The Impact of Patient Location on Attendance to Cardiology Outpatient Appointments

Abstract

Background: There is a disparity in cardiovascular outcomes between metropolitan and rural Australia. Rural patients travel significant distances to receive specialist care. Travel assistance schemes provide financial support for patients. It is unclear whether attendance rates are equal between metropolitan and rural based patients. Objectives: To determine whether there is a difference in non-attendance rates between metropolitan and non-metropolitan patients attending cardiology outpatient clinics. To determine the cost of travel assistance for non-metropolitan patients. Method: A retrospective study was performed using coding data from cardiology outpatient clinics at a single tertiary hospital in Perth, Western Australia. Patients were separated into metropolitan or non-metropolitan. Non-metropolitan patients were divided into rural or remote, based on Patient Assisted Travel Scheme (PATS) criteria. PATS cost data was reviewed. Results: Between January 2013 and January 2016, there were 32,988 outpatient appointments, of which 3,091 were rural and 1,089 remote patients. The non-attendance rate was 16% for metropolitan patients and 25% for non-metropolitan patients (p < 0.01). The non-attendance rate was 20% for rural and 38% for remote patients (p < 0.01). The PATS cost per remote patient was $829.95 and per rural patient was $204.87 with a total of $731,460.57 being spent on 1,938 visits. Conclusion: There is a significantly higher non-attendance rate for non-metropolitan patients, particularly for remote patients. There is a significant cost involved in patient travel to access specialist care. Further studies would be useful to determine whether other options such as outreach or telehealth services can improve attendance rates and cost saving.