Did Not Attend Research Articles

Child and Adolescent Mental Health Services in Laois/Offaly: A One Year Perspective of Services (July 1, 2008 to June 30, 2009).

To examine the Laois/Offaly Child and Adolescent Mental Health Services (CAMHS), focusing on new referrals and trends in the service. Data was collected over a one-year period from July 1, 2008 to June 30, 2009 using the computer system MAISY (Medical Audit Information System) and through chart reviews. A Client Satisfaction Survey was administered to both parents and children. The Laois/Offaly CAMHS team provides service to a total population of around 140,000, of which around 32,000 are less than 16 years old. In this one-year period, 303 referrals were received with 167 offered an assessment, of which 150 availed of an appointment. Forty-six percent were offered appointments within one week of receiving the referral with 87% being assessed within one month. A further 41 were assessed from a previous waiting list, compiled prior to the actual study period, thus resulting in a total of 191 assessments. Thirty referrals required assessment only. Behavioural/Emotional difficulties and Attention Deficit Hyperactivity Disorder (ADHD) were the most common reason for referral. During this time the ADHD waiting list was suspended due to staff constraints. Seventy-six percent were diagnosed with an Axis I disorder with 34% given medication treatment. Of the return appointments over the year, eight percent of patients did not attend (DNA). Both parents and children reported being satisfied with the service, according to the Client Satisfaction Survey. The Laois/Offaly team services a catchment area of approximately three times the number recommended by A Vision for Change, with a staff equivalent less than the number recommended for one whole team. The team was able to provide a rapid service for assessment of new referrals, with the ADHD waiting list suspended. Axis I pathology was often diagnosed among those assessed (around 75%), with about one-third being treated with medication. Follow-up appointments achieved a high attrition rate, with only around eight percent not attending. Patient satisfaction with the service rated high by both parents and children.

Developing an Integrated Mental Health Care Service: Description of a Pilot Mental Health Consultation/Liaison Clinic in a Primary Care Centre.

The pattern of service use and the clinical characteristics of new patients attending a pilot consultation/liaison clinic in a local primary care centre were studied. During the first 16 months of this clinic 1.2% of patients did not attend the initial assessment in the liaison clinic versus 29.75% in the regular Outpatients Department (OPD). Less than one in five (17.1%) required a follow-up review with the clinician in the consultation/liaison clinic compared to almost all patients first seen in OPD secondary care (96.6%). A small minority of patients (6.1%) needed referral to secondary care due to the complexity of their presentation. A consultation/liaison mental health clinic in primary care results in an efficient use of manpower resources due to the low Did Not Attend (DNA) rates and low proportion of formal referrals to secondary care. As patients seem to favour this type of setting, over traditional outpatient departments, a move towards consultation/liaison clinics in the primary care team should be considered.

Improved clinical outcomes and efficacy with a nurse-led colonoscopy surveillance service

BackgroundA nurse practitioner-led colonoscopy surveillance service was introduced to improve appropriateness, validation and compliance with the National Patient Safety Agency safety alert and British Society of Gastroenterology consensus guidance for...

Failure to attend out‐patient clinics: is it in our DNA?

This paper aims to determine the reasons why patients miss clinic appointments and to ascertain patients' views on the implementation of reminder systems and penalty fees to reduce the rates of did not attend (DNAs). Overall, the paper seeks to establish novel ways to run a more efficient out-patient department (OPD) service to improve waiting times and access for patients to limited neurology resources. A questionnaire-based study was approved by the audit committee and was offered to 204 out-patients attending the neurology clinics over a three-month period (July to September 2009). The patients' demographic details and non-attendance records were reviewed. The paper aimed to ascertain, from the patients' perspective, why people failed to attend clinic appointments. Each participant was asked their views on how they felt their public hospital service might reduce the number of DNAs at their neurology OPD. A total of 204 patients took part. Participants had a mean age of 31 years (range 25-75 years) with a modal peak in the 26 to 35 age bracket. Almost 10 per cent of those surveyed admitted to missing a hospital out-patient appointment in the past. The most common reason was that they simply "forgot" (28 per cent). DNA rates by age range were proportionally similar to the overall age profile of attenders. Over 55 per cent said they would like a pre-appointment reminder via a mobile telephone text message, 19 per cent preferred a pre-appointment telephone call, and 19 per cent an e-mail. Of those surveyed, 47 per cent said they would be willing to pay a fee on booking that could be refunded on attending for their appointment. The majority of these felt Euro 20 was the most appropriate amount (39 per cent). The rate of acceptance for various fee amounts was uniform across age ranges. Over half (52 per cent) said that they would agree to a "buddy" system whereby the appointment reminder was sent to the patient but also a nominated friend or relative. Non-attendance rates at the neurology clinics in our institution are high with almost 10 per cent of attendees admitting to missing an appointment. One of the main reasons why people did not attend was because they simply "forgot" that they had an appointment and the patients favoured a text messaging reminder system to help reduce non-attendance. Almost half of the respondents said that they would be willing to pay a refundable booking fee.

Repeat offenders: non-attenders! A review of elective orthopaedic clinics

Non-attendance at out-patient clinics results in inefficiency, wasted resources and delays other patients from accessing services. We conducted a review of patients that did not attend (DNA) their second appointment over a 12 month period, to establish the reasons why patients failed to repeatedly attend, and to assess what proportion of these failed attendances were potentially preventable. 2,573 patients were scheduled for appointments (790 new patients, 1,783 review patients). 858 (33.3%) patients failed to attend. 147 patients did not attend (DNA) their second appointment. Of these 147 patients, 32 were new appointments, and 115 were reviews. The mean age was 45.1 yrs (range 12–91yrs), with the M:F ratio of 1:1.3. Chart review showed that of the 115 review patients, 74 were being managed conservatively, 7 were pre-op, 14 post-op (all for minor procedures) and 18 were being followed up after joint injection. One-third of patients did not attend (DNA) for their scheduled appointments. However 82.9% of those patients who were sent a second appointment re-attended. 74 (64%) of the review patients who did not attend for a 2nd appointment were being managed conservatively, most commonly for low back pain—47 (40.9%). Patients who are being managed non-operatively should be considered for discharge, with an option to be seen on an "as needed" basis. This would reduce the number of missed appointments.

Reducing non‐attendance at specialist clinics: an evaluation of the effectiveness and cost of patient‐focussed booking and SMS reminders at a Scottish health board

AbstractThe aim of the paper is to test the effectiveness of patient‐focussed booking and last minute reminders using short message service (SMS) messages to reduce non‐attendance at consultant outpatient clinics, and to estimate their cost to the service provider per non‐attendance [did not attend (DNA)] avoided. Non‐attendance is modelled in terms of patient‐focussed booking, reminders and a variety of control variables on new and return appointments at one health board in Scotland over a 14‐month period. Patient‐focussed booking and last minute reminders reduced non‐attendance. We find patient‐focussed booking demonstrated the importance of booking appointments no more than 6 weeks in advance, and would incur recurrent costs of £6 ($9.15, €6.73) compared with the status quo, assuming the DNA rate with neither initiative were 10%. Requiring patients also to opt in would cost an additional £200 ($305, €224). Coverage in terms of SMS reminders was limited both in respect to contact details and spread of cellphone ownership, but incurs no recurrent costs when the in‐house network, NHSmail, is used. Interactive voice response is an alternative to SMS reminders: it could achieve wide coverage, but at a cost of £5.50 ($8.39, €6.17) per DNA avoided. We conclude that SMS reminders and booking appointments no more than 6 weeks in advance can be effective and low‐cost ways to reduce non‐attendance. It is questionable whether patients should be required to opt in, unless this is by far the best way to obtain cellphone contact details. Otherwise. interactive voice response might be considered as the preferred method to send last minute reminders.

Do ‘do not attends’ at a genitourinary medicine service matter?

Patients who do not attend (DNA) clinic appointments are wasteful of resources and may also pose a potential public health risk through the onward transmission of untreated sexually transmitted infections (STIs). This service evaluation was performed to assess the demographics of DNAs, patient reasons for non-attendance and follows up data to determine the health outcomes of non-attendance. The genitourinary (GU) medicine clinic DNA rate between October 2008 and March 2009 was 6% (383/6961). Of the 383 patients who DNA'd their appointment successful telephone contact was made in 182 (48%) of them. Of these 40% of patients reported that they had forgotten they held an appointment; no patients reported that clinic opening hours prevented their attendance. Telephone contact increased GU medicine clinic attendance by 9% (35/383), but led to a greater number of subsequent DNAs; 43/75 (63%) of patients who accepted a further appointment DNA'd that appointment. Sending a SMS text message to patients who DNA notifying them of the time of walk-in services might be the most effective way of recapturing these patients without compromising future clinic appointment slots.

P47 How to reduce Did Not Attend (DNA) rates and achieve treatment targets in a NHS Foundation Hospital in the UK

P47 How to reduce Did Not Attend (DNA) rates and achieve treatment targets in a NHS Foundation Hospital in the UK

Something for the weekend! Saturday services – what do patients want and what do they need?

We investigated our patients' preferences for weekend services at the same time as commencing a new Saturday clinic. Patients were asked for their views on weekend services: 374 questionnaires were returned; 210 (56%) from women and 164 (44%) from men. Saturday services were rated as more important than Sunday services. One hundred and eleven patients (29.7%) said they would be likely/very likely to use a Saturday service, whereas only 67 (17.9%) rated Sunday services as important/very important. We also undertook an evaluation of our new Saturday service. A total of 214 patients (187 new/rebooks and 27 follow-ups) attended during the first 12 weeks; average 18 patients per clinic; 107 (50%) men. Introducing text appointment reminders reduced did not attend (DNA) rates from 19% to 14% (background clinic DNA rate 10%). There were more men (P = 0.01), more patients with symptoms (P < 0.0001) and more with sexually transmitted infections (STIs) (P = 0.02) attending on Saturdays. We have increased access for those patients who have difficulty attending on weekdays (56%), reduced anxiety (44%) and accessed a population with a high prevalence of STIs (44%). We conclude our Saturday service is affordable, sustainable and in patients' interests. Other clinics may wish to look at the needs of their local population and design services appropriate to their own area.

Audit of a Therapist-led Clinic for Carpal Tunnel Syndrome in Primary Care

An audit was designed to evaluate the effect on waiting times, did not attend (DNA) rates and quality of clinical management of a hand therapist-led clinic for Carpal Tunnel Syndrome (CTS) in Primary Care, and to investigate whether the clinic acted as an effective threshold mechanism for the Pulvertaft Hand Centre consultant clinics. Following a period of training with a senior consultant at the Pulvertaft Centre, an experienced hand therapist from the Centre worked out in Primary Care seeing patients with a provisional diagnosis of CTS who had been referred directly from General Practitioners (GPs). The referrals were assisted by the use of a local referral protocol. Tinel's and Phalen's tests were performed and areas of sensory loss were documented. A Levine Questionnaire was completed by the patient at an initial appointment and subsequently at review four to eight weeks later. Grip and pinch measurements were taken using a Jamar® Dynamometer. Mild and moderate CTS can be effectively managed by a community-based Hand Therapy Clinic. Forty five percent of GP-referred CTS patients were successfully managed without referral onto the Hand Centre and did not require further treatment for CTS in the subsequent two years. The consultation length was 30 minutes per patient at the therapist-led clinic, compared with 15 minutes at the Hand Centre. Waiting times were reduced from 90 to 20 days, and the clinic had a low (3%) DNA rate. Wrist splints were expertly chosen and fitted and patients were educated and empowered about their condition. The Hand Therapy Clinic acted as a useful threshold mechanism for Tertiary Care Hand Centre CTS referrals, removing 46% of CTS referrals from the Hand Centre clinics. The proportion of Hand Clinic-referred patients requiring carpal tunnel decompression (CTD) was therefore increased to 62% from 33%. This community-based, hand therapist-led clinic for CTS management is consistent with current Health Service initiatives.

Do women with high‐grade cervical intraepithelial neoplasia prefer a see and treat option in colposcopy?

To compare women's experiences of either see and treat (ST) or defer and treat (DT) at first visit to colposcopy following abnormal cytology. A prospective postal questionnaire survey. Colposcopy clinics of a University Hospital. A total of 272 women with high-grade cervical intraepithelial neoplasia (CIN) referred to colposcopy. A total of 136 women receiving ST and a matched sample of women receiving DT (N = 136) were sent a postal questionnaire 7 days after first appointment at colposcopy to assess evaluations of their experience, psychological distress and relief. Subsequent appointment keeping was extracted from medical records. Anxiety and subsequent behaviour. Women undergoing ST were significantly less anxious and more relieved than those undergoing DT. They also evaluated their first appointment as more motivationally congruent. While women undergoing ST were less likely than DTs to keep their second appointment, there was no overall difference in did not attend (DNA) rates at 15-month follow up. ST is psychologically beneficial and may be preferred by women with CIN2/3.

Patient feedback on helpfulness of postal information packs regarding informed consent for endoscopic procedures

Informed consent is an important part of any medical procedure. Our objective was to assess the impact of postal information on the understanding of consenting for gastrointestinal endoscopy. Cross-sectional survey. District hospital, United Kingdom. A total of 1800 patients who attended and 314 patients who did not attend (DNA) for GI endoscopy. The patients' views questionnaire was given out at discharge to attendees and mailed to nonattendees after the proposed date of the procedure with a reassurance of anonymity. Survey responses. A total of 906 (43%) of the questionnaires were returned (DNAs = 60). Most responders felt the information supplied was appropriate. The majority felt the information supplied either helped them make an informed decision or raised further questions. However, a proportion of respondents felt it made no difference to their decision making. The majority (73%) preferred to know the risks. Of the 398 responses obtained in relation to preference of display of risks, 10.8% were not bothered if the risk was rare (ie, less than 1 in 1000) and 18.6% were interested in the complication rate of the endoscopist performing their procedure From the DNA group, 8.3% had been influenced by the information provided. Lack of literacy check and suboptimal subject participation. Obtaining consent should be an individualized process tailored to the patients' needs. Patient preference for information and risk disclosure is variable but may be more than what is currently given in current clinical practice. Further research is needed to improve this communication process.

Give the patients the choice—The ‘walk in walk out’ hernia clinic

Background Patients referred with symptomatic inguinal hernias traditionally make at least three visits to the hospital and wait on average 41–53 weeks for their operation. Approximately, 10–15% of patients either do not attend (DNA) their clinic appointment, attend on the day of operation or are cancelled by the hospital due to bed shortage, lack of theatre space or associated co-morbidities. This results in a significant psychological strain on the patients and a financial drain on NHS resources. Aims To set up a hernia service within the confines of the NHS and give patients the choice of having their hernia repaired under local anaesthetic with only one visit to the hospital, on a date of their choosing, as in private hernia centres but without incurring the cost. Patients and Methods An e-mail containing two detailed proformas, “suitability criteria” and “instructions for patients” was sent to each general practitioner (GP) referring hernia patients to the North West London Hospitals NHS Trust (Northwick Park and Central Middlesex Hospitals). The GP gave each suitable and willing patient the instructions booklet and faxed a referral letter to the consultant's (RPB) scheduler. Patients were advised to read the instruction booklet and, when ready, ring the scheduler to make an appointment for a date of their convenience for the consultation and operation at the same visit. Results Ninety patients have been referred to the ‘walk in walk out’ (WIWO) clinic in the last 6 months. Ninety one percent of these patients have had successful ‘tension free’ open mesh repair under local anaesthetic. There were five (6%) inappropriate referrals (recurrent or bilateral hernias), and three patients (3%) did not attend their appointment due to ill health or family bereavement. Conclusion Patients with unilateral primary reducible inguinal hernias, regardless of their ASA status can safely have open ‘tension free’ mesh repair under local anaesthetic on a date of their choosing by making just one visit to the hospital. In just 6 months this ‘WIWO’ hernia clinic has shown a high level of patient satisfaction, significant reduction in ‘did not attend’/cancellation rates and financial savings for the Trust. Similar clinics set up across the nation would multiply the benefits we have shown.

An investigation into why patients do not attend for out-patient radiology appointments

Introduction Patients who do not attend (DNA) for out-patient hospital appointments cause delays in the diagnosis and subsequent treatment of their own, and other patient's, illnesses, with potentially hazardous consequences. This also impacts upon waiting lists. Failure to attend is viewed as a specific type of non-compliance and social cognition theories have been applied to previous studies in an attempt to uncover the reasons why patients choose not to keep their appointments. Methods A case-control study was conducted throughout the X-ray departments of a District General type of NHS Trust, using telephone interview questionnaires based on the Health Belief Model, in an attempt to identify any significant differences between attenders and non-attenders, so that likely non-attenders could be targeted. Results Principal reasons for non-attendance were that the patient forgot or that they did not receive their appointment. The results differed from previous research, in that specific health beliefs were not the primary reasons for non-attendance. Departments that gave patients the opportunity to arrange their appointments for a mutually convenient time had exceptionally low DNA rates, as did those which had rigorous confirmation systems in place.

No easy solutions: lessons learned from an intervention to reduce clinic non-attendance rates in a Scottish hospital

Hospital waiting lists and times have become the public measure of government success or failure. This research examined existing hospital outpatient capacity and considered the age-old problem of patients who fail to attend their appointment. A reduction in did-not-attend (DNA) rates would maximize utilization of capacity, ensure early diagnosis and drive down waiting times. The research was designed to determine whether the introduction of outpatient letters, which included the need for positive confirmation of attendance, decreased the incidence of patient non-attendance. Utilizing an experimental design, data gathered at two Plastic Surgery clinics were compared over two three-month periods, pre- and post-implementation. Total attendance and non-attendance were examined in terms of new and review patients, gender and age profile. The research concludes that the intervention tested in this form can now be discounted thus allowing the exploration of subtler solutions.

Patients treated by dental students in outreach: the first year of a pilot project

This paper describes the patients treated by 4th year undergraduate students during the first year of a pilot outreach course to teach Restorative Dentistry in community clinics in 2001-02. Data were collected from 908 summaries of patient treatment completed by the students, and from 139 patient questionnaires. Some 75% of patients were aged between 16 and 64, 58% were female, and 16% had dental phobia or anxiety. Most lived locally to the clinic and 41% made their initial contact as an emergency or drop-in. Some 37% made only a single visit (including children treated as emergencies) but 22% made six or more visits. Did not attend (DNA) was a problem and 18% of patients DNA to complete their treatment. Students undertook the full range of restorative procedures, with the emphasis on direct restorations, preventive treatment and advice, scaling, extractions and emergency treatment. Patients' main reasons for attending the clinic were lay recommendation, the need for treatment, convenience, free treatment, or the lack of access to a dentist. Some 30% said they did not have or did not know of an alternative source of dental care, and half had not seen a dentist for at least 2 years. The study demonstrates that despite difficulties related to attendance, a suitable patient base can be established offering students the opportunity to provide comprehensive care for adults in a primary care setting.

Treating obesity: a follow‐up study. Can the stages of change model be used as a postal screening tool?

We have previously shown that although a postal questionnaire based on the stages of change model (SCQ) failed to distinguish outpatients most likely to lose weight, it appeared to influence attendance rates. We therefore audited attendance upon receiving a pre-appointment SCQ in the post and compared this to previous standard practice in 1996. Seventy-eight obese outpatients (BMI 36.7 +/- 6.7 kg m-2, age 43 +/- 15 years) (mean +/- SD) were included. Twenty-nine per cent of patients failed to return an SCQ and were not sent an appointment and therefore did not block dietetic time. Eleven per cent returned an SCQ but did not attend (DNA) visit 1, whilst 21% attended visit 1 but DNA visit 2. Thirty-nine per cent attended both appointments and lost a significant amount of weight (105 +/- 23 vs. 103.2 +/- 23 kg, P < 0.0001) in 4 weeks. There was no difference in SCQ results between groups. Overall attendance rate at initial and follow-up appointments increased by 11%, while DNA rates fell by 20% compared with the 1996 audit. The SCQ has sifted out one in four patients who previously DNA an initial dietetic outpatient appointment. This has reduced waiting-list time as appointments are only book on return on the SCQ form, increased effective use of dietetic time through increased attendance rates, and lowered the DNA rate of follow-up appointments.

THE CHILD WHO DID NOT ATTEND

THE CHILD WHO DID NOT ATTEND