Non-attendance Rate Research Articles

Wait times, health care touchpoints, and nonattendance in an academic pediatric dermatology clinic.

Timely access to pediatric dermatology care remains a challenge. While awaiting appointments, many patients and families utilize so-called health care touchpoints outside of the dermatology clinic such as primary care or emergency department visits to address dermatologic concerns. Long waiting periods also factor into nonattendance rates at pediatric dermatology appointments. This observational retrospective study investigated wait times, relevant health care touchpoints, and factors related to nonattendance at a pediatric dermatology clinic. We reviewed demographic, health care touchpoint, and nonattendance data for patients referred by a primary care affiliate to the Children's Hospital of Philadelphia (CHOP) pediatric dermatology clinic from February 2016 to May 2017. Descriptive statistics were used to identify trends among analyzed variables. We reviewed 250 patient records. The average number of touchpoints per patient was 0.56, and factors that significantly correlated with increased numbers of touchpoints included younger patient age and longer wait time while payer, primary diagnosis, and time of year were not associated. The nonattendance rate was 26%, and factors significantly associated with increased nonattendance rate included longer wait times and winter and spring appointments. Long wait times impact numbers of touchpoints and appointment attendance rate when referring to pediatric dermatology. A platform such as teledermatology may represent an opportunity to improve access to care by allowing for earlier input from the pediatric dermatologist.

Rate and predictors for non-attendance of patients undergoing hospital outpatient treatment for chronic diseases: a register-based cohort study

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).

Nonattendance rates of scheduled outpatient appointments in a university general hospital.

We aimed to estimate nonattendance to scheduled medical ambulatory appointments rates globally and by subgroups. We designed a retrospective cohort of all adult outpatients over 18years old who requested at least one scheduled ambulatory medical appointment from 1 January 2015 to 31 December 2016. Hospital Italiano de Buenos Aires is a university general hospital in the Autonomous City of Buenos Aires, Argentina. It includes an integrated health care network that is formed by two high complexity hospitals and 22 primary care centers. The age median was 60.4years, and 31.33% of the appointments were scheduled by men; 2526549 appointments fulfilled selection criteria, belonging to 348420 patients. The global nonattendance rate was 27.84% (95% CI, 27.79-27.9). The nonattendance rate to general practitioner appointments was 25.53% (95% CI, 25.42-25.63); to clinical specialties, 27.78% (95% CI, 27.68-27.87); and to surgical specialties, 29.31% (95% CI, 29.23-29.4). Because of the consistent variability of nonattendance in different settings, it is strongly recommended that local estimates are used in the design of effective interventions to improve adherence with outpatient healthcare scheduled appointments.

The Effects of Electrification on School Enrollment in Bangladesh: Short- and Long-Run Perspectives

This paper aims to show the impact of access to electricity on school enrollment in Bangladesh. It offers an empirical investigation of the relationship between access to electricity and school enrollment statuses, such as grade progression, repetition, and non-attendance. The data were taken from Bangladesh’s Multiple Indicator Cluster Survey (MICS) database 2012–2013 provided by the Bangladesh Bureau of Statistics (BBS) and UNICEF; the data include two years of grading information for children of ages ranging from 5–15. We applied the propensity score matching (PSM) and the Markov schooling transition model using matched sample data. The results show that access to electricity has a significant positive effect on grade progression and a significant negative effect on non-attendance in the short run as well as in the long run. The simulation result shows that the non-attendance rate is lower and the school enrollment rate for children grades 9-11 is higher in the electrified areas compared to unelectrified areas. This result suggests that access to electricity is an important strategic indicator for increasing school enrollment in both primary and secondary schools.

Improving nonattendance rates among pediatric patients with Medicaid or private insurance

Access to dermatologists is low among Medicaid-insured patients. Higher clinic nonattendance among Medicaid-insured patients might affect provider decisions to accept these patients. To determine the effect of different scheduling policies on the attendance among children seen at a pediatric dermatology clinic. In this retrospective review, we compared nonattendance among children for 3 different scheduling policies implemented over 3 consecutive years. The scheduling policies used were a first-available open scheduling policy, a 2-week in advance scheduling policy, and a 4-week in advance scheduling policy. Subset analyses were performed by clinic location and insurance type. The interval between scheduling and appointment date was directly related to nonattendance rates; rates were higher for Medicaid-insured than privately insured patients. Open scheduling was associated with a 37% nonattendance rate for Medicaid-insured patients and 18% nonattendance rate for privately insured patients. A 4-week in advance scheduling policy significantly decreased the nonattendance rate to 19% among Medicaid-insured and 7% among privately insured patients. A 2-week in advance policy further decreased the nonattendance rate to 11% among Medicaid-insured patients and 4% among privately insured patients. This is a retrospective study, and same-day cancellations were not tracked. Decreasing the time interval between scheduling and appointment dates can significantly decrease nonattendance. This strategy might help dermatologists incorporate more Medicaid-insured patients into their practices.

This Nudge Was Not Enough: a Randomised Trial of Text Message Reminders of Court Dates to Victims and Witnesses

Research QuestionDo text messages to mobile phones of victims and witnesses two or three days before they are scheduled to appear in court reduce their non-appearance rates in minor criminal cases?DataA sample of 811 victims and witnesses sent a postal notice to attend a specific magistrates’ court in Staffordshire on a specific date. Cambridge Crime Harm Index value of the criminal charges, court appearance and trial outcome data were collected in all cases.MethodsA text message reminder was randomly assigned to be sent to 405 treatment cases 2–3 days before the court trial date. Treatment as delivered comprised 84% of the treatment group.FindingsThe base rate of victims and witnesses not attending magistrates’ trials prior to the RCT was 26%. The non-attendance rate during the RCT was 22% in the control group and 24% in the treatment group (p = 0.444). A 14% higher guilty rate for trials attended by the treatment group (58%) than the control group (51%) was marginally significant (p = 0.052). No treatment-control differences in attendance were found when moderated by crime type or Crime Harm Index score.ConclusionA text message in isolation did not significantly affect victim and witness attendance at criminal cases in the three magistrates’ courts. However, it does show that texting is a reliable, quick and cheap method of communicating with witnesses.

Association between age and outpatient clinic arrival time: myth or reality?

BackgroundNon-attendance and late arrivals diminish patient flow in outpatient clinics. On the other hand, patient earliness may also be undesirable. Physicians often experience that older patients are more punctual than younger patients, and often they come excessively early. The aim of this study was to determine whether an association between age and outpatient clinic arrival time could be established or not, i.e. to find out if it is a myth or a reality.MethodsProspective descriptive study performed at a neurological outpatient clinic. Data were collected from all scheduled appointments during an eight-week period. Variables included were age, gender, appointment time, arrival time, no-shows, appointment type, need for assistance and if it was an early or late appointment. Outcomes were unpunctuality (early and late arrivals) and non-attendance.ResultsOf 1353 appointments, non-attendance rate was 9.5 and 5.1% were late arrivals. Median age increased with increased patient earliness (p < 0.001). Younger age (p = 0.007) and new referrals (p = 0.025) were associated with non-attendance.ConclusionsThe intuition of an association between age and outpatient clinic arrival time was confirmed, thus it is a reality that older patients attend their appointments more frequently and have better punctuality than younger adults. This age effect in outpatient clinics should be considered when developing future simulation models and intervention studies.

Post-operative telephone review is safe and effective: prospective study - Monash outpatient review by phone trial.

Studies have shown that post-operative telephone follow-up is satisfactory and effective. As high quality evidence is scant, we conducted a randomized controlled trial to compare it against outpatient clinic review for emergency laparoscopic appendicectomy or cholecystectomy. Patients who received emergency laparoscopic appendicectomy or cholecystectomy were eligible for this study. Once recruited, they were randomly allocated to either clinic review or telephone follow-up on discharge. Participants were reviewed at 2 weeks after operation and contacted again at 4 weeks after initial follow-up for satisfaction survey. One hundred and seventy-nine participants were recruited with one withdrawn consent and six excluded. Ninety-six underwent laparoscopic appendicectomy and 76 had laparoscopic cholecystectomy. Ninety-six attended clinic review and 76 had telephone follow-up. The two groups were similar in baseline variables. Non-attendance rate was higher for clinic review cohort (24% vs 6.6%, P = 0.002). Participants who received telephone review reported higher satisfaction level (9.31 vs 8.85, P = 0.002), and most patients prefer telephone follow-up (73.1%, P < 0.0001). No difference was detected for missed complications (P = 0.354). Telephone follow-up post laparoscopic appendicectomy or cholecystectomy is safe, satisfying and effective.

The effect of SMS (text message) reminders on attendance at a community adult mental health service clinic: do SMS reminders really increase attendance?

Non-attendance at outpatient clinics is common and costly. This study aimed to determine if sending SMS ('short message service' or text message) reminders to patients before appointments reduced non-attendance. We collected outpatient data at Ballyfermot and Lucan Community Adult Mental Health Service, Dublin, Ireland during 6-month periods (a) immediately prior to the introduction of SMS reminders for outpatient appointments; (b) immediately following the introduction of SMS reminders; and (c) two and a half years later. In the 6-month period prior to SMS reminders, 2170 outpatient appointments were offered and there was a 22.2% non-attendance rate. In the 6-months following the introduction of SMS reminders, 2092 appointments were offered and the non-attendance rate fell to 13.9% (p < 0.001), with the lower non-attendance rate among those who did not receive SMS reminders (9.7%) rather than those who did (15.7%) (p = 0.0002). There were 98 appointment cancellations during this period (73% via SMS messaging). In the 6-month period two and a half years after the introduction of SMS reminders, 2474 appointments were offered and the non-attendance rate rose to 19.3%; this did not differ between those who received SMS reminders (19.3%) and those who did not (19.1%) (p = 0.38209) and was still lower than the rate prior to SMS reminders (p = 0.01321). During this period, 197 appointments were cancelled (75% via SMS messaging). The chief value of SMS reminders lies not in reminding patients of appointments but in providing a convenient way to cancel them, thus allowing more appointments to be offered.

Non-attendance of vulnerable populations within epilepsy outpatient services in Ireland.

Outpatient non-attendance is a prevalent issue that contributes to significant wasted clinical resources and can be influenced by a number of complex factors. The aim of this study is to characterize "did not attend" (DNA) rates in three identified subpopulations of epilepsy patients to determine if current care provision models suffice. In this study, we identified all patients residing in social housing, in residential care, and those incarcerated who have been offered appointments by our service. We calculated the total number of appointments issued to each group over their entire interaction with our service and their subsequent non-attendance rate as a group. Additionally, we calculated the baseline DNA rate for our epilepsy clinic as a whole for comparison. We found that the baseline DNA rate for the clinic as a whole was 18.9%. Those in social housing, in residential care, and incarcerated had significantly higher DNA rates of 24, 20.2, and 54.3%, respectively. This study provided evidence that in certain groups of patients, clinicians may need to explore other care delivery models due to high DNA rates.

High Intrapatient Variability of Tacrolimus Levels and Outpatient Clinic Nonattendance Are Associated With Inferior Outcomes in Renal Transplant Patients

Nonadherence to immunosuppressants is associated with rejection and allograft loss. Intrapatient variability (IPV) of immunosuppression levels is a marker of nonadherence. This study describes the impact of IPV of tacrolimus levels in patients receiving a tacrolimus monotherapy immunosuppression protocol. We retrospectively analyzed the outpatient tacrolimus levels of kidney-only transplant patients taken between 6 and 12 months posttransplant. IPV was determined using the coefficient of variance. Six hundred twenty-eight patients with a mean number of 8.98 ± 3.81 tacrolimus levels and a mean follow-up of 4.72 ± 2.19 years were included. Multivariate analysis showed death was associated with increasing age (1.04 [1.01-1.07], P = 0.0055), diabetes at time of transplant (2.79 [1.44-5.41], P = 0.0024), and rejection (2.34 [1.06-5.19], P = 0.036). Variables associated with graft loss included the highest variability group (2.51 [1.01-6.27], P = 0.048), mean tacrolimus level less than 5 ng/mL (4.32 [1.94-9.63], P = 0.0003), a high clinic nonattendance rate (1.10 [1.01-1.20], P = 0.03), and rejection (9.83 [4.62-20.94], P < 0.0001). Independent risk factors for rejection were de novo donor-specific antibody (3.15 [1.84-5.39], P < 0.0001), mean tacrolimus level less than 5 ng/mL (2.57 [1.27-5.19], P = 0.00860, and a high clinic nonattendance rate (1.11 [1.05-1.18], P = 0.0005). This study shows that high tacrolimus IPV and clinic nonattendance are associated with inferior allograft survival. Interventions to minimize the causes of high variability, particularly nonadherence are essential to improve long-term allograft outcomes.

Análisis del coste económico del absentismo de pacientes en consultas externas

AimTo estimate the economic costs of missed Outpatient appointments by the Costa del Sol Health Agency (ASCS). MethodAn analysis was performed on the costs arising from missed outpatient appointments (first appointment and examinations) of each of the specialities in the Centres belonging to the ASCS. A formula was used to determine the unit cost per appointment and per centre and speciality. This involved the direct imputation of the controllable costs and the indirect imputation of the service costs, together with an estimated cost of re-appointments based on a previous case-control study. ResultsThe cost of missed appointments per centre in the Costa del Sol Hospital was €2,475,640, with a failure rate of 14.2% (256,377 appointments). In the Benalmádena High Resolution Hospital it was €515,936, with an absence rate of 12.2% (44,848 appointments), and in the Mijas High Resolution Centre, a cost of €395,342 with an absence rate of the 13.5% (99,536 appointments). The mean extra cost of a re-appointment was €12.95. The specialities with a higher medium cost were Digestive Diseases, Internal Medicine, and Rehabilitation. ConclusionsThe economic cost of patients not turning up for scheduled appointments in the ASCS was greater than 3 million Euros for a non-attendance rate of the 13.8%, with Mijas High Resolution Centre being the centre that showed the lowest mean unitary cost per medical appointment.

Incentivised chronic disease management and the inverse equity hypothesis: findings from a longitudinal analysis of Scottish primary care practice-level data

BackgroundThe inverse equity hypothesis asserts that new health policies initially widen inequality, then attenuate inequalities over time. Since 2004, the UK’s pay-for-performance scheme for chronic disease management (CDM) in primary care general practices (the Quality and Outcomes Framework) has permitted practices to except (exclude) patients from attending annual CDM reviews, without financial penalty. Informed dissent (ID) is one component of exception rates, applied to patients who have not attended due to refusal or non-response to invitations. ‘Population achievement’ describes the proportion receiving care, in relation to those eligible to receive it, including excepted patients. Examination of exception reporting (including ID) and population achievement enables the equity impact of the UK pay-for-performance contract to be assessed. We conducted a longitudinal analysis of practice-level rates and of predictors of ID, overall exceptions and population achievement for CDM to examine whether the inverse equity hypothesis holds true.MethodsWe carried out a retrospective, longitudinal study using routine primary care data, analysed by multilevel logistic regression. Data were extracted from 793 practices (83% of Scottish general practices) serving 4.4 million patients across Scotland from 2010/2011 to 2012/2013, for 29 CDM indicators covering 11 incentivised diseases. This provided 68,991 observations, representing a total of 15 million opportunities for exception reporting.ResultsAcross all observations, the median overall exception reporting rate was 7.0% (7.04% in 2010–2011; 7.02% in 2011–2012 and 6.92% in 2012–2013). The median non-attendance rate due to ID was 0.9% (0.76% in 2010–2011; 0.88% in 2011–2012 and 0.96% in 2012–2013). Median population achievement was 83.5% (83.51% in 2010–2011; 83.41% in 2011–2012 and 83.63% in 2012–2013). The odds of ID reporting in 2012/2013 were 16.0% greater than in 2010/2011 (p < 0.001). Practices in Scotland’s most deprived communities were twice as likely to report non-attendance due to ID (odds ratio 2.10, 95% confidence interval 1.83–2.40, p < 0.001) compared with those in the least deprived; rural practices reported lower levels of non-attendance due to ID. These predictors were also independently associated with overall exceptions. Rates of population achievement did not change over time, with higher levels (higher remuneration) associated with increased rates of overall and ID exception and more affluent practices.ConclusionsNon-attendance for CDM due to ID has risen over time, and higher rates are seen in patients from practices located in disadvantaged areas. This suggests that CDM incentivisation does not conform to the inverse equity hypothesis, because inequalities are widening over time with lower uptake of anticipatory care health checks and CDM reviews noted among those most in need. Incentivised CDM needs to include incentives for engaging with the ‘hard to reach’ if inequalities in healthcare delivery are to be tackled.

Does pain take holidays? Non-attendance rates at a hospital-based pain clinic are elevated during the Jewish high-holidays

BackgroundPatient non-attendance is an expensive and persistent problem worldwide with rates between 5–39% reported in the literature. The objective of the study was to assess whether there is a higher incidence of non-attendance in a hospital-based pain clinic during the period of the Jewish High Holidays (Rosh-Hashanah to Sukkot) and whether this is further compounded by other factors, such as demographic characteristics and previous visits to the clinic.MethodsRecords were taken from the Lowenstein Rehabilitation Hospital appointment scheduling system. Data was gathered from two time-periods: High-Holidays and Control for each year, over a total of 6 years 2008–2013. Non-attendance was analyzed by period, by age, by gender and by previous visits to the clinic.ResultsIn the entire population studied (666 distinct records), the non-attendance rate was higher during the High-Holidays as compared to the Control period (32 vs. 24.1%; p = 0.030). Non-attendance rates were significantly higher during the Holidays among repeating patients (28.6 vs. 14.8%; p = 0.002) and among women (34.6 vs. 20.7%; p = 0.004).DiscussionOur data suggest that non-attendance is elevated during the High-Holidays in specific groups of patients, namely, repeating patients and women. Despite no direct inquiry into the reasons for non-attendance, we speculate that the elevated well-being and familial support during the holidays contribute to the patients’ ability to cope with persistent pain and possibly directly reduce the amount of pain, leading to patients missing their pain clinic appointments.ConclusionOur results, provided they can be corroborated by larger-scale studies, can assist in scheduling policy adjustments such as avoidance of appointments during the High-holidays for specific patient populations and more rigorous reminder efforts during these times of the year that may lead to reduction in overall non-attendance rates in the pain clinic. Further, our data provide an impetus for further studies of non-attendance patterns among pain clinic patients, in order to acquire a better understanding of the reasons for non-attendance and develop strategies to reduce it and thus contribute to the continuous improvement of the Israeli health systems as well as others worldwide.

The Impact of Patient Location on Attendance to Cardiology Outpatient Appointments

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.

Impact of Telephone Reminders on Attendance Rate at Paediatric Clinics

Background: Non-attendance in clinics has major economic impact in the national health service. Literature review indicates that main reason for non-attendance is forgetfulness and reminders reduce the non-attendance rate (NAR). Objectives: We aimed to evaluate the NAR at the paediatric outpatient clinics after implementation of telephone reminders. Patients and Methods: NAR was reviewed for 6 months (February-July 2013) and compared with the NAR for similar duration in 2014 (before and after implementation of telephone reminders). Within 2014 data, comparison was also made for patients who confirmed attendance during telephone reminders versus those left a voice message and patients who were not contactable. Results: Total number of patients in 6 months were 4156 [2674 follow-up (F/U), 1482 New] in 2013 and 4732 [3100 F/U, 1632 New] in 2014. Overall NAR in 2014 was significantly lower (5.1%) than in 2013 (P = < 0.001)). The difference for follow up appointments was 6.9% (P = < 0.001), and 1.75% for new appointments (P = 0.147). Patients who confirmed attendance were more likely to attend their appointment (97.9%) compared with those left a voice message (91.4%) and those that were not contactable (82.1%). Conclusions: Our results validate that telephonic confirmation of clinic appointment plays a significant role in reducing the NAR in paediatric out-patient clinic setting.

Using Quality Improvement Methods and Time-Driven Activity-Based Costing to Improve Value-Based Cancer Care Delivery at a Cancer Genetics Clinic.

To meet increasing demand for cancer genetic testing and improve value-based cancer care delivery, National Cancer Centre Singapore restructured the Cancer Genetics Service in 2014. Care delivery processes were redesigned. We sought to improve access by increasing the clinic capacity of the Cancer Genetics Service by 100% within 1 year without increasing direct personnel costs. Process mapping and plan-do-study-act (PDSA) cycles were used in a quality improvement project for the Cancer Genetics Service clinic. The impact of interventions was evaluated by tracking the weekly number of patient consultations and access times for appointments between April 2014 and May 2015. The cost impact of implemented process changes was calculated using the time-driven activity-based costing method. Our study completed two PDSA cycles. An important outcome was achieved after the first cycle: The inclusion of a genetic counselor increased clinic capacity by 350%. The number of patients seen per week increased from two in April 2014 (range, zero to four patients) to seven in November 2014 (range, four to 10 patients). Our second PDSA cycle showed that manual preappointment reminder calls reduced the variation in the nonattendance rate and contributed to a further increase in patients seen per week to 10 in May 2015 (range, seven to 13 patients). There was a concomitant decrease in costs of the patient care cycle by 18% after both PDSA cycles. This study shows how quality improvement methods can be combined with time-driven activity-based costing to increase value. In this paper, we demonstrate how we improved access while reducing costs of care delivery.

Compliance without pressure for minimal income policy management.

In a field study for a French public organization, 3 strategies designed to enhance attendance at meetings were compared. Recipients of a minimum income allowance receive invitation letters to orientation meetings; these letters usually emphasize coercion and threaten to withdraw their allowance. This approach has limitations: the participation rate is poor, and the consequences are detrimental for both the organization and the beneficiaries. To overcome those difficulties, we tested alternative ways of promoting compliance without pressure and influence. The first strategy involved sending the traditional peremptory invitation letter; the second strategy involved sending a new version of the letter that emphasized commitment factors and freedom evocation (“the binding mail technique”); and the third strategy involved behaviorally involving the beneficiaries by a combination of binding communication, level of action identification, and freedom evocation before the traditional letter was sent. Results showed that the use of compliance-gaining procedures led the nonattendance rate to diminish from 76% (the peremptory letter) to 57% with the binding mail, and to 33% for the combined techniques. These impressive results, however, are tempered somewhat by the fact that a study in a second agency yielded nonsignificant effects, with nonattendance rates at approximately the same level in all conditions (respectively 52%, 41%, and 43%). Results are discussed in light of commitment theory, social identity theory, and behavioral science; further research is proposed and the adoption of a “binding identities” meta-theoretical perspective advocated.

Non-attendance of mammographic screening: the roles of age and municipality in a population-based Swedish sample.

BackgroundInequality in health and health care is increasing in Sweden. Contributing to widening gaps are various factors that can be assessed by determinants, such as age, educational level, occupation, living area and country of birth. A health care service that can be used as an indicator of health inequality in Sweden is mammographic screening. The non-attendance rate is between 13 and 31 %, while the average is about 20 %. This study aims to shed light on three associations: between municipality and non-attendance, between age and non-attendance, and the interaction of municipality of residence and age in relation to non-attendance.MethodsThe study is based on data from the register that identifies attenders and non-attenders of mammographic screening in a Swedish county, namely the Radiological Information System (RIS). Further, in order to provide a socio-demographic profile of the county’s municipalities, aggregated data for women in the age range 40–74 in 2012 were retrieved from Statistics Sweden (SCB), the Public Health Agency of Sweden, the National Board of Health and Welfare, and the Swedish Social Insurance Agency. The sample consisted of 52,541 women. Analysis conducted of the individual data were multivariate logistic regressions, and pairwise chi-square tests.ResultsThe results show that age and municipality of residence associated with non-attendance of mammographic screening. Municipality of residence has a greater impact on non-attendance among women in the age group 70 to 74. For most of the age categories there were differences between the municipalities in regard to non-attendance to mammographic screening.ConclusionsAge and municipality of residence affect attendance of mammographic screening. Since there is one sole and pre-selected mammographic screening facility in the county, distance to the screening facility may serve as one explanation to non-attendance which is a determinant of inequity. From an equity perspective, lack of equal access to health and health care influences facility utilization.

Factores determinantes y coste económico del absentismo de pacientes en consultas externas de la Agencia Sanitaria Costa del Sol

Background. To identify factors related to the people, the process and the context that determine patient compliance with their appointments in the ambulatory outpatient services in the Costa del Sol Health Care Agency; and to obtain the profile of patients who fail to keep their appointments, the reasons for this failure and an estimation of its economic cost. Methods. Observational multicenter case-control study, through a survey carried out on patients with an appointment in the ambulatory outpatient services during 2013 and 2014, and analysis of the cost per appointment. Results. In total, 882 patients participated in the study (294 cases and 588 controls). The main reasons for missing an appointment were forgetting about it (29, 6%; n=87), and failure in communication (16%; n=47). A shorter time period before the appointment and older age were significantly associated with fewer absences, as well as the fact of having attended more consultations in the past year. The economic cost was more than 3 million euros for a non-attendance rate of 13.8%. Conclusions. Young patients who usually do not visit outpatient clinics are at greatest risk of absence from scheduled appointments in our health area. The main reasons for absenteeism are preventable and interventions such as improved communication procedures or appointment reminder systems could be beneficial.