From statistics to stories: understanding the complex landscape of missed medical appointments.

Abstract

Research suggests that in both France and the UK, between 5 to 10% of appointments with General Practitioners (GPs) are unattended. A comprehensive Irish study linked missed appointments with an increased short-term risk of mortality, prompting further investigation into the reasons behind absenteeism. This study seeks to delve into the underlying causes of missed appointments, within the context of an urban health center. Using a mixed-method approach, this study combines qualitative telephone interviews with quantitative analysis of medical records. The research focuses on patients who failed to attend appointments at an urban health center over a 15-day period. The interview guide collected data on circumstances leading to missed appointments and explored patients' social determinants of health. Additionally, patients' socio-economic backgrounds was undertaken of medical records. Among 53 missed appointments (4.9% of all scheduled), 22 patients were interviewed. SHC beneficiaries (68% of the sample) cited socio-economic instability, including precarious work hours, social isolation, and multiple commitments, as reasons for non-attendance. For non-SHC beneficiaries, forgetfulness was the main cause. Remarkably, 36% disclosed a history of domestic violence. Retrospective analysis by physicians deemed over a quarter of these missed appointments as significant. The findings indicate that missed appointments can highlight social inequality, emphasising the need to align healthcare with patients' temporal realities. The identification of patients who have experienced violence and the use of missed appointments as triggers for follow-up calls seems to be promising strategies to enhance care and mitigate health inequalities.