Why We Don’t Come: Patient Perceptions on No-Shows

PURPOSE Patients who schedule clinic appointments and fail to keep them have a negative impact on the workflow of a clinic in many ways. This study was conducted to identify the reasons patients in an urban family practice setting give for not keeping scheduled appointments. METHODS Semistructured interviews were conducted with 34 adult patients coming to the clinic for outpatient care. Interviews were audiotaped and transcribed verbatim. A multidisciplinary team used an immersion-crystallization organizing style to analyze the content of the qualitative interviews individually and in team meetings. RESULTS Participants identified 3 types of issues related to missing appointments without notifying the clinic staff: emotions, perceived disrespect, and not understanding the scheduling system. Although they discussed logistical issues of appointment keeping, participants did not identify these issues as key reasons for nonattendance. Appointment making among these participants was driven by immediate symptoms and a desire for self-care. At the same time, many of these participants experienced anticipatory fear and anxiety about both procedures and bad news. Participants did not feel obligated to keep a scheduled appointment in part because they felt disrespected by the health care system. The effect of this feeling was compounded by participants’ lack of understanding of the scheduling system. CONCLUSIONS The results of this study suggest that reducing no-show rates among patients who sometimes attend might be addressed by reviewing waiting times and participants’ perspectives of personal respect.

[1]  K Kroenke,et al.  Visit-specific expectations and patient-centered outcomes: a literature review. , 2000, Archives of family medicine.

[2]  H. Bernard,et al.  Data Management and Analysis Methods , 2000 .

[3]  Y. Bar-dayan,et al.  Waiting time is a major predictor of patient satisfaction in a primary military clinic. , 2002, Military medicine.

[4]  R B Haynes,et al.  An overview of interventions to improve compliance with appointment keeping for medical services. , 1992, JAMA.

[5]  K. Hardy,et al.  Information given to patients before appointments and its effect on non-attendance rate , 2001, BMJ : British Medical Journal.

[6]  A. Hixon,et al.  Failure to keep clinic appointments: implications for residency education and productivity. , 1999, Family medicine.

[7]  J. Talaga,et al.  Appointment breaking: causes and solutions. , 1992, Journal of health care marketing.

[8]  N. Denzin,et al.  Handbook of Qualitative Research , 1994 .

[9]  A. Gatrad A completed audit to reduce hospital outpatients non-attendance rates , 2000, Archives of disease in childhood.

[10]  M. Cosgrove,et al.  Defaulters in general practice: reasons for default and patterns of attendance. , 1990, The British journal of general practice : the journal of the Royal College of General Practitioners.

[11]  Kimberly C Kirby,et al.  From telephone to office: intake attendance as a function of appointment delay. , 2002, Addictive behaviors.

[12]  A. Farrow,et al.  Non-attendance or non-invitation? A case-control study of failed outpatient appointments. , 1989, BMJ.

[13]  B. Yawn,et al.  Factors associated with appointment keeping in a family practice residency clinic. , 1994, The Journal of family practice.

[14]  W. Abdullah Arch Dis Childhood , 1994 .

[15]  S. Moser Effectiveness of post card appointment reminders. , 1994, Family practice research journal.

[16]  D. Sharp,et al.  Non-attendance at general practices and outpatient clinics , 2001, BMJ : British Medical Journal.

[17]  Effectiveness of post card appointment reminders. , 1994 .

[18]  Suzanne M. Miller,et al.  Enhancing adherence following abnormal Pap smears among low-income minority women: a preventive telephone counseling strategy. , 1997, Journal of the National Cancer Institute.

[19]  D. Berwick,et al.  Advanced access: reducing waiting and delays in primary care. , 2003, JAMA.

[20]  G O'Brien,et al.  Telephone call reminders and attendance in an adolescent clinic. , 1998, Pediatrics.

[21]  C. G. Moore,et al.  Time and money: effects of no-shows at a family practice residency clinic. , 2001, Family medicine.

[22]  Nicola Mead,et al.  Setting standards based on patients' views on access and continuity: secondary analysis of data from the general practice assessment survey , 2003, BMJ : British Medical Journal.

[23]  J. Smoller,et al.  How do clinicians respond to patients who miss appointments? , 1998, The Journal of clinical psychiatry.

[24]  E. Ginzler,et al.  Using the Health Belief Model to Explain Clinic Appointment-Keeping for the Management of a Chronic Disease Condition , 1998, Journal of Community Health.

[25]  T. Bodenheimer,et al.  Improving timely access to primary care: case studies of the advanced access model. , 2003, JAMA.

[26]  W. Barron,et al.  Failed appointments. Who misses them, why they are missed, and what can be done. , 1980, Primary care.

[27]  Yawn Bp,et al.  Factors associated with appointment keeping in a family practice residency clinic. , 1994, The Journal of family practice.