Non-attendance at psychological therapy appointments

Abstract

Purpose Research demonstrates that non-attendance at healthcare appointments is a waste of scarce resources; leading to reduced productivity, increased costs, disadvantaged patients through increased waiting times and demoralised staff. The purpose of this paper is to investigate non-attendance and implemented interventions to improve practice. Design/methodology/approach A mixed methods service audit took place in a primary care psychological therapies service. Existing service guidelines and reporting systems were reviewed. A cross-sectional design was used to compare a year’s cohort of completers of cognitive behavioural therapy (CBT) (n=140) and drop-outs (n=61). Findings Findings suggested contrasting guidelines and clinically inaccurate reporting systems. The overall service did not attend (DNA) rate was 8.9 per cent; well below rates suggested in the literature. The drop-out rate from CBT was 17 per cent. The most influential factor associated with CBT drop-out was the level of depression. The level of anxiety, risk ratings and deprivation scores were also different between completers and drop-outs. The main reasons given for non-attendance were forgetting, being too unwell to attend, having other priorities, or dissatisfaction with the service; again these findings were consistent with prior research. Originality/value A range of recommendations for practice are made, many of which were implemented with an associated reduction in the DNA rate.

Predicting first attendance at psychiatry appointments in patients with dissociative seizures

“…Our overall level of non-attendance at a psychiatry appointment (18.6 %) was at a level that is similar to other studies of referral to mental health services [17], a study in the US of attendance of 123 patients with dissociative seizures referred in the US (20 %) [26] and a previous study of patients with functional neurological disorders referred by neurologists to psychiatrists [19], but higher than levels of non-attendance to general medical services (which tend to run at 5-10 %). This data was obtained in the course of recruiting patients to an RCT reducing the generalisability to general neurological practice.…”

“…Reasons often given by patients for non-attendance include forgetting, apathy, illness, work commitments and clerical errors [17]. Psychiatric appointments have a higher rate of missed appointments than general medical ones (20 % vs 10 % in one study [17]). Specific reasons related to psychiatric settings include being unhappy with the referral in the first place (5/29 psychiatric new patients in one study [18]), stigma and fear of what might happen during the appointment.…”

“…Studies of non-attendance after referral to secondary specialist medical care from primary care suggest that young age (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), males, low socio-economic status, longer delay to appointment, transport and rapport are factors associated with missed appointments [15,16]. Reasons often given by patients for non-attendance include forgetting, apathy, illness, work commitments and clerical errors [17]. Psychiatric appointments have a higher rate of missed appointments than general medical ones (20 % vs 10 % in one study [17]).…”

Therapy discontinuation in a primary care psychological service: why patients drop out

“…Previous studies showed that patients who attended a greater number of treatment sessions showed a better clinical recovery (Gyani et al, 2011). However, there are a high proportion of individuals failing to complete the full course of their offered treatment (Chan and Adams, 2014) and focusing on the drop-out rate of treatment is considered to be an important area of research (Binnie and Boden, 2016). Yet little is known about the experiences of patients who discontinue their therapy, if they feel better or worse and what may contribute to their recovery.…”

“…Previous research suggests that different components could predict the drop-out rates from treatment including a low standard of education (Keijsers et al, 2001), higher levels of social deprivation (Grant et al, 2012;Self et al, 2005), psychological distress (Saxon et al, 2017), avoidance (Lincoln et al, 2005), high depression (Jarrett et al, 2013), low motivation (Keijsers et al, 2001), higher level of risk to self (Binnie and Boden, 2016), type of therapy format patients received (Karekla et al, 2019) and personal circumstances such as work commitments and physical illness. Rachael et al (2010) reported that drop-out rate for psychoeducation courses was more significantly associated with personal circumstances (75%) than dissatisfaction with the course (25%).…”