Increased Likelihood of Missed Appointments (“No Shows”) for Racial/Ethnic Minorities in a Safety Net Health System

Shimotsu, Scott T.; Roehrl, Anne; McCarty, Michael E.; Vickery, Katherine; Guzman-Corrales, Laura; Linzer, Mark; Garrett, Nancy

doi:10.1177/2150131915599980

Cited by 40 publications

(34 citation statements)

References 5 publications

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“…Missed physician appointments was the primary outcome for this study. Following previous research, missed physician appointments was assessed through self‐report by family caregivers who indicated whether they had missed one or more physician's appointments in the past 6 months (yes/no).…”

Section: Methodsmentioning

confidence: 99%

Adult Day Service Use Decreases Likelihood of a Missed Physician's Appointment Among Dementia Caregivers

Parker

Gaugler

Samus³

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVE Adult day services (ADSs) that provide community‐based supervised support for persons with dementia (PWD) may also function as a respite for familial caregivers to attend to self‐care needs. Guided by a revised version of the Andersen Healthcare Utilization Model, the objective of this study was to identify the association between use of ADSs and a missed physician's appointment among family caregivers for community‐dwelling familial PWD. A secondary objective was to identify other predisposing, enabling, and need factors associated with a missed physician's appointment. DESIGN Secondary analysis of baseline, cross‐sectional data from two randomized controlled trials (Advancing Caregiver Training, n = 272; and Care of Persons With Dementia in Their Environments, n = 237). SETTING Community. PARTICIPANTS Community‐dwelling caregivers for PWD (n = 509). MEASUREMENTS Missed physician's appointment was measured using the caregivers' self‐report of one or more missed physician's appointments (yes/no) in the past 6 months. ADS use was measured using the caregivers’ self‐report of ADS use (yes/no). RESULTS Over a third of the caregivers utilized ADSs for their PWD. Caregivers who utilized ADSs for their familial PWD were 49% less likely (95% confidence interval = 0.32‐0.81) to miss a physician's appointment in the past 6 months. More black compared to white caregivers missed appointments regardless of ADS use. Caregivers with increased chronic health conditions were more likely to miss a physician's appointment compared to those with fewer conditions. CONCLUSION ADSs’ provision of respite enables caregivers the time to address self‐care needs by decreasing the likelihood that caregivers miss a physician's appointment. Findings suggest that ADSs may promote positive health behaviors for caregivers and should be expanded as part of comprehensive dementia care for families. Factors associated with missed physician appointments need further examination and intervention to support black caregivers.

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Section: Methodsmentioning

confidence: 99%

Adult Day Service Use Decreases Likelihood of a Missed Physician's Appointment Among Dementia Caregivers

Parker

Gaugler

Samus³

et al. 2019

J American Geriatrics Society

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“…Many of these studies reached the same conclusion that being young, from minority racial or ethnic groups, or single, all significantly increased the likelihood of missing appointments. [12][13][14][15][16][17][18][19] Other possible predictors were insurance status, gender, lower income, and day and time of appointment. 18,19 A wide range of reasons why patients do not adhere to their medical appointments have also been extensively studied.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Negative Reinforcement on Increasing Patient Adherence to Appointments at King Abdullah University Hospital in Jordan

Alyahya

Hijazi

Nusairat

2016

INQUIRY

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Appointment nonadherence is a health behavior that represents a burden to health care systems. On March 1, 2015, a new negative reinforcement intervention involving “service fees” for a visit without appointment was implemented at King Abdullah University Hospital in Jordan. To evaluate the effect of this intervention in improving patient adherence to medical appointment, a retrospective preintervention and postintervention analysis was used, including all patients (n = 65 535) who had scheduled appointments at 39 outpatient clinics. A repeated-measures analysis of variance was first performed. Then, a multivariate linear regression model was used to identify factors that might predict individuals who are likely to attend or miss their appointments and those who have a greater tendency to visit the hospital with or without appointments. Although the average percentage of appointments attended was more than missed preintervention and postintervention, the decrease in percentage of missed appointments was more pronounced postintervention. Also, the average percentage of visits without appointments was less than visits with appointments in both times, but the decrease in the percentage of visits without appointments was more prominent after. The regression analysis revealed that younger, married and male patients were more likely to miss their appointment before and after the intervention. Also, younger patients had a tendency to attend without appointments. Conversely, patients with the lower copayment rate had a tendency to adhere to appointment times. In conclusion, negative reinforcement interventions could improve patient appointment adherence rates. Accordingly, interventions designed that consider evidence and are theory-based are needed to change patient behavior.

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“…1,2 Younger age, racial minority status, Medicaid enrollment, low educational level, and living in an underserved geographic area are all associated with missing scheduled health appointments. [3][4][5][6][7][8][9][10] This should not be surprising because patients with fewer social resources face more practical barriers to keeping appointments, such as housing insecurity and transportation failure, and frequently must juggle priorities that directly compete with their personal health. [11][12][13] Missed appointments, in turn, not only disrupt care but are additionally associated with worse health outcomes, higher medical comorbidity, and higher utilization of emergency services.…”

mentioning

confidence: 99%

A Successful Walk-In Psychiatric Model for Integrated Care

et al. 2019

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Accommodating walk-in psychiatry visits in primary care can improve access to psychiatric care for patients from historically underserved groups. We sought to determine whether a walk-in psychiatry model embedded within an integrated care practice could be sustained over time, and to characterize the patients who accessed care through it. Methods: We reviewed electronic health records linked to 811 psychiatry encounters in an integrated care practice between October 1, 2015 and September 30, 2017. Primary outcomes were the initial and return psychiatry encounters per month. Secondary outcomes were the demographics and diagnoses of patients who accessed their initial visits through walk-in sessions and scheduled appointments. Results: 490 initial psychiatry evaluations and 321 return encounters took place over the 2-year study period. The volume of initial psychiatry evaluations per month did not significantly change, but the volume of psychiatry follow-up encounters significantly increased after the walk-in session expanded. Medicaid recipients (OR, 1.9; 95% CI, 1.2 to 3.0); individuals without a college degree (OR, 1.7; 95% CI, 1.1 to 2.5); individuals who were single, divorced, or separated (OR, 1.7; 95% CI, 1.1 to 2.5); and individuals who identified as Black or Hispanic (OR, 2.5; 95% CI, 1.7 to 3.6) were more likely to access an initial psychiatry evaluation through a walk-in session as opposed to a scheduled appointment. Conclusions: Providing psychiatric care on a walk-in basis in integrated care is sustainable. Patients from historically underserved groups may access psychiatric care disproportionately through a walk-in option when it is available.

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Increased Likelihood of Missed Appointments (“No Shows”) for Racial/Ethnic Minorities in a Safety Net Health System

Cited by 40 publications

References 5 publications

Adult Day Service Use Decreases Likelihood of a Missed Physician's Appointment Among Dementia Caregivers

Adult Day Service Use Decreases Likelihood of a Missed Physician's Appointment Among Dementia Caregivers

The Effects of Negative Reinforcement on Increasing Patient Adherence to Appointments at King Abdullah University Hospital in Jordan

A Successful Walk-In Psychiatric Model for Integrated Care

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