Appointment Wait Time, Primary Care Provider Status, and Patient Demographics are Associated With Nonattendance at Outpatient Gastroenterology Clinic

Goals: We intended to identify the factors associated with missed appointments at a gastroenterology (GI) clinic in an academic setting. Background: Missed clinic appointments reduce clinic efficiency, waste resources, and increase costs. Limited data exist on subspecialty clinic attendance. Study: We performed a case-control study using data from the electronic health record of patients scheduled for an appointment at the adult GI clinic at the Banner University Medical Center between March and October of 2014. Patients who missed their appointment during the study period served as cases. Controls were randomly selected from patients who completed their appointment during the study period. Analysis included univariate and multivariate logistic regression analysis. Results: Of 2331 scheduled clinic appointments, 195 (8.4%) were missed appointments. Longer waiting time from referral to scheduled appointment was significantly associated with missed appointment (AOR=1.014; 95% CI, 1.01-1.02; P<0.001). Patients with primary care providers (PCPs) were less likely to miss their appointment than those without PCPs (AOR=0.35; 95% CI, 0.18-0.66; P=0.001). Among patient demographic characteristics, ethnicity and marital status were associated with missed appointment. Conclusions: Wait time, ethnicity, marital status, and PCP status were associated with missed GI clinic appointments. Further investigations are needed to assess the effects of intervention strategies directed at reducing appointment wait time and increasing PCP-based care.

[1]  J. Inadomi,et al.  Non-English Speakers Attend Gastroenterology Clinic Appointments at Higher Rates Than English Speakers in a Vulnerable Patient Population , 2009, Journal of clinical gastroenterology.

[2]  M. Lloyd,et al.  Non-attendance at outpatient clinics: is it related to the referral process? , 1993, Family practice.

[3]  Jesús Sáez,et al.  Factors associated with non-attendance at outpatient endoscopy , 2008, Scandinavian journal of gastroenterology.

[4]  P. Brantley,et al.  Predictors of outpatient medical appointment attendance among persons with HIV. , 1999, AIDS care.

[5]  R. Williams,et al.  General practice orthopaedic outpatient referrals in North Staffordshire. , 1983, British medical journal.

[6]  T. Brennan,et al.  Insurance or a regular physician: which is the most powerful predictor of health care? , 1998, American journal of public health.

[7]  G. Oppenheim,et al.  Failed appointments: a review. , 1979, The Journal of family practice.

[8]  Priscilla L. Stephenson,et al.  Methods to Reduce Outpatient Non-attendance , 2012, The American journal of the medical sciences.

[9]  B. Calhoun,et al.  Patient access and clinical efficiency improvement in a resident hospital-based women's medicine center clinic. , 2007, The American journal of managed care.

[10]  M. Matas,et al.  A profile of the noncompliant patient: a thirty-month review of outpatient psychiatry referrals. , 1992, General hospital psychiatry.

[11]  N. Penneys,et al.  The incidence of cancellation and nonattendance at a dermatology clinic. , 1999, Journal of the American Academy of Dermatology.

[12]  Michael Pignone,et al.  Estimating the Cost of No-Shows and Evaluating the Effects of Mitigation Strategies , 2013, Medical decision making : an international journal of the Society for Medical Decision Making.

[13]  G M Forbes,et al.  Nonattendance at Outpatient Endoscopy , 2004, Endoscopy.

[14]  Kevin Fiscella,et al.  Disparities in Health Care by Race, Ethnicity, and Language Among the Insured: Findings From a National Sample , 2002, Medical care.

[15]  G. Leung,et al.  Waiting Time, Doctor Shopping, and Nonattendance at Specialist Outpatient Clinics: Case-Control Study of 6495 Individuals in Hong Kong , 2003, Medical care.

[16]  M. Walshe,et al.  Influence of a Nurse Practitioner on Non-Attendance Rate for Barium Enema , 2002 .

[17]  W. Yoong,et al.  A demographic study to profile non-attenders at a gynaecology outpatient clinic , 2012, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.

[18]  J. Leighton,et al.  Factors Contributing to Patient Nonattendance at Open-access Endoscopy , 2006, Digestive Diseases and Sciences.

[19]  J. Menegazzi,et al.  Compliance with emergency department patient referral. , 1992, The American journal of emergency medicine.

[20]  R A Deyo,et al.  Dropouts and broken appointments. A literature review and agenda for future research. , 1980, Medical care.

[21]  M. Matas,et al.  Who Misses Appointments? An Empirical Analysis , 1991, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

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

[23]  I Forgacs,et al.  The effects of a preassessment clinic on nonattendance rates for day-case colonoscopy. , 2000, Endoscopy.

[24]  Gina R Kruse,et al.  Factors associated with missed first appointments at a psychiatric clinic. , 2002, Psychiatric services.

[25]  J. Frey,et al.  A multi-method intervention to reduce no-shows in an urban residency clinic. , 2013, Family medicine.

[26]  J. Abraham,et al.  How might the Affordable Care Act's coverage expansion provisions influence demand for medical care? , 2014, The Milbank quarterly.

[27]  G. Kaplan.  Health Care Scheduling and Access: A Report From the IOM. , 2015, JAMA.

[28]  R. Hales,et al.  Compliance with psychiatric referrals from a general hospital psychiatry outpatient clinic. , 1988, General hospital psychiatry.

[29]  D. Sharp,et al.  Patient, hospital, and general practitioner characteristics associated with non-attendance: a cohort study. , 2002, The British journal of general practice : the journal of the Royal College of General Practitioners.

[30]  M. Olfson,et al.  Predictors of missed appointments for psychiatric consultations in a primary care clinic. , 1996, Psychiatric services.

[31]  A Murdock,et al.  Why Do Patients not Keep their Appointments? Prospective Study in a Gastroenterology Outpatient Clinic , 2002 .

[32]  A D Cohen,et al.  Nonattendance of adult otolaryngology patients for scheduled appointments. , 2007, The Journal of laryngology and otology.

[33]  H. Ashktorab,et al.  Factors associated with attendance to scheduled outpatient endoscopy , 2014, Postgraduate Medical Journal.

[34]  F. Rosner,et al.  Missed appointments among patients new to a general medical clinic. , 1988, New York state journal of medicine.

[35]  D. Kyriacou,et al.  Brief report: Factors affecting outpatient follow-up compliance of emergency department patients , 2005, Journal of general internal medicine.