A comparison of hematology/oncology clinic attendance between insured and under-insured patients at an urban academic hospital: Identifying barriers and ways to overcome them

Abstract

16015 Background: There are persistent disparities in cancer outcomes based on non-clinical factors such as race, socioeconomic status, and access to care. Successful treatment outcomes in oncology and symptom control depend heavily on patient compliance. To improve patient attendance at oncology appointments, the reasons why patients miss appointments must be understood, and then interventions must be enacted to rectify the problem. Methods: At the hematology/oncology clinics of Virginia Commonwealth University, the fellows’ clinic consists of patients that are primarily uninsured or underinsured, and the faculty clinic consists of patients that are primarily well-insured. On Mondays and Fridays from January 31–June 30, 2005, attendance of scheduled patients was recorded. Patients were then called and asked why they did not attend their appointments. Also, the patient’s sex, age, race, diagnosis, and insurance status were recorded. Results: Of the 1705 appointments scheduled in the predominantly under-insured fellows’ clinic, 223 (13.1%) of these were no shows. Of the 1614 appointments scheduled in the better-insured faculty clinic, 115 (7.1%) of these were no-shows (p < .0001). Of African-American patients in both clinics, 30.9% did not attend their appointments as compared to 19.4% of Caucasian patients (p = .0003). The no-show rate among women was 22.4% as compared to 28.6% for men in both clinics (p = .025). Of all patients under age 50, 30.1% did not show up as compared with 22.4% of all patients aged 50 or higher (p = .009). Chi-square was used to test for significance. Among both clinics, the reasons for missing appointments included: the patient did not know of the appointment (35), patient illness (24), transportation difficulties (12), family emergency (7), forgot (7), and weather (2). Conclusions: In this study, appointment knowledge and patient illness affect oncology clinic attendance most. It is our goal to implement measures, such as appointment reminders and transportation assistance, and then reassess attendance rates. No significant financial relationships to disclose.