PURPOSE:To discover why indigent patients miss their appointments. Indigent patients who fail to keep their appointments (“no-show”) miss out on opportunities for care. The 2006 no-show rate in the investigator's pulmonary clinic was 36% of scheduled appointments. In order to identify the causes of such a high no-show rate, the investigator collected and analyzed patients'self-reported reasons for missing appointments. The information collected in this ongoing study will be used to plan interventions to improve clinic attendance.
METHODS:Using patient-provided contact information,the investigator telephoned all patients who missed appointments after 4/15/08 (date of IRB approval). Patients were invited to explain why they had not come to their appointment that morning. If a patient was unavailable, a message was left with the person answering the phone, or on an answering machine, asking the patient to call the investigator at the pulmonary clinic.
RESULTS:During the period 4/15/08–4/25/08 15 patients each missed 1 appointment. The 7 patients interviewed attributed their absence to: confusion about date/place (3), forgot (1), too ill (1),need to reschedule (1), and lack of transportation (1). 8 patients could not be contacted. Although messages were left with a person (2) or on an answering machine (2), there were no follow-up calls to the investigator. No means were available to leave messages for the remaining 4 patients.
CONCLUSION:Incomplete information about appointment date/time/place contributed most frequently to missed appointments in this population. Outdated patient contact information may also contribute, but could not be verified. Lack of transportation also ws a contributing factor.
CLINICAL IMPLICATIONS:Patients who miss their appointments not only fail to get care in a timely manner, but risk becoming lost to follow-up. This study suggests that minor interventions such as providing assistance with transportation or making an extra effort to verify contact information and appointment date/time could have a significant impact on indigent patients access to health care. Follow-up telephone calls are also an opportunity for the physician to check up on patients, and to stress the importance of keeping the next appointment.
DISCLOSURE:Barbara Lutey, No Financial Disclosure Information; No Product/Research Disclosure Information