BackgroundPatients 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.MethodThis 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.ResultsThe 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.ConclusionsOur 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.

BACKGROUND Direct-acting antivirals (DAA) are safe, effective treatment of hepatitis C virus (HCV). Suboptimal linkage to specialists and access to DAAs are the leading barriers to treatment; however, data are limited. AIM Determine predictors of follow-up, receipt of DAAs, and reasons for the lack thereof. METHODS We used clinical data from retrospective cohort of HCV-infected patients with previously established HCV care in the US Department of Veterans Affairs to examine predictors of follow-up in HCV clinics and DAA treatment (during 12/1/2013–4/30/2015). We then conducted a structured review of medical charts of HCV patients to determine reasons for lack of follow-up and treatment. RESULTS We identified 84,221 veterans who were previously seen in HCV clinics during the pre-DAA era. Of these, 47,165 (56.0%) followed-up in HCV specialty clinics, 13,532 (28.7%) of whom received DAAs. Older age, prior treatment, presence of cirrhosis or HCC, HIV/HBV co-infection, and psychiatric illness were predictors of follow-up. Alcohol/drug abuse and medical comorbidity were predictors of lack of treatment. Of the 905 prospectively recruited patients, 56.2% patients had a specialist visit and 28% received DAAs. Common reasons for lack of follow-up were relocation (n=148, 37.4%) and missed/cancelled appointments (n=63, 15.9%). Reasons for lack of treatment included waiting for newer therapy (n=99, 38.8%), co-morbidities (n=66, 25.9%), and alcohol/drug abuse (n=63, 24.7%). CONCLUSIONS Half of patients with established HCV care were followed-up in the DAA era and only 29% received DAAs. Targeted efforts focusing on patient and system-levels may improve the reach of treatment with the new DAAs.

Psychosocial factors, especially depression, are strong indicators of impaired HRQOL for HCV-infected veterans not receiving antiviral therapy. Screening and treatment of psychosocial factors is recommended.