Between the Cup and the Lip: Missed Dental Appointments

Barriers to and facilitators for attending dental care appointments among adults in low- and middle-income countries: a scoping review

BACKGROUND

Oral diseases are a major public health concern in Low and Middle Income Countries (LMICs), where effective treatment requires multiple appointments. Despite its importance, limited research has explored appointment adherence among adults in these settings. This scoping review identifies the barriers and facilitators to attending dental care appointments in LMICs.

METHODS

The current review followed JBI Scoping Review Methodology. The Databases of Dentistry, Oral Sciences Source (EBSCO), MEDLINE (Ovid), Embase (Ovid), Cochrane CENTRAL, Scopus and grey literature sources were searched systematically from inception till November 2024. Two independent reviewers performed data extraction using a customized JBI data extraction form. The Theoretical Domains Framework categorized barriers and facilitators of dental appointment keeping. Findings were tabulated and synthesized narratively with recommendations to improve dental attendance.

RESULTS

Ten articles met the inclusion criteria after being screened through 5571 titles, abstracts, and 210 full texts. Knowledge, social and professional roles and identity, beliefs about capabilities, consequences, memory, attention, decision-making processes, environmental context and resources, social influence, and emotion are the main domains under which barriers and facilitators were identified. Environmental context and resource constraints were the most common barriers, while social influence was the main facilitator. The dental appointment adherence issues were determined to be comparable in public practice and university settings.

CONCLUSION

It is necessary to acknowledge the barriers and facilitators to dental appointment keeping to improve the effectiveness of the dental health system, ensure continuity of care, and encourage better patient-doctor relationships. Tailored interventions are required in the dental setting to effectively manage and reduce disparities in patient care.

Patient understanding and compliance with post-operative instructions and follow-up at Yekatit 12 Hospital, Addis Ababa, Ethiopia

BACKGROUND

Patient understanding, compliance with post-operative instructions, and follow-up are useful for obtaining good patient outcomes. Lack of understanding and non-compliance are common problems that significantly impact patients' health. Understanding the level of compliance and identifying associated reasons are important for achieving successful patient outcomes.

OBJECTIVE

This study evaluated patient understanding and compliance with post-operative instructions and follow-up after dental procedures at Yekatit 12 Hospital in Addis Ababa, Ethiopia.

METHODS

An institutional cross-sectional study was conducted at the dental clinic of Yekatit 12 Hospital. Study participants were selected using a systematic sampling method. Over two months, trained data collectors administered a semi-structured questionnaire to 227 consenting patients attending the dental clinic. Patient records were reviewed to retrieve important information. Data collected included patient demographics, post-operative instructions, and frequency of attendance at follow-up appointments. The data were entered into the SPSS version 26 software package. A chi-square test was used to assess the relationships between the independent and dependent variables.

RESULTS

The overall patient compliance rate with post-operative instructions was 67.9% and the follow-up appointment attendance rate was 66%. This study revealed that patients who missed follow-up appointments cited forgetfulness as their primary reason. The compliance rate with post-operative instructions varied based on the mode of instructional delivery and patient literacy level.

CONCLUSIONS

This study revealed suboptimal patient compliance with post-operative instructions and follow-up appointment attendance at Yekatit 12 Hospital. The most common reasons for missing appointments included forgetfulness and economic issues. Patient education and good communication are required to improve patient compliance and follow-up. Additionally, follow-up reminder systems such as text messages should be implemented to increase patient attendance at follow-up appointments.

Identifying barriers to pediatric dental appointments: insights from a study at Prince Faisal bin Al-Hussein Hospital

Ensuring good oral health is crucial for overall well-being. Missed appointments can negatively impact the quality of care and oral health outcomes, making it essential to identify the factors contributing to non-attendance. This study aimed to identify the factors associated with non-attendance at a pediatric dental clinic. The study used a cross-sectional design, which included a random sample (n = 265) of eligible pediatric patients under 12 years old, with data collected through questionnaires completed by their parents. Data were collected over 3 months, from November 2023 to January 2024, and analyzed using descriptive statistics and a chi-square test, with a confidence level of 95%. Results indicated that 76% of patients were school-age children, and 44% of children had missed their appointments. The critical barriers to attendance mentioned by parents were social and family commitments (15.2%), forgetfulness (11.2%), illness (8.6%), school commitments (6.9%), and fear of dental treatment (3.5%). The administrative barriers were due to staff miscommunications (10.3%), while non-attendance for unspecified reasons was 11.2%. Finally, the relationship between age, gender, and type of transportation with missed appointments was statistically significant (P < 0.05). This study highlights the significant rate of missed appointments and the factors contributing to non-attendance at pediatric dental clinics.

Perceptions of barriers towards dental appointment keeping among patients of a tertiary care setting: A mixed method exploration

Objectives

To explore the barriers governing dental appointment keeping among patients reporting to a tertiary care setting. To assess the prevalence of missed dental appointments in a tertiary care center.

Primary

To explore the barriers governing dental appointment keeping among patients reporting to a tertiary care setting.

Secondary

To assess the prevalence of missed dental appointments in a tertiary care center.

Methodology

The study design adopted is a sequential explanatory mixed method design; here, quantitative data collection and analysis is followed by qualitative data/analysis. The quantitative arm recorded six months of retrospective data on missed appointments in the centre. Prevalence was estimated, and descriptive and inferential statistics were performed. For the qualitative component, focus group discussions and in-depth interviews were conducted among dental health professionals and patients. Data was transcribed, and thematic content analysis was performed using NVivo software.

Results

The prevalence of missed appointments in the tertiary care centre was 8.4 %. Personal/health issues (30.7 %) were noticed to be the most reported reason for missed appointments. Other causes include distance to the clinic (17.2 %), inflexible work schedule (14.7 %), transportation (12.3 %), dental anxiety (6.7 %), and economic issues (5.5 %). Qualitative data revealed the appointment system, experiences, consequences, responsible factors, management, and prevention of missed appointments in a tertiary care dental centre.

Conclusion and recommendations

Multiple barriers are identified for dental appointment-keeping behavior. Missed appointments are prevalent in the study setting, as dental treatments require multiple sittings to complete. The study's findings primarily focus on a tertiary care center and may reflect reduced prevalence due to the COVID-19 pandemic. Tailor-made interventions are suggested for tertiary care settings to manage and prevent missed appointments, paving the way for successful health care delivery.

Why Do Patients Miss Dental Appointments in Eastern Province Military Hospitals, Kingdom of Saudi Arabia?

No-shows for scheduled appointments are a frequent occurrence, creating unused appointment slots and reducing patient quality of care and access to services while increasing loss to follow-up and medical costs. The aim of our study was to determine the factors that lead to patients missing their dental appointments in Eastern Province Military Hospitals, Kingdom of Saudi Arabia. The study population included military personnel and their families attending the dental clinics of these hospitals. In our study, the percentage of missed appointments was 58.1%, while 54.4% of participants canceled dental appointments in the past. Thirty-six percent preferred morning appointments while 56% preferred an afternoon appointment and were likely to miss a morning appointment if given one. The most common reasons for missing an appointment were forgetting about it (24.3%) and the inability to get time off either from work or school (15.4%); 1.5% of patients stated they had a bad dental experience and feared dental treatment while the unavailability of transport accounted for 0.7% of patients. Of the reasons given for canceling an appointment, the inability to get time off from work/school was the most common (22.1%) while a dislike for treatment was the least common (0.7%). Canceling an appointment was significantly correlated with missing an appointment among the surveyed sample (P=0.00). In our research, 60.3% of participants still relied on their personal diary to remember appointments, which could be a reason for the high rate of missed appointments. Fifty-nine percent of respondents felt that missing an appointment was important to them, while 72% stated that missed appointments could affect the work of the clinic but still believed that automatic appointments should be given to patients who missed them and a change be made accordingly. Since major factors included a lack of a reminder message and appointments scheduled at inconvenient timings, some steps that can help reduce the frequency of missed appointments include sending a reminder message to patients, giving preference to their schedules for appointments, giving patients shorter appointments, reducing intervals between subsequent appointments, and educating patients regarding the treatment plan, to reduce anxiety.