Out-patient appointments: a necessary evil? a literature review and survey of patient attendance records

Reuven Manfred Magnes

doi:10.1192/pb.bp.108.020065

Abstract

Aims and MethodTo describe the effect of a postal reminder system on UK adult psychiatry clinic attendance. A literature review was completed and a serial cross-sectional survey of patient attendance records in an inner-city psychiatric hospital during 2006 and 2007 was undertaken.ResultsA simple postal prompt reduces non-attendance by up to 50% and data from the serial cross-sectional survey of attendance records (n=36) powered at 77% supported this finding. Postal prompts in the survey accounted for 30% improvement in the variance (r2).Clinical ImplicationsA simple postal prompt that takes less than 30 s to read, sent up to 2 weeks prior to the appointment improves attendance by up to 50% and is useful for maintaining standards of excellence.

Highlights

Seven were suitable for inclusion (Rusius, Magnes Patient attendance at out-patient appointments 1995; Killaspy et al, 2000; Reda & Makhoul, 2001; Sharp & Hamilton, 2001; Hamilton et al, 2002; McIvor & Ek, 2004; Hawker, 2007) and the decision to include a study was based on whether it was carried out on an adult service in the UK and whether it was informative on improving out-patient attendance
Poor psychiatric out-patient attendance continues to be an extravagant waste of resources with wasted appointments being up to 35% or higher
A simple postal prompt reduces nonattendance by up to 50% and data from the serial cross-sectional survey of attendance records (n=36) powered at 77% supported this finding

Summary

Methods

A literature review of peer-reviewed psychiatry journals 1974-2007 was conducted. A number of databases were searched (EMBASE, MEDLINE, PsycLit, King’s Fund, CINAHL, PsycINFO) with keywords: ‘psychiatry outpatient’, ‘improve out-patient attendance’, ‘nonattendance’. The search was limited to papers published in English and peer-reviewed journals. 1995; Killaspy et al, 2000; Reda & Makhoul, 2001; Sharp & Hamilton, 2001; Hamilton et al, 2002; McIvor & Ek, 2004; Hawker, 2007) and the decision to include a study was based on whether it was carried out on an adult service in the UK and whether it was informative on improving out-patient attendance.

Results

Discussion

Conclusion