Abstract
BackgroundFailure to keep medical appointments results in inefficiencies and, potentially, in poor outcomes for patients. The aim of this study is to describe non-attendance rate and to investigate predictors of non-attendance among patients receiving hospital outpatient treatment for chronic diseases.MethodsWe conducted a historic, register-based cohort study using data from a regional hospital and included patients aged 18 years or over who were registered in ongoing outpatient treatment courses for seven selected chronic diseases on July 1, 2013. A total of 5895 patients were included and information about their appointments was extracted from the period between July 1, 2013 and June 30, 2015. The outcome measure was occurrence of non-attendance. The associations between non-attendance and covariates (age, gender, marital status, education level, occupational status, specific chronic disease and number of outpatient treatment courses) were investigated using multivariate logistic regression models, including mixed effect.ResultsDuring the two-year period, 35% of all patients (2057 of 5895 patients) had one or more occurrences of non-attendance and 5% of all appointments (4393 of 82,989 appointments) resulted in non-attendance. Significant predictors for non-attendance were younger age (OR 4.17 for 18 ≤ 29 years as opposed to 80+ years), male gender (OR 1.35), unmarried status (OR 1.39), low educational level (OR 1.18) and receipt of long-term welfare payments (OR 1.48). Neither specific diseases nor number of treatment courses were associated with a higher non-attendance rate.ConclusionsPatients undergoing hospital outpatient treatments for chronic diseases had a non-attendance rate of 5%. We found several predictors for non-attendance but undergoing treatment for several chronic diseases simultaneously was not a predictor. To reduce non-attendance, initiatives could target the groups at risk.Trial registrationThis study was approved by the Danish Data Protection Agency (Project ID 18/35695).
Highlights
Failure to keep medical appointments results in inefficiencies and, potentially, in poor outcomes for patients
A total of 195 appointments had occurrences of attendance and non-attendance on the same day; these were categorized as attendances
Among the specific disease groups, patients with type 1 diabetes (28% vs. 20% p < 0.001) had a higher non-attendance rate while a lower non-attendance rate was seen among patients with rheumatoid arthritis (11% vs. 14% p < 0.001) and osteoporosis (4% vs. 8% p < 0.001)
Summary
Failure to keep medical appointments results in inefficiencies and, potentially, in poor outcomes for patients. The aim of this study is to describe non-attendance rate and to investigate predictors of non-attendance among patients receiving hospital outpatient treatment for chronic diseases. Patients who do not attend scheduled appointments in hospital outpatient clinics are a challenge for the health care system. Non-attendance is resource demanding, as missed appointments remain unused and new bookings must be made. Non-attendance may interrupt continuity of care resulting in reduced health outcomes e.g. impaired diabetes [1, 3, 4] and hyperlipidemia management [1]. A recent systematic review including studies in primary care and specialty clinics showed an average nonattendance rate of 23% with large variations according to medical specialties and continents [5]. Studies in Denmark have shown non-attendance rates of up to 14% [6, 7]
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