 PMCID: PMC6485985 DOI: 10.1002/14651858.cd007458.pub3] [Citation(s) in RCA: 226] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This review is an update of the original Cochrane review published in July 2012. Missed appointments are a major cause of inefficiency in healthcare delivery with substantial monetary costs for the health system, leading to delays in diagnosis and appropriate treatment. Patients' forgetfulness is one of the main reasons for missed appointments. Patient reminders may help reduce missed appointments. Modes of communicating reminders for appointments to patients include face-to-face communication, postal messages, calls to landlines or mobile phones, and mobile phone messaging. Mobile phone messaging applications, such as Short Message Service (SMS) and Multimedia Message Service (MMS), could provide an important, inexpensive delivery medium for reminders for healthcare appointments. OBJECTIVES To update our review assessing the effects of mobile phone messaging reminders for attendance at healthcare appointments. Secondary objectives include assessment of costs; health outcomes; patients' and healthcare providers' evaluation of the intervention and perceptions of safety; and possible harms and adverse effects associated with the intervention. SEARCH METHODS Original searches were run in June 2009. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2012, Issue 8), MEDLINE (OvidSP) (January 1993 to August 2012), EMBASE (OvidSP) (January 1993 to August 2012), PsycINFO (OvidSP) (January 1993 to August 2012) and CINAHL (EbscoHOST) (January 1993 to August 2012). We also reviewed grey literature (including trial registers) and reference lists of articles. SELECTION CRITERIA Randomised controlled trials (RCTs) assessing mobile phone messaging as reminders for healthcare appointments. We only included studies in which it was possible to assess effects of mobile phone messaging independent of other technologies or interventions. DATA COLLECTION AND ANALYSIS Two review authors independently assessed all studies against the inclusion criteria, with any disagreements resolved by a third review author. Study design features, characteristics of target populations, interventions and controls, and results data were extracted by two review authors and confirmed by a third author. Two authors assessed the risk of bias of the included studies. As the intervention characteristics and outcome measures were similar across included studies, we conducted a meta-analysis to estimate an overall effect size. MAIN RESULTS We included eight randomised controlled trials involving 6615 participants. Four of these studies were newly identified during this update.We found moderate quality evidence from seven studies (5841 participants) that mobile text message reminders improved the rate of attendance at healthcare appointments compared to no reminders (risk ratio (RR) 1.14 (95% confidence interval (CI) 1.03 to 1.26)). There was also moderate quality evidence from three studies (2509 participants) that mobile text message reminders had a similar impact to phone call reminders (RR 0.99 (95% CI 0.95 to 1.02). Low quality evidence from one study (291 participants) suggests that mobile text message reminders combined with postal reminders improved the rate of attendance at healthcare appointments compared to postal reminders alone (RR 1.10 (95% CI 1.02 to 1.19)). Overall, the attendance to appointment rates were 67.8% for the no reminders group, 78.6% for the mobile phone messaging reminders group and 80.3% for the phone call reminders group. One study reported generally that there were no adverse effects during the study period; none of the studies reported in detail on specific adverse events such as loss of privacy, data misinterpretation, or message delivery failure. Two studies reported that the costs per text message per attendance were respectively 55% and 65% lower than costs per phone call reminder. The studies included in the review did not report on health outcomes or people's perceptions of safety related to receiving reminders by text message. AUTHORS' CONCLUSIONS Low to moderate quality evidence included in this review shows that mobile phone text messaging reminders increase attendance at healthcare appointments compared to no reminders, or postal reminders.Text messaging reminders were similar to telephone reminders in terms of their effect on attendance rates, and cost less than telephone reminders. However, the included studies were heterogeneous and the quality of the evidence therein is low to moderate. Further, there is a lack of information about health effects, adverse effects and harms, user evaluation of the intervention and user perceptions of its safety. The current evidence therefore still remains insufficient to conclusively inform policy decisions.There is a need for more high-quality randomised trials of mobile phone messaging reminders, that measure not only patients' attendance rates, but also focus on the cost-effectiveness of these interventions. Health outcomes, patients' and healthcare providers' evaluation and perceptions of the safety of the interventions, potential harms, and adverse effects of mobile phone messaging reminders should be assessed. Studies should report message content and timing in relation to the appointment.
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Affiliation(s)
- Ipek Gurol‐Urganci
- London School of Hygiene and Tropical MedicineHealth Services Research and PolicyLondonUK
| | | | - Vlasta Vodopivec‐Jamsek
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicinePoljanski nasip 58LjubljanaSlovenia1000
| | - Rifat Atun
- Imperial College LondonImperial College Business SchoolSouth Kensington CampusLondonUKSW7 2AZ
| | - Josip Car
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicinePoljanski nasip 58LjubljanaSlovenia1000
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthReynolds BuildingSt Dunstans RoadLondonUKW6 8RP
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Car J, Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev 2012:CD007458. [PMID: 22786507 DOI: 10.1002/14651858.cd007458.pub2] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Missed appointments are a major cause of inefficiency in healthcare delivery, with substantial monetary costs for the health system, leading to delays in diagnosis and appropriate treatment. Patients' forgetfulness is one of the main reasons for missed appointments, and reminders may help alleviate this problem. Modes of communicating reminders for appointments to patients include face-to-face communication, postal messages, calls to landlines or mobile phones, and mobile phone messaging. Mobile phone messaging applications such as Short Message Service (SMS) and Multimedia Message Service (MMS) could provide an important, inexpensive delivery medium for reminders for healthcare appointments. OBJECTIVES To assess the effects of mobile phone messaging reminders for attendance at healthcare appointments. Secondary objectives include assessment of patients' and healthcare providers' evaluation of the intervention; costs; and possible risks and harms associated with the intervention. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2009, Issue 2), MEDLINE (OvidSP) (January 1993 to June 2009), EMBASE (OvidSP) (January 1993 to June 2009), PsycINFO (OvidSP) (January 1993 to June 2009), CINAHL (EbscoHOST) (January 1993 to June 2009), LILACS (January 1993 to June 2009) and African Health Anthology (January 1993 to June 2009). We also reviewed grey literature (including trial registers) and reference lists of articles. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-randomised controlled trials (QRCTs), controlled before-after (CBA) studies, or interrupted time series (ITS) studies with at least three time points before and after the intervention. We included studies assessing mobile phone messaging as reminders for healthcare appointments. We only included studies in which it was possible to assess effects of mobile phone messaging independent of other technologies or interventions. DATA COLLECTION AND ANALYSIS Two review authors independently assessed all studies against the inclusion criteria, with any disagreements resolved by a third review author. Study design features, characteristics of target populations, interventions and controls, and results data were extracted by two review authors and confirmed by a third author. Primary outcomes of interest were rate of attendance at healthcare appointments. We also considered health outcomes as a result of the intervention, patients' and providers' evaluation of the intervention, perceptions of safety, costs, and potential harms or adverse effects. As the intervention characteristics and outcome measures were similar across included studies, we conducted a meta-analysis to estimate an overall effect size. MAIN RESULTS We included four randomised controlled trials involving 3547 participants. Three studies with moderate quality evidence showed that mobile text message reminders improved the rate of attendance at healthcare appointments compared to no reminders (risk ratio (RR) 1.10 (95% confidence interval (CI) 1.03 to 1.17)). One low quality study reported that mobile text message reminders with postal reminders, compared to postal reminders, improved rate of attendance at healthcare appointments (RR 1.10 (95% CI 1.02 to 1.19)). However, two studies with moderate quality of evidence showed that mobile phone text message reminders and phone call reminders had a similar impact on healthcare attendance (RR 0.99 (95% CI 0.95 to 1.03). The costs per attendance of mobile phone text message reminders were shown to be lower compared to phone call reminders. None of the included studies reported outcomes related to harms or adverse effects of the intervention, nor health outcomes or user perception of safety related to the intervention. AUTHORS' CONCLUSIONS There is moderate quality evidence that mobile phone text message reminders are more effective than no reminders, and low quality evidence that text message reminders with postal reminders are more effective than postal reminders alone. Further, according to the moderate quality evidence we found, mobile phone text message reminders are as effective as phone call reminders. Overall, there is limited evidence on the effects of mobile phone text message reminders for appointment attendance, and further high-quality research is required to draw more robust conclusions.
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Affiliation(s)
- Josip Car
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London,UK.
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Differences in Temporal Variables Between Voice Therapy Completers and Dropouts. J Voice 2011; 25:62-6. [DOI: 10.1016/j.jvoice.2009.07.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 07/22/2009] [Indexed: 11/19/2022]
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Stav K, Dwyer PL, Rosamilia A, Lee J. Long-term outcomes of patients who failed to attend following midurethral sling surgery - A comparative study and analysis of risk factors for non-attendance. Aust N Z J Obstet Gynaecol 2010; 50:173-8. [PMID: 20522076 DOI: 10.1111/j.1479-828x.2010.01138.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kobi Stav
- Department of Urogynaecology, Melbourne University, Mercy Hospital for Women, 163 Studley Road, Heidelberg, Victoria 3084, Australia.
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Jayaram M, Rattehalli RD, Kader I. Prompt letters to reduce non-attendance: applying evidence based practice. BMC Psychiatry 2008; 8:90. [PMID: 19014606 PMCID: PMC2621156 DOI: 10.1186/1471-244x-8-90] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 11/16/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-attendance rates in psychiatric outpatient clinics have been a topic of considerable interest. It is measured as an indicator of quality of service provision. Failed attendances add to the cost of care as well as having an adverse impact on patients leading to missing medications, delay in identifying relapses and increasing waiting list time. Recent trials have demonstrated that prompting letters sent to patients led to a decrease in non-attendance rates. We applied this evidence based practice in our community mental health setting to evaluate its impact. METHODS Using a before and after study design, we sent prompting letters to all patients due to attend outpatient clinic appointments for a period of six months in 2007. Non-attendance rates were compared with the corresponding period in 2006. We also looked at trends of non-attendance prior to this intervention and compared results with other parts of our service where this intervention had not been applied. RESULTS 1433 prompting letters were sent out to all out-patient appointments made from June to November 2007. This resulted in an average non-attendance rate of 17% which was significantly less compared to 27% between June and November 2006 (RR 0.65, 95% CI 0.56 to 0.76, NNT 11). No downward trend in non-attendance rate was identified either prior to the intervention or when compared with similar teams across the city. CONCLUSION Prompt letters have been shown to reduce non-attendance rates in previous RCTs and systematic reviews. Our findings demonstrate a reduction in non-attendance rates with prompting letters even under non-trial conditions. Majority of the patients were constant during the two periods compared although there were some changes in medical personnel. This makes it difficult to attribute all the change, solely to the intervention alone. Perhaps our work shows that the results of pragmatic randomised trials are easily applicable and produce similar results in non-randomised settings. We found that prompting letters are a useful and easy to apply evidence based intervention to reduce non-attendance rates with a potential to achieve significant cost savings.
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Affiliation(s)
- Mahesh Jayaram
- Leeds Partnerships NHS Foundation Trust, Bridge House, Balm Road, Leeds LS10 2TP, UK.
| | - Ranganath D Rattehalli
- Specialist Registrar, Leeds Partnerships NHS Foundation Trust, Millfield House, Kirk Lane, Leeds LS19 7LX, UK
| | - Ihsan Kader
- Consultant Psychiatrist, Leeds Partnerships NHS Foundation Trust, Bridge House, Balm Road, Leeds LS10 2TP, UK
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Car J, Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R. Mobile phone messaging reminders for attendance at scheduled healthcare appointments. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd007458] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sola-vera J, Sáez J, Laveda R, Girona E, García-Sepulcre MF, Cuesta A, Vázquez N, Uceda F, Pérez E, Sillero C. Factors associated with non-attendance at outpatient endoscopy. Scand J Gastroenterol 2008; 43:202-6. [PMID: 17852875 DOI: 10.1080/00365520701562056] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Non-attendance at endoscopy procedures leads to wasted resources and increased costs. The purpose of this study was to investigate the factors associated with non-attendance. MATERIAL AND METHODS All patients who attended the outpatient clinic for gastroscopy or colonoscopy examinations were included in the study. Patients who missed their appointment were identified and their data were collected prospectively. Patients who kept their appointment in the same period of time served as controls. RESULTS Between August 2002 and February 2003, 1051 gastroscopies and 756 colonoscopies were scheduled. A total of 265 patients (14.7%) missed their appointment. No significant differences were found between attendees and non-attendees for mean age, gender, type of examination and day of the week on which the examination was scheduled. The time on the waiting list was longer in patients who did not keep their appointment than in those who did. Fewer appointments were missed in patients with a preferent referral, and among patients referred by their general practitioner a higher percentage failed to keep their appointment compared with those referred by a specialist. In the multivariate analysis, length of time on the waiting list and the source of referral were the only two independent predictive factors for non-attendance. CONCLUSIONS A longer time on the waiting list and referral by a general practitioner are factors associated with patients failing to keep their endoscopy appointment.
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Portone C, Johns MM, Hapner ER. A Review of Patient Adherence to the Recommendation for Voice Therapy. J Voice 2008; 22:192-6. [PMID: 17572065 DOI: 10.1016/j.jvoice.2006.09.009] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 09/21/2006] [Indexed: 11/19/2022]
Abstract
SUMMARY Voice therapy is a preferred treatment for many voice problems. Many patients referred to voice therapy by their otolaryngologist fail to follow through with the recommendation. Unlike other behavior change therapies, there are no studies documenting the incidence of poor patient attendance in voice therapy. The primary purpose of this study was to document initial patient adherence to the physician's recommendation for voice therapy. A retrospective review of 294 charts was conducted at 2 voice institutions in Atlanta, GA. Reviews included adherence to (1) the physician's referral to the speech-language pathologist and (2) the speech-language pathologist's recommendation for follow-up voice therapy. Thirty-eight percent of patients did not adhere to the physician's recommendation to attend voice therapy. Of those who initiated follow-through, 47% did not return after the initial speech-language pathology evaluation session. There was no significant difference in attendance by gender or by age group. The primary reasons reported for nonattendance were insurance denials, resolution of the problem, and distance to the clinic. The attendance rates described in this study were low but consistent with research published in the fields of otolaryngology, gastroenterology, and psychology. Poor patient attendance is an important area to consider in outcomes research and the cost to healthcare.
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Affiliation(s)
- Carissa Portone
- Evelyn Trammell Voice and Swallowing Center, Saint Joseph's Hospital of Atlanta, Atlanta, Georgia, USA
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21
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Thornton R, Ballard K. Why Military Personnel Fail to Keep Medical Appointments. J ROY ARMY MED CORPS 2008; 154:26-30. [DOI: 10.1136/jramc-154-01-08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Holloway SM, Bernhard B, Campbell H, Cetnarskyj R, Lam WWK. Inequality of use of cancer genetics services by members of breast, ovarian and colorectal cancer families in South East Scotland. Fam Cancer 2008; 7:259-64. [PMID: 18246448 DOI: 10.1007/s10689-008-9184-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 01/18/2008] [Indexed: 01/25/2023]
Abstract
Some studies have found a deficiency of male, younger and more socially deprived individuals amongst referrals to and/or attendees at cancer genetics clinics. We investigated this inequality of use of genetics services from data on 4,178 Scottish patients with a family history of breast and/or ovarian cancer (BOC) or colorectal cancer (CRC) referred from 2000--2006. Some 98% BOC and 60% CRC referrals were female. Median age of female referrals was greater in the CRC than the BOC group (45.3 vs. 38.7 years, P < 0.001). Both groups of referrals were less socially deprived than the general population (P < 0.001) and the CRC less deprived than the BOC group (P < 0.001). Some 88% patients attended the first appointment offered. Attendance was greater in the CRC group (P < 0.001) and in older patients (P < 0.001) and in the BOC group was highly significantly lower in more socially deprived patients (P < 0.001). Male relatives may feel counselling is less relevant and relatives of both sexes may delay counselling until approaching the age of onset of cancer in a relative. We suggest that medical professionals and the general public may have more knowledge about the genetics of BOC than of CRC. Thus relatives in CRC families seeking counselling are likely to be those with access to more information. The lower attendance amongst more deprived relatives in BOC families may result from poor understanding of the reason for referral. These findings confirm the need to provide male, younger and more socially deprived relatives with more helpful information on cancer genetics.
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Affiliation(s)
- Susan M Holloway
- Department of Clinical Genetics, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK.
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Casey RG, Quinlan MR, Flynn R, Grainger R, McDermott TED, Thornhill JA. Urology out-patient non-attenders: are we wasting our time? Ir J Med Sci 2007; 176:305-8. [PMID: 17453321 DOI: 10.1007/s11845-007-0028-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Accepted: 03/26/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND Out-patient non-attendance leads to inefficiency and patient morbidity. AIMS AND METHODS A phone survey of urology out-patient non-attenders over 1-month was performed to determine reasons for non-attendance, to identify patients who could be discharged, and the manner in which patients want reminders. RESULTS Seventy-six non-attenders were contacted. Fourteen were GP referred new patients. The reason for non-attendance (n = 10) was due to patient issues. Of the patients due for review (n = 62), it was a first non-attendance in 56. Only 41 (66%) claimed to have received notification or appointment cards. Eight patients said they were written to and 13 (21%) denied either receiving a written notification or an appointment card. Only eight patients rang to confirm/change their appointment. Ninety-nine percent said that they would like a further appointment by text message (34%), phone (37%), letter (36%) or email (6%). CONCLUSIONS We now hope to implement a number of methods to further reduce non-attendance rates based on the findings in this study.
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Affiliation(s)
- R G Casey
- Adelaide & Meath Hospital, Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland.
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Cohen AD, Goldbart AD, Levi I, Shapiro J, Vardy DA. Health provider factors associated with nonattendance in pediatric dermatology ambulatory patients. Pediatr Dermatol 2007; 24:113-7. [PMID: 17461803 DOI: 10.1111/j.1525-1470.2007.00354.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Nonattendance for dermatology appointments disrupts the management of medical delivery and leads to inefficient allocation of resources and lost revenue. The factors that determine nonattendance in pediatric dermatology patients have not been well documented. We investigated health provider factors for nonattendance in pediatric dermatology patients. We assessed the effects of waiting time for an appointment and the timing of the appointment (during the day, week, and year) on nonattendance proportions during a 1 year period. Chi-squared tests were used to analyze statistically significant differences of categorical variables. Logistic regression was used for multivariate analyses. A total of 1696 children visits were included in the study. The overall rate of nonattendance at the dermatology clinic was 30.5%. Nonattendance was 29.7% during the periods between 8 a.m. to 1 p.m. and 3 p.m. to 7 p.m. and 40.7% during the periods between 1 p.m. to 3 p.m. and 7 p.m. to 8 p.m. (p = 0.013). Nonattendance was 21.1% when the waiting time for an appointment was short (1-7 days), 32.5% when it was intermediate (8-14 days) and 43.5% when the wait time was long (15 days and above) (p-value < 0.001). A multivariate logistic regression model demonstrated that the hour of the day and the waiting time for an appointment were significantly associated with nonattendance (p value = 0.009, p value < 0.001, respectively). We conclude that in children attending a dermatology clinic, health provider factors that determine nonattendance include the waiting time for an appointment and the hour of the appointment within the day.
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Affiliation(s)
- Arnon D Cohen
- Clalit Health Services, Siaal Research Center for Family Medicine and Primary Care, Faculty Ben-Gurion University, Beer-Shiva, Israel.
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Gurudu SR, Fry LC, Fleischer DE, Jones BH, Trunkenbolz MR, Leighton JA. Factors contributing to patient nonattendance at open-access endoscopy. Dig Dis Sci 2006; 51:1942-5. [PMID: 17009114 DOI: 10.1007/s10620-006-9215-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 12/23/2005] [Indexed: 12/09/2022]
Abstract
Patients who miss endoscopy appointments cause inefficient utilization of medical resources. Because national nonattendance rates are as high as 27% and reasons for nonattendance have not been well studied, we sought to quantitate nonattendance at our tertiary care institution. We conducted a retrospective records review of the institutional database to identify patients who did not attend a scheduled endoscopy appointment between January 2000 and December 2003. Nonattendance was defined as either not showing up for an appointment or canceling it on the day it was scheduled. At our institution, patient care assistants contact such patients to document their reasons in the database. Of 36,480 patients scheduled for outpatient endoscopy, 1,490 (4.1%) did not show up because of either facility-related (44.3%; e.g., scheduling errors) or patient-related (55.7%; e.g., noncancellation, illness, or hospitalization) reasons. Our 4.1% nonattendance rate over 4 years is considerably lower than that reported by other endoscopy centers.
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Affiliation(s)
- Suryakanth R Gurudu
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona 85259, USA.
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van Baar JD, Joosten H, Car J, Freeman GK, Partridge MR, van Weel C, Sheikh A. Understanding reasons for asthma outpatient (non)-attendance and exploring the role of telephone and e-consulting in facilitating access to care: exploratory qualitative study. Qual Saf Health Care 2006; 15:191-5. [PMID: 16751469 PMCID: PMC2464862 DOI: 10.1136/qshc.2004.013342] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To understand factors influencing patients' decisions to attend for outpatient follow up consultations for asthma and to explore patients' attitudes to telephone and email consultations in facilitating access to asthma care. DESIGN Exploratory qualitative study using in depth interviews. SETTING Hospital outpatient clinic in West London. PARTICIPANTS Nineteen patients with moderate to severe asthma (12 "attenders" and 7 "non-attenders"). RESULTS Patients' main reasons for attending were the wish to improve control over asthma symptoms and a concern not to jeopardise the valued relationship with their doctor. Memory lapses, poor health, and disillusionment with the structure of outpatient care were important factors implicated in non-attendance. The patients were generally sceptical about the suggestion that greater opportunity for telephone consulting might improve access to care. They expressed concerns about the difficulties in effectively communicating through non-face to face media and were worried that clinicians would not be in a position to perform an adequate physical examination over the telephone. Email and text messaging were viewed as potentially useful for sending appointment reminders and sharing clinical information but were not considered to be acceptable alternatives to the face to face clinic encounter. CONCLUSIONS Memory lapses, impaired mobility due to poor health, and frustration with outpatient clinic organisation resulting in long waiting times and discontinuity of care are factors that deter patients from attending for hospital asthma assessments. The idea of telephone review assessments was viewed with scepticism by most study subjects. Particular attention should be given to explaining to patients the benefits of telephone consultations, and to seeking their views as to whether they would like to try them out before replacing face to face consultations with them. Email and text messaging may have a role in issuing reminders about imminent appointments.
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Affiliation(s)
- J D van Baar
- Department of General Practice, University of Nijmegen, The Netherlands
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Cohen AD, Kaplan DM, Shapiro J, Levi I, Vardy DA. Health Provider Determinants of Nonattendance in Pediatric Otolaryngology Patients. Laryngoscope 2005; 115:1804-8. [PMID: 16222199 DOI: 10.1097/01.mlg.0000175202.50499.63] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Nonattendance for otolaryngology appointments disrupts the management of medical care and leads to ineffective use of resources. The determinants of nonattendance in pediatric otolaryngology patients have not been well documented. OBJECTIVES To investigate health provider determinants of nonattendance in pediatric otolaryngology patients. STUDY DESIGN We assessed the effects of waiting time for an appointment and the timing of the appointment (during the day, week, and year) on nonattendance proportions during a 1 year period. Chi square tests were used to analyze statistically significant differences of categorical variables. Logistic regression was used for multivariate analyses. RESULTS A total of 2,628 pediatric visits were included in the study. The overall proportion of nonattendance at the pediatric otolaryngology clinic was 33.0%. Nonattendance proportions were 32.7% between 7 AM and 9 AM; 28.3% between 9 AM and 2 PM, and 36.5% between 2 PM and 8 PM (P < .001). The proportion of nonattendance was 24.1% when there was a short waiting time for an appointment (0-7 days), and 36.3% when there was an intermediate waiting time (7-15 days), and 36.6% when there was a long waiting time (15 days and above)(P < .001, P < .012, respectively). CONCLUSIVE: Health provider determinants of nonattendance in pediatric otolaryngology clinic appointments include the waiting time for an appointment and the hour of the appointment within the day.
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Affiliation(s)
- Arnon D Cohen
- Clalit Health Services, Siaal Research Center for Family Medicine and Primary Care, Beer-Sheva, Israel
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Bech M. The economics of non-attendance and the expected effect of charging a fine on non-attendees. Health Policy 2005; 74:181-91. [PMID: 16153478 DOI: 10.1016/j.healthpol.2005.01.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Accepted: 01/04/2005] [Indexed: 11/21/2022]
Abstract
Non-attendance is claimed to waste substantial health care resources. However, this is only vaguely supported by empirical evidence. The epidemiology of non-attendees is explored in a rather large number of studies along with a sizeable number of studies documenting the effectiveness of various interventions to reduce non-attendance rates. Very few studies include more than one intervention and very few report information on the cost of the intervention which enables only vague conclusions about the cost-effectiveness of the interventions. The effectiveness of charging a fine on non-attendees, which has recently been suggested in Denmark and United Kingdom, has been studied in very few studies. These studies reveal that a fine will as most economists expected reduce the non-attendance rate. The literature of non-attendance discloses an immense need for studies addressing the non-attendance problem applying economic theory and standards of analysis.
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Affiliation(s)
- Mickael Bech
- Institute of Public Health, Health Economics, University of Southern Denmark, Winslowparken 19,3, 5000 Odense C, Denmark.
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Bossyns P, Van Lerberghe W. The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger. HUMAN RESOURCES FOR HEALTH 2004; 2:1. [PMID: 15059284 PMCID: PMC400759 DOI: 10.1186/1478-4491-2-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2003] [Accepted: 04/01/2004] [Indexed: 05/21/2023]
Abstract
BACKGROUND: For a health district to function referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. METHODS: Information was triangulated from three sources in two rural districts in Niger: first, 46 semi-structured interviews with health centre nurses; second, 42 focus group discussions with an average of 12 participants - patients, relatives of patients and others; third, 231 semi-structured interviews with referred patients. RESULTS: Passive patients without 'voice' reinforce authoritarian attitudes of health centre staff. The latter appear reluctant to refer because they see little added value in referral and fear loss of power and prestige. As a result staff communicates poorly and show little eagerness to convince reluctant patients and families to accept referral proposals. CONCLUSIONS: Diminishing referral costs and distance barriers is not enough to correct failing referral systems. There is also a need for investment in district hospitals to make referrals visibly worthwhile and for professional upgrading of the human resources at the first contact level, so as to allow for more effective referral patterns.
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Affiliation(s)
- Paul Bossyns
- German Technical Cooperation (GTZ), Niamey, Niger
| | - Wim Van Lerberghe
- Department of Health Systems Policy and Operations, World Health Organization, Geneva, Switzerland
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Abstract
OBJECTIVE To assess which aspects of referral care for headache are associated with improvement of pain and subjective quality of life. BACKGROUND In managed care, referrals to a specialist are sometimes kept to a minimum. It has been questioned whether patients with headache do better after consultation with a specialist. METHODS We mailed a questionnaire to all patients referred for headache to a neurologic center in northern Norway during a 2-year period (n = 1403). The questionnaire included items concerning diagnosis and treatment, along with simple visual analog scales to assess whether the patient's headache syndrome and self-perceived quality of life had changed after seeing the specialist. RESULTS There were 1052 responders (75%). Headache generally decreased after consultation with a specialist; it decreased significantly more in the 527 patients who were assigned a diagnosis compared to the 344 patients who claimed they were not. Reduction of headache also was significantly more obvious in the 483 patients who had treatment prescribed, as compared to the 385 patients not receiving any therapeutic measure. Self-perceived quality of life was generally improved, significantly more when the patient was given a diagnosis, and even when the diagnosis did not lead to treatment. CONCLUSIONS Patients referred to a neurologic center for evaluation of headache generally experience a significantly greater improvement in their headache syndrome and quality of life. This appears particularly so when they receive a diagnosis, even if no treatment is prescribed.
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Affiliation(s)
- Rolf Salvesen
- Departments of Neurology, University of Tromsø, Nordland Sentralsykehus, 8092 Bodø, Norway
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Murdock A, Rodgers C, Lindsay H, Tham TCK. Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic. J R Soc Med 2002; 95. [PMID: 12042374 PMCID: PMC1279909 DOI: 10.1258/jrsm.95.6.284] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Unkept 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 reflects apathy, no strategy to improve attendance is likely to have great impact. Since the non-attendance rate is reasonably constant, it can be taken into account when patients are booked.
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Affiliation(s)
- A Murdock
- Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast BT16 1RH, Northern Ireland, UK
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Murdock A, Rodgers C, Lindsay H, Tham TCK. Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic. J R Soc Med 2002; 95:284-6. [PMID: 12042374 PMCID: PMC1279909 DOI: 10.1177/014107680209500605] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Unkept 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 reflects apathy, no strategy to improve attendance is likely to have great impact. Since the non-attendance rate is reasonably constant, it can be taken into account when patients are booked.
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Affiliation(s)
- A Murdock
- Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast BT16 1RH, Northern Ireland, UK
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Sharp DJ, Hamilton W. Non-attendance at general practices and outpatient clinics. BMJ (CLINICAL RESEARCH ED.) 2001; 323:1081-2. [PMID: 11701560 PMCID: PMC1121587 DOI: 10.1136/bmj.323.7321.1081] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bekkelund SI, Salvesen R. Are headache patients who initiate their referral to a neurologist satisfied with the consultation? A population study of 927 patients--the North Norway Headache Study (NNHS). Fam Pract 2001; 18:524-7. [PMID: 11604376 DOI: 10.1093/fampra/18.5.524] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Headache is a common problem in primary care. Although most patients are treated by GPs, many are referred to specialist consultation. Knowledge of how the referrals can be improved is therefore an important issue. OBJECTIVES The aim of this study was to determine the relationship between self-initiating referral to a neurologist and the patient's satisfaction with the specialist consultation. METHODS All patients who had been examined by a neurologist for headache within a 2-year period from three neurological centres in North Norway completed a questionnaire. RESULTS A total of 1052 patients from a population of 1403 headache patients (75%) returned the questionnaire while 927 patients answered questions about initiating the referral to the specialist. Two hundred and twenty patients (24%) initiated the referral to the neurologist themselves; 52% of those who self-initiated the referral were dissatisfied with the specialist consultation compared with 42% of those referred by the doctor, P = 0.002. Chronic headache, tension-type headache (TTH) and daily use of analgesic drugs were associated with dissatisfaction. CONCLUSIONS Patients with headache who initiated the referral to a neurologist themselves were less satisfied with the specialist consultation. Selecting referrals containing proper medical information may improve satisfaction in severe headache patients treated in a neurological practice.
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Affiliation(s)
- S I Bekkelund
- Department of Neurology, Tromsø University Hospital, Norway
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Abstract
OBJECTIVE To examine a group of patients satisfying criteria for "frequent attending" as part of an audit of an outpatient gastroenterology service, and to note the prevalence of those with no conspicuous organic disease to account for their symptomatology. METHODS We used the hospital computer (Oxford Patient Administration System, OXPAS) to identify 2530 consecutive patients who were given an appointment to attend the gastroenterology clinic during an 11-month period. Patients designated "frequent attenders" had their notes flagged before the clinic attendance and were examined in more detail. A frequent attender was defined as a patient who had attended any hospital outpatient clinic in the three Oxford general hospitals on four or more occasions in the previous 12 months. The gastroenterologist then interviewed the patients satisfying these criteria and indicated whether he/she was satisfied that there was no relevant organic disease to account for the symptoms. RESULTS Of the total 2530 patients, 762 (30%) satisfied our criteria for frequent attendance (FA). Of these, 452 (59%) had organic disease, 128 (17%) either did not attend or cancelled and 159 (21%) had no relevant organic disease. The diagnosis was uncertain in 23 patients (3%). Of patients satisfying our criteria for frequent attending, approximately 20-25% had no established gastroenterological disease. CONCLUSIONS Frequent attenders present formidable management problems for the gastroenterologist. If they can be identified by computer before the outpatient visit then assessment and management might be more appropriately supervised in designated clinics by more experienced gastroenterology staff.
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Affiliation(s)
- C Bass
- Department of Psychological Medicine, John Radcliffe Hospital, Headington, OX3 9DU, Oxford, UK
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Ritchie PD, Jenkins M, Cameron PA. A telephone call reminder to improve outpatient attendance in patients referred from the emergency department: a randomised controlled trial. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 2000; 30:585-92. [PMID: 11108069 DOI: 10.1111/j.1445-5994.2000.tb00860.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor compliance with attendance at outpatient clinic appointments in patients referred from emergency departments (EDs) is a major problem in public hospitals. AIMS To determine whether the intervention of a telephone call within three days of ED attendance would improve: 1. the proportion of patients making recommended outpatient appointments; and 2. the proportion of patients attending scheduled appointments. To characterise reasons for non-attendance at appointments made by patients referred from the ED. METHODS A randomised controlled trial was undertaken of 400 patients recommended to make outpatient appointments during attendance at The Royal Melbourne Hospital ED in July-August 1999. INTERVENTION a telephone call one to three days after attendance to remind the patient about the appointment (and its importance for medical follow-up) if one had been made and to offer to make an appointment if one had not been made. OUTCOME MEASURES 1. making the recommended appointment; 2. attendance at the scheduled appointment; and 3. reasons for non-attendance at scheduled appointments. RESULTS The telephone intervention improved attendance at scheduled appointments from 54.4% to 70.7% (p=0.002). The proportion of patients making appointments was not significantly affected. The commonest reasons given for non-attendance were: attended general practitioner (13%), attended private specialist (6.6%), inpatient in hospital at time of appointment (6.6%), too busy or inconvenient (5.3%), claimed to have attended (5.3%) and did not differ by intervention. CONCLUSIONS A significant improvement in the proportion of patients attending outpatients appointments can be made by a simple reminder telephone call one to three days after attendance at the ED.
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Affiliation(s)
- P D Ritchie
- Emergency Medicine, The Royal Melbourne Hospital, Vic.
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Killaspy H, Banerjee S, King M, Lloyd M. Prospective controlled study of psychiatric out-patient non-attendance. Characteristics and outcome. Br J Psychiatry 2000; 176:160-5. [PMID: 10755054 DOI: 10.1192/bjp.176.2.160] [Citation(s) in RCA: 195] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Psychiatric clinics have high non-attendance rates and failure to attend may be a sign of deteriorating mental health. AIMS To investigate why psychiatric out-patients fail to attend, and the outcome of attenders and non-attenders. METHOD Prospective cohort study of randomly selected attenders and non-attenders at general adult psychiatric out-patient clinics. Subjects were interviewed at recruitment and severity of mental disorder and degree of social adjustment were measured. Six and 12 months later their engagement with the clinic and any psychiatric admissions were ascertained. RESULTS Of the 365 patients included in the study, 30 were untraceable and 224 consented to participate. Follow-up patients were more psychiatrically unwell than new patients. For follow-up patients, non-attenders had lower social functioning and more severe mental disorder than those who attended. At 12-month follow-up patients who missed their appointment were more likely to have been admitted than those who attended. CONCLUSIONS Those who miss psychiatric follow-up out-patient appointments are more unwell and more poorly socially functioning than those who attend. They have a greater chance of drop-out from clinic contact and subsequent admission.
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Affiliation(s)
- H Killaspy
- Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London
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Hamilton W, Round A, Sharp D. Effect on hospital attendance rates of giving patients a copy of their referral letter: randomised controlled trial. BMJ (CLINICAL RESEARCH ED.) 1999; 318:1392-5. [PMID: 10334750 PMCID: PMC27884 DOI: 10.1136/bmj.318.7195.1392] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate whether sending patients a copy of their referral letter can reduce non-attendance at outpatient departments. DESIGN Blinded randomised controlled trial. SETTING 13 general practices in Exeter, Devon. SUBJECTS 2078 new consultant referrals from 26 doctors. MAIN OUTCOME MEASURES Non-attendance at outpatient departments. RESULTS The doctors excluded 117 (5.6%) referrals, and 100 (4.8%) received no appointment. Attendance data were available for 1857 of the 1861 patients sent an appointment (99.8%). The receipt of a copy letter had no effect on the non-attendance rate: copy 50/912 (5.5%) versus control 50/945 (5.3%). CONCLUSION Copy letters are ineffective in reducing non-attendance at outpatient departments.
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Affiliation(s)
- W Hamilton
- North and East Devon Health Authority, Southernhay East, Exeter EX1 1PQ
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Donohoe MT, Kravitz RL, Wheeler DB, Chandra R, Chen A, Humphries N. Reasons for outpatient referrals from generalists to specialists. J Gen Intern Med 1999; 14:281-6. [PMID: 10337037 PMCID: PMC1496579 DOI: 10.1046/j.1525-1497.1999.00324.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the relative importance of medical and nonmedical factors influencing generalists' decisions to refer, and of the factors that might avert unnecessary referrals. DESIGN Prospective survey of all referrals from generalists to subspecialists over a 5-month period. SETTING University hospital outpatient clinics. PARTICIPANTS Fifty-seven staff physicians in general internal medicine, family medicine, dermatology, orthopedics, gastroenterology, and rheumatology. MEASUREMENTS AND MAIN RESULTS For each referral, the generalist rated a number of medical and nonmedical reasons for referral, as well as factors that may have helped avert the referral; the specialist seeing the patient then rated the appropriateness, timeliness, and complexity of the referral. Both physicians rated the potential avoidability of the referral by telephone consultation. Generalists were influenced by a combination of both medical and nonmedical reasons for 76% of the referrals, by only medical reasons in 20%, and by only nonmedical reasons in 3%. In 33% of all referrals, generalists felt that training in simple procedures or communication with a generalist or specialist colleague would have allowed them to avoid referral. Specialists felt that the vast majority of referrals were timely (as opposed to premature or delayed) and of average complexity. Although specialists rated most referrals as appropriate, 30% were rated as possibly appropriate or inappropriate. Generalists and specialists failed to agree on the avoidability of 34% of referrals. CONCLUSIONS Generalists made most referrals for a combination of medical and nonmedical reasons, and many referrals were considered avoidable. Increasing procedural training for generalists and enhancing informal channels of communication between generalists and subspecialists might result in more appropriate referrals at lower cost.
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Affiliation(s)
- M T Donohoe
- Robert Wood Johnson Clinical Scholars Program, Stanford, Calif., USA
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Abstract
Outpatient non-attendance is a common source of inefficiency in a health service, wasting time and resources and potentially lengthening waiting lists. A prospective audit of plastic surgery outpatient clinics was conducted during the six months from January to June 1997, to determine the clinical and demographic profile of non-attenders. Of 6095 appointments 16% were not kept. Using the demographic information, we changed our follow-up guidelines to reflect risk factors for multiple non-attendances, and a self-referral clinic was introduced to replace routine follow-up for high risk non-attenders. After these changes, a second audit in the same six months of 1998 revealed a non-attendance rate of 11%--i.e. 30% lower than before. Many follow-up appointments are sent inappropriately to patients who do not want further attention. This study, indicating how risk factor analysis can identify a group of patients who are unlikely to attend again after one missed appointment, may be a useful model for the reduction of outpatient non-attendance in other specialties.
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Affiliation(s)
- C A Stone
- Department of Plastic and Reconstructive Surgery, Royal Devon and Exeter Hospital
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Abstract
PURPOSE To determine the effect of the source of referral on appointment compliance of adolescents to referring doctors or to consultants at tertiary medical centers. METHODS This analysis included 421 adolescent patients aged 10-18 years who were referred to the tertiary teaching hospital in Taiwan by 75 primary care doctors, including 56 pediatricians and 19 general practitioners in 1987-1996. Medical records were abstracted to determine clinical severity and demography. Data of compliance with return appointments were collected by an independently trained interviewer. RESULTS A total of 18.07% of referrals were initiated by patients or families and 81.93% were initiated by primary care doctors. More severe illness was found in patient-initiated referrals than in doctor-initiated referrals. After controlling for demographic, family features, medical payment, and doctor specialty, this study showed that if the referral were initiated by patients or families, adolescent patients were less likely to return to either the primary care doctors or tertiary teaching hospitals. CONCLUSIONS Although in a competitive environment, follow-up care is more likely to occur for both primary care doctors and consultants at tertiary teaching hospitals when the referral was initiated by primary care doctors.
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Affiliation(s)
- J W Hsu
- Graduate Research Institute of Medicine, Kaohsiung Medical College, Taiwan, ROC
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McGuire SL, Gerber DE, Clemen-Stone S. Meeting the diverse needs of clients in the community: effective use of the referral process. Nurs Outlook 1996; 44:218-22. [PMID: 8905834 DOI: 10.1016/s0029-6554(96)80095-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Because clients today generally move quickly from one care setting to another, it is essential to identify their need for follow-up care in the community. A wide array of helping resources are available to enhance continuous, comprehensive care for these clients. When nurses have an understanding of the referral process, they can help clients gain access to appropriate community resources. Establishing an effective referral system facilitates use of the referral process and identification of clients who need ongoing care.
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