Abstract
BackgroundPatients who no-show to primary care appointments interrupt clinicians’ efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics.MethodsA prospective cohort study was conducted using data from 8,787 adult diabetic patients attending outpatient clinics associated with a medical center in Indiana. The outcomes examined were hospital admissions or ED visits in the 6 months (182 days) following the patient’s last scheduled primary care appointment. The Andersen-Gill extension of the Cox proportional hazard model was used to assess risk separately for hospital admissions and ED visits. Adjustment was made for variables associated with no-show status and acute care utilization such as gender, age, race, insurance and co-morbid status. The interaction between utilization of the acute care service in the six months prior to the appointment and no-show was computed for each model.ResultsThe six-month rate of hospital admissions following the last scheduled primary care appointment was 0.22 (s.d. = 0.83) for no-shows and 0.14 (s.d. = 0.63) for those who attended (p < 0.0001). No-show was associated with greater risk for hospitalization only among diabetics with a hospital admission in the prior six months. Among diabetic patients with a prior hospital admission, those who no-showed were at 60% greater risk for subsequent hospital admission (HR = 1.60, CI = 1.17–2.18) than those who attended their appointment. The six-month rate of ED visits following the last scheduled primary care appointment was 0.56 (s.d. = 1.48) for no-shows and 0.38 (s.d. = 1.05) for those who attended (p < 0.0001); after adjustment for covariates, no-show status was not significantly related to subsequent ED utilization.ConclusionsNo-show to a primary care appointment is associated with increased risk for hospital admission among diabetics recently hospitalized.
Highlights
Patients who no-show to primary care appointments interrupt clinicians’ efforts to provide continuity of care
Results from the Andersen Gill model revealed that the interaction between prior hospital admission and no-show on subsequent hospital admissions was significant (p = 0.0017)
Among the subgroup of diabetic patients who had a prior hospital admission, those who no-showed were at 60% greater risk for subsequent hospital admission (HR = 1.60, CI = 1.17-2.18) than those who attended their appointment
Summary
Patients who no-show to primary care appointments interrupt clinicians’ efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics. Diabetes mellitus was ranked as the seventh leading cause of death in 2009 [1]. There were nearly 125 million visits to Emergency Departments (ED) in 2008 and over 98.5 million were for adults; the most frequent reasons for adult ED visits revealed that diabetes mellitus without complications ranked third (9.3%) of all ED visits [3]. In 2007, an estimated $3.87 billion was attributed to emergency department costs for diabetes [4]. In 2008 over 7.7 million hospital admissions and $83 billion in costs were attributed to diabetes [5]
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