Nonattendance in pediatric pulmonary clinics: an ambulatory survey

Abstract

BackgroundNonattendance for scheduled appointments disturbs the effective management of pediatric pulmonary clinics. We hypothesized that the reasons for non-attendance and the necessary solutions might be different in pediatric pulmonary medicine than in other pediatric fields. We therefore investigated the factors associated with nonattendance this field in order to devise a corrective strategy.MethodsThe effect of age, gender, ethnic origin, waiting time for an appointment and the timing of appointments during the day on nonattendance proportion were assessed. Chi-square tests were used to analyze statistically significant differences of categorical variables. Logistic regression models were used for multivariate analysis.ResultsA total of 1190 pediatric pulmonology clinic visits in a 21 month period were included in the study. The overall proportion of nonattendance was 30.6%. Nonattendance was 23.8% when there was a short waiting time for an appointment (1–7 days) and 36.3% when there was a long waiting time (8 days and above) (p-value < 0.001). Nonattendance was 28.7% between 8 a.m. to 3 p.m. and 37.5% after 3 p.m. (p = 0.007). Jewish rural patients had 15.4% nonattendance, Jewish urban patients had 31.2% nonattendance and Bedouin patients had 32.9% nonattendance (p < 0.004). Age and gender were not significantly associated with nonattendance proportions. A multivariate logistic regression model demonstrated that the waiting time for an appointment, time of the day, and the patients' origin was significantly associated with nonattendance.ConclusionThe factors associated with nonattendance in pediatric pulmonary clinics include the length of waiting time for an appointment, the hour of the appointment within the day and the origin of the patient.

Education Research: A new system for reducing patient nonattendance in residents' clinic

“…The rapid access system was developed based on investigations of outpatient clinics in neurology and other subspecialties; these have demonstrated a strong association between longer waiting times and nonattendance. [5][6][7][8][9][10] In one report of a neurology clinic, there was a 50% difference in nonattendance for waiting times Ͼ2 months (32%) vs Յ2 months (17%). 5 Smaller differences were found for Ն1 vs Ͻ1 week in otorhinolaryngology, pulmonary medicine, and obstetrics/gynecology studies (30%-37% nonattendance for Ͼ1 week vs 24%-27% for Յ1 week, p Ͻ 0.001 for all studies).…”

“…5 Smaller differences were found for Ն1 vs Ͻ1 week in otorhinolaryngology, pulmonary medicine, and obstetrics/gynecology studies (30%-37% nonattendance for Ͼ1 week vs 24%-27% for Յ1 week, p Ͻ 0.001 for all studies). [7][8][9] We chose a 3-week maximum waiting time for rapid access since it is a practical period for nonurgent scheduling in a medical subspecialty. [7][8][9] Introduction of the new system was not associated with any measurable changes in demographics or diagnoses.…”

“…[7][8][9] We chose a 3-week maximum waiting time for rapid access since it is a practical period for nonurgent scheduling in a medical subspecialty. [7][8][9] Introduction of the new system was not associated with any measurable changes in demographics or diagnoses. Furthermore, patients in both groups were equally likely to return for a follow-up visit.…”

“…5 While this relatively long waiting time was associated with greater than double the nonattendance rate, studies in other specialties have shown that waiting times of even 1-2 weeks can make a dramatic difference in nonattendance. [6][7][8][9][10] In our US-based academic neurology program, we developed a new scheduling system for residents' clinic that reduced average waiting times for appointments from 4 months to Յ3 weeks. The purpose of this study was to compare rates of nonattendance for clinics scheduled using the new model (termed "rapid access") vs those scheduled using the traditional system.…”

“…[5][6][7][8][9][10] Studies emphasize the strength of this association across a variety of cultures and health care systems. [5][6][7][8][9][10] In one study of neurology practices in Ireland, factors associated with nonattendance included male sex, age Ͻ50 years, urban home address, referral from emergency departments, and Ͼ2-month waiting time for the appointment. 5 While this relatively long waiting time was associated with greater than double the nonattendance rate, studies in other specialties have shown that waiting times of even 1-2 weeks can make a dramatic difference in nonattendance.…”