Issues regarding nonattendance at a paediatric dermatology centre

Hon, Kam Lun; Leung, Ting‐Fan; C., K.

doi:10.1046/j.1365-2230.2002.01163.x

Cited by 24 publications

(27 citation statements)

References 9 publications

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“…Non-attendance was associated with the waiting time for an appointment, as was observed in previous studies (12). Non-attendance varied between 13.0% and 30.8% according to the treating dermatologist.…”

Section: Discussionsupporting

confidence: 76%

Non-attendance in Adult Dermatological Patients

Cohen¹,

Vardy²

2006

Acta Derm Venereol

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Sir, Non-attendance (failure to attend clinic appointments) is a common prohlem in dermatology clinics. Non-attendance proportions range from 15% to 25% and lead to inefficient use of space and personnel and increased costs (1-7).To improve the management of dermatological clinics, factors that determine non-attendance should he identified and addressed. In the past, only a few studies were performed on non-attendance in general dermatology clinics. The factors that determine non-attendance in adult dermatology clinics include the payer type, inadequate communication hetween the hospital and patients, patients forgetting their appointment date or illness, and prohlems related to appointments (8-11). In paediatric dermatological patients, non-attendance was associated with male gender and referrals from emergency department as opposed to referrals from private physicians (12).In this study we investigated factors that determine non-attendance in adults visiting an ambulatory dermatology clinic. and 3071 male (40.5%) patients. The mean age was 45.9 years (range 18-100 years).The overall proportion of non-attendance at the dermatology clinic was 26.1%. Non-attendance was 27.2% in female and 24.5% in male patients (p = 0.009). Non-attendance was 30.1% in patients helow 50 years, 21.4% in patients in the age range 50-70 years, 18.0% in patients in the age range 70-90 years and 31.7 in patients ahove 90 years (p <0.001). Non-attendance was 23.8% when there was a short waiting time for an appointment (1-7 days), 30.6% when there was an intermediate waiting time (8-14 days) and 34.0% when there was a long waiting time (15 days and ahove) (p <0.001). Nonattendance proportion varied hetween 13.0% and 30.8% depending on the treating dermatologist (p <0.001).A multivariate logistic regression model demonstrated that the age and gender of the patients, waiting time for an appointment, and the treating dermatologist were factors that were significantly associated with non-attendance. MATERIALS AND METHODSThe study was conducted in the southern district of Clalit Health Services. Clalit Health Services is the largest organization of managed care in Israel. In the southern district of Israel, Clalit Health Services serves a population of 470,000 enrollees. The dermatology service in this district includes 17 active dermatologists, working in 23 clinics, accounting for approximately 110,000 patient-physician encounters annually. The central ambulatory clinic resides in the district town Beer-Sheva.Visits to district central ambulatory clinic were obtained from a computer-generated listing of scheduled appointments from January 1 to December 31, 2003. The list contained the patient's age, gender, visit date and time, waiting time for an appointment and the treating dermatologist for all new appointments in the clinic. In this clinic, patients were not required to pre-authorize the appointment and did not receive a reminder ofthe scheduled appointment. Statistical analysisResults of continuous variables are shown as means. Results ...

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Section: Discussionsupporting

confidence: 76%

Non-attendance in Adult Dermatological Patients

Cohen¹,

Vardy²

2006

Acta Derm Venereol

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“…Other studies found NA rates in dermatology clinics ranging from 7.8 to 43.5% with rates from 17 to 27.6 being typical for clinics with a broad service provided to the general population. [4][5][6][7][8][9] Reasons for NA were prolonged waiting list, young age, gender and system errors. There is of course a major variation from one locality to another.…”

Section: Discussionmentioning

confidence: 99%

Non‐attendance rate in a Danish University Clinic of Dermatology

Carlsen

Serup

2011

Acad Dermatol Venereol

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“…In contrast, a study of attendance at a specialist alcohol treatment centre in the UK 89 undertook multivariate analysis of patient characteristics of non-repliers (n = 100), non-attenders (n = 100) and attenders (n = 100) and found no statistically significant association between source of referral and attendance. A study in a paediatric dermatology clinic in Hong Kong 122 found that non-attendance was significantly higher among referrals from the emergency department than among referrals by private practitioners (p = 0.05).…”

Section: Patterns and Influences On Health-care Attendance Behaviourmentioning

confidence: 99%

“…Moore et al 126 investigated over 4000 appointments at a family practice centre in the USA and found that females tended to be less likely to miss appointments than males, although the effect was of borderline statistical significance in a multivariate analysis (OR 0.8, 95% CI 0.7 to 1.0; p = 0.06). Hon et al 122 report on a study of non-attendance at a paediatric dermatology clinic in Hong Kong and found that 67% of non-attenders were male and that males were more than twice as likely as females to fail to attend clinic (p = 0.010).…”

Section: Gendermentioning

confidence: 99%

“…For example, Hon et al 122 were unable identify the exact reasons for higher non-attendance among male patients in their paediatric dermatology clinic in Hong Kong, but speculated that female referrals may involve more serious dermatological conditions. However, as noted above (see Sex), it is also recognised that differential patterns of referral for male and female patients, as well as differential responses by patients (and their carers/parents in the case of children), could also contribute to the patterns of attendance observed.…”

Section: Patterns and Influences On Health-care Attendance Behaviourmentioning

confidence: 99%

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Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis

McLean

Gee

Booth

et al. 2014

Health Services and Delivery Research

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BackgroundMissed appointments are an avoidable cost and a resource inefficiency that impact on the health of the patient and treatment outcomes. Health-care services are increasingly utilising reminder systems to counter these negative effects.ObjectivesThis project explores the differential effect of reminder systems for different segments of the population for improving attendance, cancellation and rescheduling of appointments.DesignThree inter-related reviews of quantitative and qualitative evidence relating to theoretical explanations for appointment behaviour (review 1), the effectiveness of different approaches to reminding patients to attend health service appointments (review 2) and factors likely to influence non-attendance (review 3).Data sourcesDatabase searches were conducted on Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, The Cochrane Library, EMBASE (via NHS Evidence from 1 January 2000 to January/February 2012), Health Management Information Consortium database, Institute of Electrical and Electronics EngineersXplore, The King’s Fund Library Catalogue, Maternity and Infant Care, MEDLINE, Physiotherapy Evidence Database, PsycINFO, SPORTDiscus and Web of Science from 1 January 2000 to January/February 2012. Supplementary screening of references of included studies was conducted to identify additional potentially relevant studies. Conceptual papers were identified for review 1, randomised controlled trials (RCTs) and systematic reviews for review 2 and a range of quantitative and qualitative research designs for review 3.MethodsWe conducted three inter-related reviews of quantitative and qualitative evidence, involving a review of conceptual frameworks of reminder systems and adherence behaviours, a review of the reminder effectiveness literature and a review informed by realist principles to explain the contexts and mechanisms that explain reminder effectiveness. A preliminary conceptual framework was developed to show how reminder systems work, for whom they work and in which circumstances. Six themes emerged that potentially influence the effectiveness of the reminder or whether or not patients would attend their appointment, namely the reminder–patient interaction, reminder accessibility, health-care settings, wider social issues, cancellation and rebookings, and distal/proxy attributes. Standardised review methods were used to investigate the effectiveness of reminders to promote attendance, cancellation or rebooking across all outpatient settings. Finally, a review informed by realist principles was undertaken, using the conceptual framework to explain the context and mechanisms that influence how reminders support attendance, cancellation and rebooking.ResultsA total of 466 papers relating to 463 studies were identified for reviews 2 and 3. Findings from 31 RCTs and 11 separate systematic reviews (review 2 only) revealed that reminder systems are consistently effective at reducing non-attendance at appointments, regardless of health-care setting or patient subgroups. Simple reminders that provide details of timing and location of appointments are effective for increasing attendance at appointments. Reminders that provide additional information over and above the date, time and location of the appointment (‘reminder plus’) may be more effective than simple reminders at reducing non-attendance and may be particularly useful for first appointments and screening appointments; simple reminders may be appropriate thereafter for most patients the majority of the time. There was strong evidence that the timing of reminders, between 1 and 7 days prior to the appointment, has no effect on attendance; substantial numbers of patients do not receive their reminder; reminders promote cancellation of appointments; inadequate structural factors prevent patients from cancelling appointments; and few studies investigated factors that influence the effectiveness of reminder systems for population subgroups.LimitationsGenerally speaking, the systematic review method seeks to provide a precise answer to a tightly focused question, for which there is a high degree of homogeneity within the studies. A wide range of population types, intervention, comparison and outcomes is included within the RCTs we identified. However, use of this wider approach offers greater analytical capability in terms of understanding contextual and mechanistic factors that would not have been evident in a more narrowly focused review and increases confidence that the findings will have relevance in a wide range of service settings.ConclusionsSimple reminders or ‘reminder plus’ should be sent to all patients in the absence of any clear contraindication. Other reminder alternatives may be relevant for key groups of patients: those from a deprived background, ethnic minorities, substance abusers and those with comorbidities and/or illnesses. We are developing a practice guideline that may help managers to further tailor their reminder systems for their service and client groups. We recommend future research activities in three main areas. First, more studies should routinely consider the potential for differential effects of reminder systems between patient groups in order to identify any inequalities and remedies. Second, ‘reminder plus’ systems appear promising, but there is a need for further research to understand how they influence attendance behaviour. Third, further research is required to identify strategies to ‘optimise’ reminder systems and compare performance with current approaches.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Issues regarding nonattendance at a paediatric dermatology centre

Cited by 24 publications

References 9 publications

Non-attendance in Adult Dermatological Patients

Non-attendance in Adult Dermatological Patients

Non‐attendance rate in a Danish University Clinic of Dermatology

Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis

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