Reducing Patient No-Shows: An Initiative at an Integrated Care Teaching Health Center

Missed Healthcare Visits During the COVID-19 Pandemic: A Longitudinal Study

INTRODUCTION

Missed visits have been estimated to cost the U.S. healthcare system $50 billion annually and have been linked to healthcare inefficiency, higher rates of emergency department visits, and worse outcomes. COVID-19 disrupted existing outpatient healthcare utilization patterns. In our study, we sought to examine the frequency of missed outpatient visits over the course of the COVID-19 pandemic and to examine patient-level characteristics associated with non-attendance.

METHODS

This study utilized data from a longitudinal cohort study (the Chicago COVID-19 Comorbidities (C3) study). C3 participants were enrollees in 1 of 4 active, "parent" studies; they were rapidly enrolled in C3 at the onset of the pandemic. Multiple waves of telephone-based interviews were conducted to collect experiences with the pandemic, as well as socio-demographic and health characteristics, health literacy, patient activation, and depressive and anxiety symptoms. For the current analysis, data from waves 3 to 8 (05/01/20-05/19/22) were analyzed. Participants included 845 English or Spanish-speaking adults with 1 or more chronic conditions.

RESULTS

The percentage of participants reporting missed visits due to COVID-19 across study waves ranged from 3.1 to 22.4%. Overall, there was a decline in missed visits over time. No participant sociodemographic or health characteristic was consistently associated with missed visits across the study waves. In bivariate and multivariate analysis, only patient-reported anxiety was significantly associated with missed visits across all study waves.

CONCLUSION

Findings reveal that anxiety was consistently associated with missed visits during the COVID-19 pandemic, but not sociodemographic or health characteristics. Results can inform future public health initiatives to reduce absenteeism by considering patients' emotional state during times of uncertainty.

Reducing missed psychotherapy appointments: An advanced practice nurse-initiated telephone orientation protocol

PURPOSE

Missed appointments pose significant challenges to the health care system as they contribute to the inefficient use of resources, increase costs, and result in poor outcomes. The aim of this project was to reduce the rate of missed adult psychotherapy appointments by implementing a Psychiatric-Mental Health Nurse Practitioner-initiated telephone orientation protocol (TOP).

DESIGN

Quasi-experimental.

METHODS

The TOP intervention combined an attendance policy review, psychoeducation, and motivational interviewing techniques. Missed appointment rates were compared before and after initiation of the TOP.

FINDINGS

The TOP significantly reduced the rates of missed appointments by 55% over 12 weeks.

PRACTICE IMPLICATIONS

The TOP can be implemented as standard care to increase client engagement, improve appointment attendance, and boost clinician productivity.

Study of Impact of Telehealth Use on Clinic "No Show" Rates at an Academic Practice

OBJECTIVE

To examine the clinic no-show rate across different modalities of care delivery (Face to Face, Telephone visits and Audio-Video visits).

METHODS

Clinic no show data for adult patients was extracted from the electronic health records used by the psychiatry clinic for 10 months before pandemic and 10 months during pandemic. No show rate was analyzed by visits type (new vs return) and across different modalities (face-to-face vs Telephone vs Audio-Video) before and during COVID pandemic.

RESULTS

There were 13,916 scheduled visits during the 10-month period before the pandemic of which 2,522 were no show. There were 13,251 scheduled visits during the 10-month period during the COVID pandemic of which 2,029 were no show. The overall clinic no show rate decreased from pre pandemic to pandemic period (18.1% vs 15.3%) after transitioning to telehealth. Across different modalities during the pandemic, the no-show rate for Telephone visits was significantly lower than for face- to-face visits. No difference was identified for no-show rates between face-to-face visits and audio-video visits during the pandemic. The no-show rate for face-to-face visits before the pandemic compared to during the pandemic also showed no difference.

CONCLUSION

Using technology in health care delivery can decrease the clinic no show rate. Digital literacy for patients and providers is critical for successful utilization of telehealth.

Mental Health Staffing at HRSA-Funded Health Centers May Improve Access to Care

OBJECTIVE

The study objective was to examine the association between mental health staffing at health centers funded by the Health Resources and Services Administration (HRSA) and patients' receipt of mental health treatment.

METHODS

Data were from the 2014 HRSA-funded Health Center Patient Survey and the 2013 Uniform Data System. Colocation of any mental health staff, including psychiatrists, psychologists, and other licensed staff, was examined. The outcomes of interest were whether a patient received any mental treatment and received any such treatment on site (at the health center). Analyses were conducted with multilevel generalized structural equation logistic regression models for 4,575 patients ages 18-64.

RESULTS

Patients attending health centers with at least one mental health full-time equivalent (FTE) per 2,000 patients had a higher predicted probability of receiving mental health treatment (32%) compared with those attending centers with fewer than one such FTE (24%) or no such staffing (22%). Among patients who received this treatment, those at health centers with no staffing had a significantly lower predicted probability of receiving such treatment on site (28%), compared with patients at health centers with fewer than one such FTE (49%) and with at least one such FTE (65%). The predicted probability of receiving such treatment on site was significantly higher if there was a colocated psychiatrist versus no psychiatrist (58% versus 40%).

CONCLUSIONS

Colocating mental health staff at health centers increases the probability of patients' access to such treatment on site as well as from off-site providers.