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Shao CC, Katta MH, Smith BP, Jones BA, Gleason LT, Abbas A, Wadhwani N, Wallace EL, Mugavero MJ, Chu DI. Reducing no-show visits and disparities in access: The impact of telemedicine. J Telemed Telecare 2024:1357633X241241357. [PMID: 38557212 DOI: 10.1177/1357633x241241357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND No-show visits have serious consequences for patients, providers, and healthcare systems as they lead to delays in care, increased costs, and reduced access to services. Telemedicine has emerged as a promising alternative to in-person visits by reducing travel barriers, but risks exacerbating the digital divide. The aim of this study was to assess the impact of telemedicine (video and phone) at a tertiary care academic center on no-show visits compared to in-person visits. METHODS A retrospective cohort analysis of all weekday clinic visits among in-state adult patients at a single tertiary care center in the southeast from January 2020 to April 2023 was performed. Rates of no-show visits for patients who were seen via phone and video were compared with those who were seen in-person. Demographic and clinical characteristics of these groups were also compared, including age, sex, race/ethnicity, socioeconomic status, and visit type. The primary outcome was the rate of no-show visits for each visit type. RESULTS Our analysis included 3,105,382 scheduled appointments, of which 81.2% were in-person, 13.4% via video, and 5.4% via phone calls. Compared to in-person visits, phone calls and video visits reduced the odds of no-show visits by 50% (aOR 0.5, CI 0.49-0.51) and 15% (aOR 0.85, CI 0.84-0.86), respectively. Older patients, Black patients, patients furthest from clinic, and patients from counties with the greatest degree of vulnerability and disparities in digital access were more likely to use phone visits. No-shows were more common among non-white, male, and younger patients from counties with lower socioeconomic status. CONCLUSION Telemedicine effectively reduced no-show visits. However, limiting telemedicine to video-based visits only exacerbated disparities in access. Phone calls allow historically underserved patients from lower socioeconomic backgrounds to access healthcare and should be included within the definition of telemedicine.
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Affiliation(s)
- Connie C Shao
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meghna H Katta
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burke P Smith
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bayley A Jones
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lauren T Gleason
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alizeh Abbas
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nikita Wadhwani
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eric L Wallace
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J Mugavero
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel I Chu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Leibner G, Brammli-Greenberg S, Mendlovic J, Israeli A. To charge or not to charge: reducing patient no-show. Isr J Health Policy Res 2023; 12:27. [PMID: 37550725 PMCID: PMC10408071 DOI: 10.1186/s13584-023-00575-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND In order to reduce patient no-show, the Israeli government is promoting legislation that will allow Health Plans to require a co-payment from patients when reserving an appointment. It is hoped that this will create an incentive for patients to cancel in advance rather than simply not show up. The goal of this policy is to improve patient access to medical care and ensure that healthcare resources are utilized effectively. We explore this phenomenon to support evidence-based decision making on this issue, and to determine whether the proposed legislation is aligned with the findings of previous studies. MAIN BODY No-show rates vary across countries and healthcare services, with several strategies in place to mitigate the phenomenon. There are three key stakeholders involved: (1) patients, (2) medical staff, and (3) insurers/managed care organizations, each of which is affected differently by no-shows and faces a different set of incentives. The decision whether to impose financial penalties for no-shows should take a number of considerations into account, such as the fine amount, service type, the establishment of an effective fine collection system, the patient's socioeconomic status, and the potential for exacerbating disparities in healthcare access. The limited research on the impact of fines on no-show rates has produced mixed results. Further investigation is necessary to understand the influence of fine amounts on no-show rates across various healthcare services. Additionally, it is important to evaluate the implications of this proposed legislation on patient behavior, access to healthcare, and potential disparities in access. CONCLUSION It is anticipated that the proposed legislation will have minimal impact on attendance rates. To achieve meaningful change, efforts should focus on enhancing medical service availability and improving the ease with which appointments can be cancelled or alternatively substantial fines should be imposed. Further research is imperative for determining the most effective way to address the issue of patient no-show and to enhance healthcare system efficiency.
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Affiliation(s)
- Gideon Leibner
- Faculty of Medicine, Hebrew University-Hadassah, Jerusalem, Israel.
| | | | - Joseph Mendlovic
- Faculty of Medicine, Hebrew University-Hadassah, Jerusalem, Israel
- Ministry of Health, Jerusalem, Israel
- Department of Pediatrics, Shaare Zedek Medical Center, Affiliated With the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
| | - Avi Israeli
- Faculty of Medicine, Hebrew University-Hadassah, Jerusalem, Israel
- Ministry of Health, Jerusalem, Israel
- Dr. Julien Rozan Professor of Family Medicine and Health Care, Faculty of Medicine, Hebrew University-Hadassah, Jerusalem, Israel
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Biggs J, Njoku N, Kurtz K, Omar A. Decreasing Missed Appointments at a Community Health Center: A Community Collaborative Project. J Prim Care Community Health 2022; 13:21501319221106877. [PMID: 35723538 PMCID: PMC9344103 DOI: 10.1177/21501319221106877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Missed appointments are a problem for health care systems,
causing lost revenue and concern for poor health outcomes. This is particularly true at
Community Health Centers (CHCs), where clients may already face substantial barriers to
optimal care and outcomes. Identified solutions to this problem are limited, and often
focus on reminder calls and messages to clients. Methods: This project
utilized a unique academic/CHC collaboration to investigate and initiate solutions to
their high missed appointment rates. Client phone calls to determine clinic specific
needs, monthly team meetings to brainstorm and choose initiatives, engaging stake holders,
and phased implementation were the tools used to address the high missed appointment rates
within the limitations of the clinic resources available. Results: Within one
quarter, missed appointment rates at the clinic dropped by 6%-17% for different
appointment types. Conclusion: While the project was interrupted due to the
pandemic, early outcomes were promising and the model may be helpful to other CHCs with
similar concerns.
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Affiliation(s)
| | - Nnamdi Njoku
- The People's Center Clinics and Services, Minneapolis, MN, USA
| | - Kaitlyn Kurtz
- St. Catherine University, St. Paul, MN, USA.,M Health Fairview, Minneapolis, MN, USA
| | - Ayan Omar
- St. Catherine University, St. Paul, MN, USA.,Ramsey County Public Health Department, St. Paul, MN, USA
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Pinto RDS, Lucas SD, Goes PSAD, Silva SLD, Neves ÉSM, Zina LG, Vettore MV. Contextual and local determinants associated with the achievement of goals in the endodontics specialty in Brazilian dental speciality centres: A multilevel analysis. Community Dent Oral Epidemiol 2021; 50:74-82. [PMID: 34967969 DOI: 10.1111/cdoe.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/17/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess which factors were associated with the achievement of endodontic goals. METHODS Cross-sectional study using secondary data from the second cycle of the Program for the Improvement of Access and Quality in the dental speciality centres-in Portuguese PMAQ-CEO. The independent variables extracted from this database were related to dental speciality centres (CEO in Portuguese). In addition, variables referring to the CEO host city were incorporated into the model. The outcome variable was the number of endodontic goals achieved calculated from the production of the CEO available in the Ambulatory Health Information System in 2018. Descriptive analyses and multilevel Poisson regression were performed with the software SPSS 23.0 and STATA 14.0. RESULTS CEOs with more than 20% of patients' absenteeism were 26% less likely to reach the goals of the endodontics specialty; CEOs with availability of endodontists for more than 40 hours a week were two times more likely to reach the goals than those with less than 40 hours in endodontics specialty. CEOs with a waiting time for endodontic procedures greater than 45 days achieved a number of goals 31% lower than those with a waiting time up to 45 days. CEO type I and CEO type II showed 2.10 and 1.20 higher likelihood to reach the number of goals of the endodontics specialty than CEO type III. The number of endodontic instruments in sufficient number was positively associated with the achievement of goals. CEOs located in municipalities that reached more than 5% in the supervised brushing indicator had 2.26 greater likelihood to achieve the goals than those that did not reach this percentage. CONCLUSION Contextual and local determinants are associated with the achievement of goals in the endodontic specialty in the dental speciality centres in Brazil.
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Affiliation(s)
- Rafaela da Silveira Pinto
- School of Dentistry, Department of Community and Preventive Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Simone Dutra Lucas
- School of Dentistry, Department of Community and Preventive Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Sávio Angeiras de Goes
- Department of Clinical and Preventive Dentistry, School of Dentistry, Universidade Federal de Pernambuco, Recife, Brazil
| | - Samuel Lucas da Silva
- School of Dentistry, Department of Community and Preventive Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Érika Said Monteiro Neves
- School of Dentistry, Department of Community and Preventive Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Primary Health Care Service, Municipal Health Secretariat of Belo Horizonte, Belo Horizonte, Brazil
| | - Lívia Guimarães Zina
- School of Dentistry, Department of Community and Preventive Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mario Vianna Vettore
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Brazil
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Crisan EL, Covaliu BF, Chis DM. A Systematic Literature Review of Quality Management Initiatives in Dental Clinics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11084. [PMID: 34769604 PMCID: PMC8582852 DOI: 10.3390/ijerph182111084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 12/17/2022]
Abstract
By considering the recently proposed definitions and metrics, oral healthcare quality management (OHQM) emerges as a distinct field in the wider healthcare area. The goal of this paper is to systematically review quality management initiatives (QMIs) implementation by dental clinics. The research methodology approach is a review of 72 sources that have been analyzed using the Context-Intervention-Mechanism-Outcome Framework (CIMO). The analysis identifies five mechanisms that explain how quality management initiatives are implemented by dental clinics. The simplest QMIs implementations are related to (1) overall quality. The next ones, in terms of complexity, are related to (2) patient satisfaction, (3) service quality, (4) internal processes improvement, and (5) business outcomes. This paper is the first attempt to provide a critical review of this topic and represents an important advancement by providing a theoretical framework that explains how quality management is implemented by practitioners in this field. The results can be used by scholars for advancing their studies related to this emerging research area and by healthcare managers in order to better implement their quality management initiatives.
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Affiliation(s)
- Emil Lucian Crisan
- Faculty of Economics and Business Administration, Department of Management, Babes-Bolyai University, 400591 Cluj-Napoca, Romania;
| | - Bogdan Florin Covaliu
- Faculty of Medicine, Department of Community Medicine, Public Health and Management, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400337 Cluj-Napoca, Romania
| | - Diana Maria Chis
- Faculty of Economics and Business Administration, Department of Finance, Babes-Bolyai University, 400591 Cluj-Napoca, Romania;
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Weber K, DaSilva AF, Dault JT, Eber R, Huner K, Jones D, Kornman K, Ramaswamy V, Snyder M, Ward BB, Nalliah RP. Using business intelligence and data visualization to understand the characteristics of failed appointments in dental school clinics. J Dent Educ 2021; 85:521-530. [PMID: 33508149 DOI: 10.1002/jdd.12538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVES Broken appointments are an important cause of waste in health care. Patients who fail to attend incur costs to providers, deny trainees learning opportunities, and impact their own health as well as that of other patients who are waiting for care. METHODS A total of 410,000 appointment records over 3 years were extracted from our electronic health record. We conducted exploratory data analysis and assessed correlations between appointment no-shows and other attributes of the appointment and the patient. The University of Michigan Medical School's Committee on Human Research reviewed the study and deemed that no Institutional Review Board oversight was necessary for this quality improvement project that was, retrospectively, turned into a study with previously de-identified data. RESULTS The patient's previous attendance record is the single most significant correlation with attendance. We found that patients who said they are "scared" of dental visits were 62% as likely to attend as someone reporting "no problem." Patients over 65 years of age have better attendance rates. There was a positive association between receiving email/text confirmation and attendance. A total of 94.9% of those emailed a reminder and 92.2% of those who were texted attended their appointment. CONCLUSION(S) We were able to identify relationships of several variables to failed and attended appointments that we were previously unknown to us. This knowledge enabled us to implement interventions to support better attendance at Dental Clinics at the University of Michigan, improving patient health, student training, and efficient use of resources.
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Affiliation(s)
- Kate Weber
- Health Infrastructures and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandre F DaSilva
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Jean T Dault
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Robert Eber
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Kim Huner
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Darlene Jones
- Dental Hygiene, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Kenneth Kornman
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Vidya Ramaswamy
- Assessment, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Mark Snyder
- Vertically Integrated Clinic, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Brent B Ward
- Oral Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Romesh P Nalliah
- Patient Services, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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8
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Gomes MAG, Abreu MHNG, Ferreira FM, Fraiz FC, Menezes JVNB. No-shows at public secondary dental care for pediatric patients: a cross-sectional study in a large Brazilian city. CIENCIA & SAUDE COLETIVA 2019; 24:1915-1923. [DOI: 10.1590/1413-81232018245.19312017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/03/2017] [Indexed: 11/22/2022] Open
Abstract
Abstract Missed appointments have a great economic, social and administrative impact on the management of public health services. This research aimed to study factors associated with non-attendance to the first appointments of pediatric patients in secondary dental care services in the city of Curitiba, Brazil. A cross-sectional study was performed using secondary data from the electronic health records of the Curitiba Municipal Secretary of Health. The study included all children (0-12 years) referred to secondary dental clinics in the years 2010 to 2013. Data were analyzed by the chi-square test and Pearson linear trend chi-square (α = 0.05). Binary logistic regression models were built. Data from 1,663 children were assessed and the prevalence of non-attendance was 28.3%. The variables associated with the non-attendance in inferential analysis (p < 0.05) and in the final model were the household income per capita (95% CI: 1.93-2.82) and the waiting time in virtual queue (95% CI: 1.000-1.002). Socioeconomic aspects and the waiting time in virtual queue, should be considered in the strategic planning of health services as they may influence the attendance of pediatric patients in secondary dental referral service.
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Mikhaeil JS, Celo E, Shanahan J, Harvey B, Sipos B, Law MP. Attend: A Two-Pronged Trial to Eliminate No Shows in Diagnostic Imaging at a Community-Based Hospital. J Med Imaging Radiat Sci 2019; 50:36-42. [DOI: 10.1016/j.jmir.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/26/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
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Miller-Matero LR, Clark KB, Brescacin C, Dubaybo H, Willens DE. Depression and literacy are important factors for missed appointments. PSYCHOL HEALTH MED 2015; 21:686-95. [PMID: 26695719 DOI: 10.1080/13548506.2015.1120329] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lapidos A, Shaefer HL, Gwozdek A. Toward a better understanding of dental appointment-keeping behavior. Community Dent Oral Epidemiol 2015; 44:85-91. [DOI: 10.1111/cdoe.12193] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/31/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | - H. Luke Shaefer
- School of Social Work; University of Michigan; Ann Arbor MI USA
| | - Anne Gwozdek
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
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Machado AT, Werneck MAF, Lucas SD, Abreu MHNG. Who did not appear? First dental visit absences in secondary care in a major Brazilian city: a cross-sectional study. CIENCIA & SAUDE COLETIVA 2015; 20:289-98. [DOI: 10.1590/1413-81232014201.01012014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 05/25/2014] [Indexed: 11/22/2022] Open
Abstract
The study sought to identify possible factors associated with non-attendance at first dental appointments scheduled in 2011 of users living in Belo Horizonte, Minas Gerais, who were referred from primary care to different dental specialties in secondary care within the public health services of the city. A cross-sectional study was conducted based on research in secondary data bases of the public health regulatory system. The dependent variable was "no shows" for scheduled appointments, and the independent variables were age, time on the waiting list, gender, health district, and the specialty to which the individual was referred. Among the 6,428 first dental visits scheduled for 2011 in the specialties selected for analysis, 32.9 % were not performed due to the absence of the user. Bivariate analysis revealed a statistically significant association between non-attendance of the user and the five independent variables. Young adults, male, and resident in given districts who were referred to the specialties of surgery and endodontics and who waited longer on the waiting list exhibited a higher frequency of no-shows.
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Holtzman JS, Atchison KA, Gironda MW, Radbod R, Gornbein J. The association between oral health literacy and failed appointments in adults attending a university-based general dental clinic. Community Dent Oral Epidemiol 2013; 42:263-70. [PMID: 24372282 DOI: 10.1111/cdoe.12089] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/18/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this study is to determine the association between personal characteristics, a person's oral health literacy, and failing to show for dental appointments at a university dental clinic. METHODS A secondary data analysis was conducted on data collected from 200 adults at a university dental clinic between January 2005 and December 2006. In the original study, an oral health literacy instrument, the Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D), was administered, sociodemographic and health information seeking behavior was gathered, and electronic records were reviewed. RESULTS Descriptive and bivariate analyses and a classification and regression tree (CART) analysis were conducted. Seeking health information through fewer sources vs. multiple sources was the strongest predictor of failing to show. The subjects' oral health literacy, as measured by the REALM-D List 3 score, was the next most significant variable. Classification and regression tree analyses also selected gender, chief complaint, age, and payment type as predictor variables. CONCLUSIONS Multiple factors contribute to failing to show for dental appointments. However, individuals who use fewer sources of oral health information, a subset of health literacy skills, are more likely to fail to show for dental appointments.
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Affiliation(s)
- Jennifer S Holtzman
- Division of Public Health and Community Dentistry, University of California, Los Angeles, School of Dentistry, Los Angeles, CA, USA
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Lalloo R, McDonald JM. Appointment attendance at a remote rural dental training facility in Australia. BMC Oral Health 2013; 13:36. [PMID: 23914805 PMCID: PMC3737087 DOI: 10.1186/1472-6831-13-36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/31/2013] [Indexed: 11/30/2022] Open
Abstract
Background Non-attended appointments have impacts on the operations of dental clinics. These impacts vary from lost productivity, loss of income and loss of clinical teaching hours. Methods Appointment data were analysed to assess the percentage of completed, failed to attend (FTA) and cancelled appointments at an Australian remote rural student dental clinic training facility. The demographic and time characteristics of FTA and cancelled appointments were analysed using simple and multivariate multinomial regression analysis, to inform interventions that may be necessary. Results Over the 2-year study period a total of 3,042 appointments were made. The percentage of FTA was 21.3% (N = 648) and cancelled appointments 13.7% (N = 418). The odds of an FTA were in excess of 4 times higher in patients aged 19–25 years (OR = 4.1; 95% CI = 2.3-7.3) and 26–35 years (OR = 4.4; 95% CI = 2.5-7.9) compared to patients 65 years and older. The odds of an FTA was 2.3 (95% CI = 1.8-3.1) times higher in public patients compared to private patients. The odds of a cancellation was 1.7 (95% CI = 1.1-2.6) times higher on a Friday compared to a Monday and 1.8 (95% CI = 1.1-2.9) times higher on the last appointment of the day compared to the first appointment. For cancelled appointments, 71.3% were cancelled on the day of the appointment and 16.6% on the day before. Conclusions Non-attended appointments (FTA or cancelled) were common at this remote rural dental clinic training facility. Efforts to reduce these need to be implemented; including telephonic reminders, educating the community on the importance of attending their appointments, block booking school children and double booking or arranging alternative activities for the students at times when non-attendance is common.
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Abstract
Background: Missed primary care appointments lead to poor disease control and later presentation to care. No-show rates are higher in clinics caring for underserved populations and may contribute to poorer health outcomes in this group. The objective of this study was to determine who were the patients not showing to primary care appointments and their reasons to no-show. Methods: A retrospective study was conducted at a community health center serving a predominantly Latino, immigrant, low-income population. Adult patients >18 years old who did not show to primary care appointments during a 5-month period were called by a bilingual (English and Spanish) patient service coordinator. The patients’ reported reason for missing the appointment was documented. Two-sided t test of proportions was used to compare demographic characteristics of the patients that showed to their appointments to patients that did not. Results: Of 7508 scheduled appointments, 5604 were included in the analysis and 927 (16.5%) no-showed. There were 735 (79%) calls made to the patients who missed their appointments and 273 (37%) were reached. The 2 most common reasons for missing an appointment were forgetting (n = 97, 35.5%) and miscommunication (n = 86, 31.5%). When compared with patients who came to their appointments, patients who no-showed were younger ( P < .0001), more likely to be black ( P = .0423) or Hispanic ( P = .0001), and to have Medicaid ( P < .0001). Conclusions: No-show rates interfere with quality primary care. Interventions designed to target reasons for no-show are needed to help reduce the no-show rate, improve access and decrease health disparities in underserved patient populations.
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Affiliation(s)
- Emma Kaplan-Lewis
- Massachusetts General Hospital Department of Medicine, Boston, MA, USA
| | - Sanja Percac-Lima
- Massachusetts General Hospital Department of Medicine, Boston, MA, USA
- Massachusetts General Hospital Chelsea HealthCare Center, Chelsea, MA, USA
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Junod Perron N, Dao MD, Righini NC, Humair JP, Broers B, Narring F, Haller DM, Gaspoz JM. Text-messaging versus telephone reminders to reduce missed appointments in an academic primary care clinic: a randomized controlled trial. BMC Health Serv Res 2013; 13:125. [PMID: 23557331 PMCID: PMC3623700 DOI: 10.1186/1472-6963-13-125] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 03/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background Telephone or text-message reminders have been shown to significantly reduce the rate of missed appointments in different medical settings. Since text-messaging is less resource-demanding, we tested the hypothesis that text-message reminders would be as effective as telephone reminders in an academic primary care clinic. Methods A randomized controlled non-inferiority trial was conducted in the academic primary care division of the Geneva University Hospitals between November 2010 and April 2011. Patients registered for an appointment at the clinic, and for whom a cell phone number was available, were randomly selected to receive a text-message or a telephone call reminder 24 hours before the planned appointment. Patients were included each time they had an appointment. The main outcome was the rate of unexplained missed appointments. Appointments were not missed if they were cancelled or re-scheduled before or independently from the intervention. We defined non-inferiority as a difference below 2% in the rate of missed appointments and powered the study accordingly. A satisfaction survey was conducted among a random sample of 900 patients (response rate 41%). Results 6450 patients were included, 3285 in the text-message group and 3165 in the telephone group. The rate of missed appointments was similar in the text-message group (11.7%, 95% CI: 10.6-12.8) and in the telephone group (10.2%, 95% CI: 9.2-11.3 p = 0.07). However, only text message reminders were cost-effective. No patient reported any disturbance by any type of reminder in the satisfaction survey. Three quarters of surveyed patients recommended its regular implementation in the clinic. Conclusions Text-message reminders are equivalent to telephone reminders in reducing the proportion of missed appointments in an academic primary care clinic and are more cost-effective. Both types of reminders are well accepted by patients.
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Affiliation(s)
- Noelle Junod Perron
- Division of primary care medicine, Department of community medicine, primary care and emergency medicine, Geneva University Hospitals, 4 rue Gabrielle Perret-Gentil, Geneva 14, 1211, Switzerland.
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