Factors associated with non-attendance at pediatric allergy clinics

To confirm your appointment, please press one: Examining demographic and health system interface factors that predict missed appointments in a pediatric outpatient neuropsychology clinic

Objective: Missed patient appointments have a substantial negative impact on patient care, child health and well-being, and clinic functioning. This study aims to identify health system interface and child/family demographic characteristics as potential predictors of appointment attendance in a pediatric outpatient neuropsychology clinic. Method: Pediatric patients (N = 6,976 across 13,362 scheduled appointments) who attended versus missed scheduled appointments at a large, urban assessment clinic were compared on a broad array of factors extracted from the medical record, and the cumulative impact of significant risk factors was examined. Results: In the final multivariate logistic regression model, health system interface factors that significantly predicted more missed appointments included a higher percentage of previous missed appointments within the broader medical center, missing pre-visit intake paperwork, assessment/testing appointment type, and visit timing relative to the COVID-19 pandemic (i.e. more missed appointments prior to the pandemic). Demographic characteristics that significantly predicted more missed appointments in the final model included Medicaid (medical assistance) insurance and greater neighborhood disadvantage per the Area Deprivation Index (ADI). Waitlist length, referral source, season, format (telehealth vs. in-person), need for interpreter, language, and age were not predictive of appointment attendance. Taken together, 7.75% of patients with zero risk factors missed their appointment, while 22.30% of patients with five risk factors missed their appointment. Conclusions: Pediatric neuropsychology clinics have a unique array of factors that impact successful attendance, and identification of these factors can help inform policies, clinic procedures, and strategies to decrease barriers, and thus increase appointment attendance, in similar settings.

Utilization of part C early intervention services for patients with cleft palate

OBJECTIVES

To investigate the utilization of early intervention services under Part C of the 2004 Individuals with Disabilities Educational Act for children with cleft palate and to better understand barriers these patients encounter when receiving services.

METHODS

A retrospective chart review was performed on children under the age of 18 who were treated for cleft palate at a single tertiary care center and referred to Tennessee's Early Intervention System (TEIS) between January 2007 and December 2018.

RESULTS

For the 61 patients included, developmental therapy was the most common TEIS referral made (n = 408, 28%), followed by speech therapy (n = 371, 26%). Most of these services were delivered as scheduled (n = 513, 80%); some families missed appointments without notifying the provider (i.e., family no-show)(n = 101, 2%). Children referred at a younger age were more likely to receive developmental therapy (p = 0.012) and to attend their services (p = 0.027). Patients with Medicaid were more likely to have absences with prior notification (p = 0.05) and without prior notification (i.e., family no-show)(p = 0.009) than patients with other types of health insurance.

CONCLUSIONS

Patients with cleft palate often have complex needs; earlier referral to ancillary services may improve attendance at appointments and impact the services they receive. Socioeconomic factors may hinder patients from accessing these services even once they are referred.

Factors Contributing to Missed Appointments in a Pediatric Otolaryngology Clinic

OBJECTIVE

To understand why pediatric otolaryngology patients do not attend scheduled clinic appointments and identify factors correlated with no-show status.

STUDY DESIGN

Retrospective cohort study.

METHODS

This is a retrospective cohort study that uses medical record data extraction of patients that was scheduled to attend new patient appointments at a pediatric otolaryngology clinic in 2018.

RESULTS

Factors associated with no-shows included complex psychiatric history (OR (95% CI) 0.789 (0.71-0.88), P < .001), increased appointment lead time (OR (95% CI) 0.981 (0.976-0.987), P < .001), afternoon appointments (OR (95% CI) 0.783 (0.64-0.99), P = .038), and complex maternal medical history (OR (95% CI) 0.987 (0.979-0.996), P < .005). In contrast, factors associated with attendance included complex patients' medical history (OR (95% CI) 1.058 (0.98-1.02), P < .001), primary care physician at the same hospital (OR (95% CI) 2.766 (2.25-3.39), P < .001), and primary language being Spanish (OR (95% CI) 2.536 (1.75-3.67) P < .001). The factors of distance from the hospital (OR (95% CI) 1.001 (0.99-1.01), P = .868), season of appointment (P = .997), race (P = .623), and ethnicity (P = .804) were not associated with attendance or no-shows.

CONCLUSION

Patient and maternal medical problems, mental health history, primary care location, appointment lead time, hour of appointment, and primary language, all contribute to appointment attendance, while appointment timing, race, and ethnicity are not associated with attendance. Further work must be performed to overcome these barriers to minimize healthcare risks and improve patient outcomes.

QUALITY OF EVIDENCE

Level 3 Laryngoscope, 2021.

Mothers' Perceived Barriers to and Recommendations for Health Care Appointment Keeping for Children Who Have Cerebral Palsy

Children with cerebral palsy (CP) require ongoing rehabilitation services to address complex health care needs. Attendance at appointments ensures continuity of care and improves health and well-being. The study's aim was to gain insight into mothers' perspectives of the factors associated with nonattendance. A qualitative descriptive design was conducted to identify barriers and recommendations for appointment keeping. Semi-structured interviews were conducted with 15 mothers of children with CP. Data underwent inductive qualitative analysis. Mothers provided rich context regarding barriers confronted for appointment keeping-transportation and travel, competing priorities for the child and family, and health services. Mothers' recommendations for improving the experience of attending appointments included virtual care services, transportation support, multimethod scheduling and appointment reminders, extended service hours, and increased awareness among staff of family barriers to attendance. The results inform services/policy strategies to facilitate appointment keeping, thereby promoting access to ongoing rehabilitation services for children with CP.

No-shows in appointment scheduling - a systematic literature review

No-show appointments significantly impact the functioning of healthcare institutions, and much research has been performed to uncover and analyze the factors that influence no-show behavior. In spite of the growing body of literature on this issue, no synthesis of the state-of-the-art is presently available and no systematic literature review (SLR) exists that encompasses all medical specialties. This paper provides a SLR of no-shows in appointment scheduling in which the characteristics of existing studies are analyzed, results regarding which factors have a higher impact on missed appointment rates are synthetized, and comparisons with previous findings are performed. A total of 727 articles and review papers were retrieved from the Scopus database (which includes MEDLINE), 105 of which were selected for identification and analysis. The results indicate that the average no-show rate is of the order of 23%, being highest in the African continent (43.0%) and lowest in Oceania (13.2%). Our analysis also identified patient characteristics that were more frequently associated with no-show behavior: adults of younger age; lower socioeconomic status; place of residence is distant from the clinic; no private insurance. Furthermore, the most commonly reported significant determinants of no-show were high lead time and prior no-show history.

Appointment-keeping behaviors and procedure day are associated with colonoscopy attendance in a patient navigator population

BACKGROUND

Patient navigator programs (PNP) have been shown to improve colonoscopy completion with demonstrated cost-effectiveness. Despite additional resources available to these patients, many still do not attend their colonoscopies. The aim of this study was to determine factors associated with colonoscopy attendance amongst patients in whom logistical barriers to attendance have been minimized through enrollment in a PNP.

METHODS

Retrospective case-control study of patients enrolled in a PNP for colonoscopy performed at a tertiary endoscopy center from 2009 to 2014. Cases were defined as patients who did not attend their first scheduled colonoscopy after PNP enrollment. Age- and gender-matched controls completed their first scheduled colonoscopy after PNP enrollment.

RESULTS

514 subjects (257 cases, mean age 57.1years, 36.6% males) were included. Patients who attended their colonoscopy were less likely to be Spanish-speaking (64.6% vs 78.2%, p=0.0003) and uninsured (0.4% vs 3.9%, p=0.006). Attendance rates were significantly lower for screening colonoscopies compared to an indication of surveillance or diagnostic (45.5% vs 65.3%, p<0.0001). Fewer patients attended colonoscopies scheduled on Monday (39.2% vs 52.1%, p=0.04) and in December (10.7% vs 52.3%, p<0.0001). On multivariate analysis, poor appointment-keeping behaviors, including a prior missed colonoscopy (OR 0.20, 95% CI 0.10-0.39) or missed office visit (OR 0.44, 95% CI 0.26-0.73) and procedures scheduled on Mondays (OR 0.51, 95% CI 0.27-0.94) were negatively associated with attendance.

CONCLUSIONS

Appointment-keeping behaviors, in addition to insurance-status, language-barriers and medical comorbidities, influence colonoscopy attendance in a PNP population. Patients scheduled for colonoscopies on Mondays or in December may require more resources to ensure attendance.

What is Known About Health and Morbidity in the Pediatric Population of Muslim Bedouins in Southern Israel: A Descriptive Review of the Literature from the Past Two Decades

The Bedouins comprise one of the ethnic groups in Israeli society. They are Muslims, most of who live in the Negev desert region of southern Israel and live by their unique traditions and customs. At the present they are going through a period of "society in transition", a unique condition that has ramifications for health and morbidity. In recent years the number of publications on the health of Bedouins in the Negev has increased. Recognition of unique socio-economic features, characteristics of health and diseases can help the medical team treat various health problems in this population as well as other populations with similar characteristics. In the present paper we survey and discuss publications on the health of Bedouin children over the past 20 years.

Prevalence, predictors and economic consequences of no-shows

Background

Patients not attending to clinic appointments (no-show) significantly affects delivery, cost of care and resource planning. We aimed to evaluate the prevalence, predictors and economic consequences of patient no-shows.

Method

This is a retrospective cohort study using administrative databases for fiscal years 1997–2008. We searched administrative databases for no-show frequency and cost at a large medical center. In addition, we estimated no-show rates and costs in another 10 regional hospitals. We studied no-show rates in primary care and various subspecialty settings over a 12-year period, the monthly and seasonal trends of no-shows, the effects of implementing a reminder system and the economic effects of missed appointments.

Results

The mean no-show rate was 18.8 % (2.4 %) in 10 main clinics with highest occurring in subspecialist clinics. No-show rate in the women clinic was higher and the no-show rate in geriatric clinic was lower compared to general primary care clinic (PCP). The no-show rate remained at a high level despite its reduction by a centralized phone reminder (from 16.3 % down to 15.8 %). The average cost of no-show per patient was $196 in 2008.

Conclusions

Our data indicates that no-show imposed a major burden on this health care system. Further, implementation of a reminder system only modestly reduced the no-show rate.

Prevalence, predictors and economic consequences of no-shows

BACKGROUND

Patients not attending to clinic appointments (no-show) significantly affects delivery, cost of care and resource planning. We aimed to evaluate the prevalence, predictors and economic consequences of patient no-shows.

METHOD

This is a retrospective cohort study using administrative databases for fiscal years 1997-2008. We searched administrative databases for no-show frequency and cost at a large medical center. In addition, we estimated no-show rates and costs in another 10 regional hospitals. We studied no-show rates in primary care and various subspecialty settings over a 12-year period, the monthly and seasonal trends of no-shows, the effects of implementing a reminder system and the economic effects of missed appointments.

RESULTS

The mean no-show rate was 18.8% (2.4%) in 10 main clinics with highest occurring in subspecialist clinics. No-show rate in the women clinic was higher and the no-show rate in geriatric clinic was lower compared to general primary care clinic (PCP). The no-show rate remained at a high level despite its reduction by a centralized phone reminder (from 16.3% down to 15.8%). The average cost of no-show per patient was $196 in 2008.

CONCLUSIONS

Our data indicates that no-show imposed a major burden on this health care system. Further, implementation of a reminder system only modestly reduced the no-show rate.

Factors associated with non-attendance at a hand surgery appointment

BACKGROUND

Patients who miss scheduled appointments without notifying office staff--"no-shows"--disrupt practice workflow and decrease access for others, resulting in misuse of resources and lost revenue. The primary purpose of this study was to identify factors associated with no-shows in a hospital-based outpatient hand office. Secondarily, we studied factors associated with cancelations.

METHODS

Of the 14,793 new adult patient appointments to our outpatient hand surgery office scheduled between January 2011 and December 2013, 880 (5.9 %) were no-shows and 2715 (18 %) were cancelations. Data on patient demographics and timing of the visit were collected to construct a multinomial logistic regression model of determinants of appointment no-shows and cancelations.

RESULTS

Factors independently associated with no-shows included younger age, Hispanic or black race, unmarried status (single or divorced), appointment on a Monday or Tuesday, and residence near the office. Factors associated with cancelations were female sex, unmarried status (widowed or divorced), winter season, and appointment on a weekday other than Friday.

CONCLUSIONS

Non-attendees are more likely to be younger, unmarried, non-white, to have their appointments at the start of the week, and to live near the office. Knowledge of these factors might prove useful for implementation of tailored quality improvement initiatives to reduce non-attendance and maximize productivity in the hand surgery office setting.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Appointment attendance at a remote rural dental training facility in Australia

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.

Patient engagement and attrition in pediatric obesity clinics and programs: results and recommendations

Pediatric tertiary care institutions are well positioned to provide multidisciplinary, intensive interventions for pediatric obesity known as stage 3 treatment. One contributor to the difficulty in administering this treatment is the high rate of patient attrition. Little is known about the practices used by pediatric weight-management clinics and group-based programs to minimize attrition. Hospital members and nonmembers of FOCUS on a Fitter Future were surveyed on the methods used to engage and retain obese children in their clinics and programs. Shortly thereafter, a benchmarking activity that centered on rates of patient nonattendance at initial and follow-up clinic visits was initiated among FOCUS-group-participating hospitals. Clinic- and group-based program results were contrasted. Staff from group-based programs reported that the majority of patients did not complete even 50% of program follow-up visits. Multiple patient/family- and clinic/program-level barriers to retention were identified. Attention to successful techniques should be paid during planning for new programs and improvement of established ones.