MAINTAINING ENGAGEMENT WITH MEDICAL SPECIALISTS

Maintaining engagement with Medical Specialists

Maintaining engagement with Medical Specialists

Introduction

Failed appointments for care are an unfortunate reality in both hospital and general practice. They appear to occur in most countries and in all disciplines. The extent of the problem is documented in well over 200 articles identified in a literature search. Researchers sought to understand why people fail medical and appointments and efforts were directed to minimise failure with variable success, the most popular methods being either telephone or postal reminders, though simply changing the appearance of recall and appointment cards has resulted in a significant decrease in failed appointments (Patel et al., 2000).

Aims of the Study

The aim of the study is to find out that how many of those who miss an appointment later reattend and resume treatment, and how many drop out of care permanently. Early non-attendance increases the risk of further non-attendance but two prospective studies suggest that many patients who occasionally miss appointments subsequently reattend.

Literature Review

The financial cost of missed appointments in the National Health Service (NHS) has been estimated at £360 million per year (Stone et al, 1999), most of this accounted for by non-attendance in primary care and hospital out-patient clinics. The purpose of this article is to review the extent and predictors of non-attendance in people with mental disorders presenting in primary and secondary care. Although one approach may be to fundamentally question the merits of out-patient clinics (Killaspy, 2006), our approach is to examine essential predictors and solutions within current models of care. In considering the classification of missed appointments it is important to distinguish between those who do not attend their first appointment and those who do not attend follow-up appointments. Unfortunately, in reviewing the literature few studies uphold this distinction. It is also useful to separate individuals who occasionally miss appointments (partial nonattendance) and those who disengage from any follow-up (often called treatment drop-outs). To put non-attendance in context, patients may experience difficulty following medical advice at each stage of their patient journey.

The extent of non-attendance in psychiatry (and perhaps its impact on the patient) may be significantly greater than in other medical specialties. In 2002-2003, 19.1% of psychiatry out-patient appointments were missed in England, compared with an NHS-wide figure of 11.7% (Department of Health, 2003). Of note, the Commission for Healthcare Improvement (now the Healthcare Commission) showed that non-attendance rates varied more than fivefold across 83 mental health trusts in England (data collated from http://www.chi.nhs.uk/ ratings). These national figures have been replicated in numerous small studies based in psychiatry outpatient clinics, which have reported non-attendance rates of 15.6-28% when examined as a proportion of all offered appointments (Carpenter et al, 1981; Matas et al, 1992; Dobscha et al, 1999; Killaspy et al, 2000). Rates of initial non-attendance are usually higher than follow-up non-attendance, although this pattern may not hold for certain specialties (Mitchell & Selmes, 2007b). The frequency of partial non-attendance is higher than the rate of full discontinuation (drop-out), echoing the findings of studies ...