Abstract
Purpose Research demonstrates that non-attendance at healthcare appointments is a waste of scarce resources; leading to reduced productivity, increased costs, disadvantaged patients through increased waiting times and demoralised staff. The purpose of this paper is to investigate non-attendance and implemented interventions to improve practice. Design/methodology/approach A mixed methods service audit took place in a primary care psychological therapies service. Existing service guidelines and reporting systems were reviewed. A cross-sectional design was used to compare a year’s cohort of completers of cognitive behavioural therapy (CBT) (n=140) and drop-outs (n=61). Findings Findings suggested contrasting guidelines and clinically inaccurate reporting systems. The overall service did not attend (DNA) rate was 8.9 per cent; well below rates suggested in the literature. The drop-out rate from CBT was 17 per cent. The most influential factor associated with CBT drop-out was the level of depression. The level of anxiety, risk ratings and deprivation scores were also different between completers and drop-outs. The main reasons given for non-attendance were forgetting, being too unwell to attend, having other priorities, or dissatisfaction with the service; again these findings were consistent with prior research. Originality/value A range of recommendations for practice are made, many of which were implemented with an associated reduction in the DNA rate.
Highlights
Non-attendance is an aspect of service delivery that has been affecting health services generally and mental health and psychological therapy services in particular for decades
A range of recommendations for practice are made, many of which were implemented with an associated reduction in the Did Not Attend (DNA) rate
The DNA benchmark set by the organisation was 5% and the DNA rate suggested from the literature search was between 10% and 20%
Summary
Non-attendance is an aspect of service delivery that has been affecting health services generally and mental health and psychological therapy services in particular for decades. In the UK up to one in ten outpatient appointments are missed (The Information Centre for Health and Social Care, ICHSC, 2006) with a calculated cost of £600 million a year (Dr Foster Research Limited, 2009). Non-monetary costs of non-attendance include longer waiting times, wasted resources, and poorer clinical outcomes (Stone, Palmer, Saxby, & Devaraj, 1999). Focusing on failure to attend appointments (i.e., Did Not Attend or DNA rates) is important, patients can still ea have successful treatment despite missing the occasional session. Focusing on the droplth out rate or non-completion of treatment is important. Drop-out can be defined as when patients leave treatment sessions early in an unplanned manner before treatment has finished; patients stop attending without prior agreement (Westbrook and Kirk, 2005).
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