Did Not Attend Research Articles

Using expert patients to co-facilitate an introductory information session: does informed patient choice enhance engagement with pulmonary rehabilitation?

Objective: As the pulmonary rehabilitation service has developed, demand on resources has increased. Patient ‘opt-in’ sessions aimed at reducing initial patient assessment Did Not Attend (DNA) rate were introduced. It was also hoped that facilitating informed patient choice would increase programme completion rates.Method: For a period of one year ‘opt-in’ sessions – 30 minute education sessions co-facilitated by ‘expert patients’ explaining the specifics of pulmonary rehabilitation – were introduced. Expert patients are patients who have successfully completed the programme, have shown evidence of fully engaging with self-management and associated maintenance behaviours, and encourage others based on their own lived experiences. Assessment appointment attendance and group completion data were collected and compared for two patient cohorts over a period of 1 year prior to, and post, instigation of the opt-in sessions.Results: Initial assessment appointment DNA rate decreased from 22.4% (original service) to 10.6% (enhanced service) with a net clinical time saving of 66 h. Programme completion rate increased from 50.2% (original service) to 77.0% (enhanced service).Conclusion: The evidence here shows that this simple intervention is associated with improved service efficiency without requiring additional resources. Opt-in sessions could be adopted by other services promoting self-management of long-term conditions.

Formative exploration of the relationship between waiting times and attendance at general adult psychiatry clinics, at a hospital in pennine care NHS Foundation Trust

IntroductionAn audit was done to assess new patient wait times. As part of this project we reviewed possible relationships between wait times and clinic attendance.ObjectiveTo examine available data, for possible explanations of patients’ attendance behaviour at outpatient clinics.AimsTo identify possible correlation between length of waiting time for adult psychiatry appointments and status of attendance.MethodService Line: New patient referrals to adult outpatient psychiatry (January–December 2015)Sample size: 401.ResultsFig. 1 and Table 1 show wait times compared with clinic attendance outcome. Percentage attendance appeared to gradually fall as wait times increased; while cancellation (%) by the NHS, and DNAs (did not attend) by the patient, appeared to rise over time.ConclusionsThis review has demonstrated a possible correlation between wait time for a clinic appointment and how patients behave. The shorter a patient has to wait; it appears they are more likely to actually attend clinic. If so, this potentially has implications for discussions around possible reorganization of services, to improve engagement and outcomes, by coming up with innovative ways of reducing wait times.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Non-attendance at psychological therapy appointments

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.

Using administrative innovation to address missed consultant outpatient appointments

An administrative innovation for booking outpatient appointments has been introduced in Wales, Scotland and Northern Ireland, variously known as ‘patient-focussed booking’ (PFB) and ‘partial booking’. It has three distinct features: patients must confirm their wish to have an appointment; patients are given a choice of date, time and place for the appointment; and the appointment is booked only a short time in advance of the due date. Previous studies have shown a reduction in missed booked appointments, either because the patient could not attend (CNA) or did not attend (DNA). Our results, covering a more recent period, confirm these findings, and show they can be sustained for longer periods. The requirement that patients must confirm their wish to have an appointment can lead to some referrals not ending up as booked appointments. Some may choose to withdraw; others simply did not reply, ‘non-responders’. Either way, those that do not are referred back to their GP. This study finds non-response was much less common that previous studies. However, it was common enough to offset the effect of PFB on missed booked appointments due to CNA and DNA. To that extent, the innovation did not make much change to civic disengagement, except for providers who are now better able to plan clinics.

PTU-122 Do the follow-up rates of positive hepatitis c screens vary depending on the source of the test?

<h3>Introduction</h3> The hepatitis C (HCV) treatment pathway usually begins with a HCV screen. In our hospital, a positive HCV screen is determined by an enzyme immunoassay that detects anti-HCV antibodies. If a patient is not known to have HCV, a further blood sample is required for quantifying HCV viral load and genotyping by polymerase chain reaction (PCR). A proportion of positive HCV screens are not followed up upon and it is the responsibility of the requesting clinician to arrange appropriate follow-up. We aimed to determine whether the follow-up rates of positive HCV screens vary depending on the source of the test. <h3>Method</h3> A retrospective, single-centre evaluation over a 10 year period from January 2004 to September 2014 was carried out. Only patients with an address within the hospital’s catchment area and over the age of 18 at the time of testing were included. The sources of the positive HCV screens were obtained from our hospital’s laboratory database and divided into five groups: Inpatients (IP), outpatients excluding gastroenterology departments (OP), general practice (GP), maternity unit (MA) and community drug team (CM). We analysed whether these patients had follow-up PCR testing and whether they were referred to a gastroenterology clinic. <h3>Results</h3> 348 patients with positive anti-HCV antibodies were identified. 227 patients (65.2%) had follow-up PCR testing done. The rates of subsequent PCR testing after a positive HCV screen were: CM (83.3%), GP (72.7%), OP (71.4%), MA (57.7%) and IP (46.1%) with significant differences between the groups (p &lt; 0.001, ANOVA). 250 patients (71.8%) were referred to a gastroenterology clinic but 39 patients (11.2%) did not attend (DNA) their first appointment. The referral rates were: CM (84.9%), GP (78.8%), OP (74.3%), IP (58.9%) and MA (57.7%); (p &lt; 0.001, ANOVA). PCR and referral outcomes are presented in the Table 1. <h3>Conclusion</h3> The follow-up rates of positive HCV screens vary depending on the source of the test. We postulate that the frequency of interactions between patients and healthcare professionals is a key factor in ensuring follow-ups. Better follow-up of HCV screening is needed in order to achieve better clinical outcomes for HCV. This is particularly important as more efficacious and tolerable drugs are becoming increasingly available. <h3>Disclosure of interest</h3> None Declared.

How effective is a SMS reminder service at reducing the rate of patients who do not attend (DNA) GP appointments and can DNA rates be further reduced?

Background Partington Family Practice is based in one of the most socio-economically deprived areas in Greater Manchester. The practice installed an SMS appointment reminder system in 2009 to decrease the DNA rates of its high proportion of service resistant patients. The aims of this project are to investigate how effective this service has been and consider any future services that could further reduce the practice’s DNA rates.

A Study of the Slot Wastage in a Sample Endoscopy Unit in United Kingdom: Analysis of the Causes

Background: Patients who do not attend (DNA) or cannot attend (CNA) outpatient endoscopy procedure appointments can be a source of resource wastage. This study is an analysis of the DNA and CNA rates of an endoscopy unit in a sample district general hospital with the aim of finding reasons for any under or over-utilization. It recommends some solutions to solve the problem. Method: Using the hospital computer records, all patients who did not attend (DNA) or could not attend (CNA) their appointment from 1st January 2014 to 30th June 2014 for endoscopy during weekdays and weekend were identified retrospectively. Results:There were 116 points available per week on average.There was thus 25% wastage in point utilization. Conclusions: This study has shown that common issue for wastage has been poor communication. This lack of communication may be between the doctor and the patient, the endoscopy manager and the patient, or the doctor and the endoscopy managers etc.

Improving health outcomes for young people with long term conditions: The role of digital communication in current and future patient-clinician communication for NHS providers of specialist clinical services for young people - LYNC study protocol.

BackgroundYoung people living with long term conditions are vulnerable to health service disengagement. This endangers their long term health. Studies report requests for digital forms of communication – email, text, social media – with their health care team. Digital clinical communication is troublesome for the UK NHS.AimIn this article we aim to present the research protocol for evaluating the impacts and outcomes of digital clinical communications for young people living with long term conditions and provide critical analysis of their use, monitoring and evaluation by NHS providers (LYNC study: Long term conditions, Young people, Networked Communications).MethodsThe research involves: (a) patient and public involvement activities with 16–24 year olds with and without long term health conditions; (b) six literature reviews; (c) case studies – the main empirical part of the study – and (d) synthesis and a consensus meeting. Case studies use a mixed methods design. Interviews and non-participant observation of practitioners and patients communicating in up to 20 specialist clinical settings will be combined with data, aggregated at the case level (non-identifiable patient data) on a range of clinical outcomes meaningful within the case and across cases. We will describe the use of digital clinical communication from the perspective of patients, clinical staff, support staff and managers, interviewing up to 15 young people and 15 staff per case study. Outcome data includes emergency admissions, A&E attendance and DNA (did not attend) rates. Case studies will be analysed to understand impacts of digital clinical communication on patient health outcomes, health care costs and consumption, ethics and patient safety.

P89 Attendance Of Secondary Care Respiratory Outpatient Appointments In Illicit Drug Users With Recurrent Hospital Admissions With 'copd' At A City Centre Teaching Hospital

Introduction Non-attendance at outpatient appointments (OPA) costs the NHS an estimated £600 m a year, with over 94,000 missed (first) OPAs in England from 2013 to 2014. 1 We reviewed the arrangement and attendance of OPAs for illicit drug smokers, after hospital re-admission with an ‘exacerbation of chronic obstructive pulmonary disease (COPD)’. Methods All illicit drug smokers re-admitted between January 2009 and September 2011 with a presumptive diagnosis of ‘exacerbation of COPD’ were included. Planned respiratory OPAs were reviewed retrospectively from our COPD admission database to determine the number attended or unattended. Unattended OPAs were classified as (a) hospital cancellation (b) patient cancellation (c) patient did not attend (DNA) or (d) ‘unknown’. Results Of 89 patients, no OPA was arranged in 28 (31.5%). 334 respiratory appointments were made for 61 patients (mean = 5.5 per patient); of these, only 86 (25.7%) were attended (see Table). Conclusion High recurrent admission rates suggests that these patients should all have specialist respiratory OPAs arranged at discharge, with the aim of preventing re-admission and improving their respiratory health. In our cohort we noted poor OPA attendance with a DNA rate of 52.0% compared with around 8.6% for first OPAs overall in England in 2012. 2 This suggests alternative approaches are needed in order to engage with these patients such as community based secondary care outreach services. We will now study the effects of an intensive community-based secondary care outreach services; involving smoking cessation, targeted pulmonary rehabilitation, specialist respiratory (consultant and nurse) involvement, vaccination, inhaler technique reviews, medication concordance checks/ prescription and health trainers. References Department of Health (2014). Referrals and Attendances for Outpatient Appointments: Hospital Activity Statistics. London: DH Department of Health (2013). NHS inpatient elective admission events and outpatient referrals and attendances, quarter ending December 2012. Available from: http://www.england.nhs.uk/statistics/2013/02/22/nhs-inpatient-elective-admission-events-and-outpatient-referrals-and-attendances-quarter-ending-december-2012

S61 High Levels Of Latent Tb Infection, Blood Borne Viruses, Poor Treatment Outcomes And Unmet Need Among Hard To Reach Groups In London: The Tb Reach Study

Background There are high rates of active tuberculosis (TB) in London’s hard to reach groups (homeless people, substance misusers and prisoners). However no systematic data are available regarding the prevalence of latent TB infection (LTBI) and blood borne viruses (BBV) - HIV, Hepatitis B and C (HBV, HCV). Hard to reach groups often present late for healthcare. We undertook a TB/BBV screening programme to assess the prevalence of LTBI and co-infection with BBVs within homeless hostels, drug services and a prison in London. We also investigated management outcomes in those referred on to healthcare services. Design/method Recruitment took place from May 2011–June 2013. Service users screened for TB on a mobile chest x-ray unit and in prison using the static digital x-ray machine were approached and, with consent, blood was drawn for IGRA (Quantiferon In-Tube) and HIV, HCV and HBV. Results were provided to participants with onward referral to healthcare services in line with current guidance. Treatment outcomes were collected via telephone follow up one year post referral for the positive cases. Results Prison (n = 511) (Table 1) LTBI: 65(13%) participants were IGRA positive [3(5%) co-infected with HCV]. Of these, 37(57%) were referred for preventive treatment, 16(43%) did not attend (DNA) appointments and were discharged or were lost to follow up (LFU). Of the 15 who commenced treatment, 9(60%) completed treatment. HCV: 22 participants were positive and referred, of which 11(50%) DNA/LFU, 11(50%) were under review and none commenced treatment. HBV: 10 participants were positive, of which 6(60%) DNA/LFU, 4(40%) were under review and none commenced treatment. There were no HIV positives. Community (N=696) (Table 1) LTBI: 116(17%) participants were IGRA positive [22(19%) co-infected with HCV]. Of the 14(12­%) referred to services, 8(57%) DNA/LFU and 3(21%) commenced treatment (2 completed). HCV: 84 were positive and referred (8 new diagnosis), 42(50%) DNA/LFU/declined referral, and 37(44%) under review. Five (6%) commenced treatment, one completed. HBV: 9 participants had current infection, none started treatment; 6 were under review and 3 DNA/LFU. HIV: 9 participants were positive and known to healthcare services. Conclusion The prevalence of LTBI, BBVs and co-infection within the hard to reach group is high compared to the general population with fewer patients starting TB prophylaxis/HCV treatment. The high overall rates of DNA/LFU (47%) seen indicate that current approaches to onward referral and retention in care for this group appear to be poor and effective measures to improve engagement with clinical services are essential. This study was supported by NIHR Programme Grant for Applied Research (RP-PG-0407–10340).

Missing mums-to-be &amp; smartphone technology: Addressing antenatal clinic DNAs with novel uses of a mobile application

Introduction: A student-led initiative has developed a free smartphone application to be piloted at the Women’s & Children’s Hospital (WCH) within the Hull and East Yorkshire NHS Trust to improve attendance at antenatal clinics following consultation with the patient population and local clinicians. The application interfaces directly with local public transport service resources to aid geographical access to antenatal clinic in addition to providing appointment reminders, a pregnancy tracker and basic healthcare information. Background & Context: Our review of antenatal clinic at the WCH identified an almost 6% Did Not Attend (DNA) rate costing the trust a direct cost of around £54,000/annum(1). This cost is in addition to the various negative health outcomes observed when women fail to attend regular antenatal clinics. The Saving Mother’s Lives report(2) showed that a third (32%) of the women who died in the period 2006-2008 failed to regularly attend antenatal appointments. The top three direct causes of maternal death in the UK are all associated with better health outcomes for the mother who regularly attends antenatal appointments(2). The same can also be said for the top three indirect causes of maternal death(2). Women who fail to attend any antenatal appointments have increased risk of low birth weight children, foetal death & neonatal death (5.46, 12.05 & 10.03, odds ratios compared to control, respectively)(2). Our team hypothesised that offering a free smartphone application with appointment reminders and public transport data could potentially improve attendance at clinics following extensive consultation with local clinicians and patients. We carried out a survey amongst women attending the antenatal service to assess interest and viability of the project. We determined there was an 89% smartphone adoption rate amongst this population (n= 91), with 84% identifying that use of a smartphone app would be useful. 9% of the population was identified as: having a smartphone, finding the concept useful & also having issues with attending antenatal appointments due to International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116517– http://www.ijic.org/ geographical access. All patients who indicated difficulties in attending clinic were within this category. Innovation: We developed a smartphone application that will directly interface with NHS systems to help the patient to keep track of their appointments for smartphones running Google Android or Apple’s iOS. We have integrated data from Travel South Yorkshire to offer public transport information based on GPS data obtained in real time from the smartphone. The mobile application also offers important health information to the woman regarding her pregnancy. This is all displayed in an intuitive format with a graphical representation of the woman’s journey through pregnancy. Impact: By addressing the needs of the patient sub-population identified through our questionnaire (i.e. geographical access issues) we hope to improve patient outcomes and decrease financial losses by improving attendance rates at antenatal clinic at the WCH. We hope to integrate this application into a suite of mobile applications currently being developed by the Hull & East Yorkshire NHS Trust and upon its deployment we aim to audit its effectiveness in a clinical setting.

Cluster randomised controlled trial evaluation of a Link Worker–delivered intervention to improve uptake of diabetic retinopathy screening in a South Asian population

Attendance at diabetic retinopathy screening in minority ethnic groups, including the South Asian population, is known to be poor. We describe a cluster randomised controlled trial conducted in 10 general practitioner (GP) surgeries in Coventry, UK, during 2007 which aimed to evaluate the use of a Link Worker-delivered intervention to improve attendance. The intervention consisted of a simple telephone reminder with the main outcome measure being attendance at diabetic retinopathy screening. We found a statistically significant difference between mean attendance proportions for intervention (0.89) and control (0.74) practices: difference (95% confidence interval (CI)) 0.15 (0.04-0.27), t = 3.03, p = 0.0162; this difference remained significant when adjusted for previous year's proportions. In this proof-of-concept study, in inner city Coventry, we demonstrated increased attendance at diabetic retinopathy screening by use of a simple Link Worker-implemented telephone call intervention. The use of Link Worker phone calls may be a useful tool to increase attendance for diabetic retinopathy screening in a group with high did-not-attend (DNA) rates and a high prevalence of diabetic retinopathy and visual impairment.

G222(P) Why do patient miss appointments? A retrospective population study in paediatric outpatients in a metropolitan hospital

AimsTo identify the main factors causing patients to miss appointments in paediatric outpatients.To identify what clinics can do to minimise these barriers and boost attendance.To attempt to illuminate any trends...

G352 Reviewof Success Transitioning Surviving Adolescents with Congenital Heart Disease to Adult Service- A Single-Centre Observational Study

AimAdvances in paediatric cardiology and surgery over the past 25 years have resulted in increasing number of children with congenital heart disease (CHD) surviving into adulthood. National standards were developed...

Studying and reducing DNAs to improve access

We originally had a 4-week advance booking system for appointments which we had for over 10 years but were not performing well on ‘access’ because of a high number of patients who did not attend (DNA). We often had over 100 DNAs per month so many appointments were being wasted. I noticed that another local practice which permitted …

P5.019 Strategies Influencing Did-Not-Attend (DNA) Rates in Sexually Transmitted Infection (STI) Clinics: A Randomised Controlled Trial (RCT) Assessing the Effectiveness of a Verbal Warning Message Given at Appointment Booking

BackgroundMissed clinic appointments cause significant wastage of health resources worldwide. The majority of cases who DNA appointments are young and of lower socio-economic status and, conversely, are most likely to...

G33 Children Who Did Not Attend (DNA) Community Paediatric Clinics. Demographics and Follow Up Outcome

AimsNon-attendance at clinic appointments puts children at risk of avoidable ill health. Wasted clinic appointments cost the NHS £700m/year with up to 6 million appointments wasted.The aim of this study...

361 – Audit of attendance of clozapine clinic two years after first audit

Aim of audit was to assess attendance at clinic and determine factors that might influence attendance. The outcome of the audit showed that mainly young men from South asian background were not attending. Recommendations from the audit included education of patient about illness and importance of maintenance treatment, education of family about illness so they can get more involved in treatment and encourage patient's compliance with treatment. Observe trends in attendance according to ethnicity. Re-evaluate attendance after recommendations were put into practice. Look at clinic lists and note DNA (did not attend) in clozapine clinic over period of 3 months. Note ethnicity of patients. 39 patients were booked into clozapine clinic over period of 3 months 8 DNA's - 2 black british and 6 white english Reasons for non attendance: 1 black british works full time, 1 black british AOT client, 1 white english was physically unwell, 1 discontinued clozapine without informing services. Another important reason for non attendance: patients don’t tend to attend clozapine clinic if blood test is not due the same day. Improvement of non attendance in South Asian client group due to education of patient and family about illness and treatment. Non attendance in other client group is mainly due to non concordance between blood test appointment and clinic appointment. Treatment team should consult client's diary to synchronise the time of blood test with time of clinic appointment.

Weekday Affects Attendance Rate for Medical Appointments: Large-Scale Data Analysis and Implications

The financial cost of missed appointments is so great that even a small percentage reduction in Did Not Attend (DNA) rate could save significant sums of money. Previous studies have identified many factors that predict DNA rate, including patient age, gender, and transport options. However, it is not obvious how healthcare providers can use this information to improve attendance, as such factors are not under their control. One factor that is under administrative control is appointment scheduling. Here we asked whether DNA rate could be reduced by altering scheduling policy. In Study 1, we examined attendance records for 4,538,294 outpatient hospital appointments across Scotland between January 1st 2008 and December 31st 2010. DNA rate was highest for Mondays (11%), lowest for Fridays (9.7%), and decreased monotonically over the week (Monday-Friday comparison [χ2(1, N = 1,585,545) = 722.33, p<0.0001]; Relative Risk Reduction 11.8%). This weekly decline was present for male and female patient groups of all ages, but was steeper for younger age groups. In Study 2, we examined attendance records for 10,895 appointments at a single GP clinic in Glasgow. Here again, DNA rate was highest for Mondays (6.2%), lowest for Fridays (4.2%), and decreased monotonically over the week (Monday-Friday comparison [χ2(1, N = 4767) = 9.20, p<0.01]; Relative Risk Reduction 32.3%). In two very different settings, appointments at the beginning of the week were more likely to be missed than appointments at the end of the week. We suggest that DNA rate could be significantly reduced by preferentially loading appointments onto high-attendance days.

O11 Health promotional messages in short message service (SMS) follow-up of GU medicine clinic defaulters; a tool to improve subsequent attendance rates?

BackgroundPatients who do not attend (DNA) booked GU medicine (GUM) clinics waste resources and may pose a public health risk through onward transmission of sexually transmitted infections. Short message services...