Why Don’t Neurosurgery Patients Return for Neuropsychological Follow-Up? Predictors for Voluntary Appointment Keeping and Reasons for Cancellation

Neuropsychological follow-up appointments are important for patients who have had intracranial surgery because cognitive deficits are common in this population and prognosis is not always optimistic. Unfortunately some patients cancel or do not show up. The current study attempted to identify predictors of non-attendance in this population. A total of 428 patients recruited over 2 years with a scheduled neuropsychological follow-up appointment after intracranial surgery in the St. Elisabeth Hospital, Tilburg, The Netherlands were included. Demographic, clinical, and other miscellaneous variables were extracted from medical records. Of this total population, 42% were non-attenders. The predictors of non-attendance were as follows: patients who had subdural hematomas and/or malignant tumors (compared to those who had other diagnoses prior to intracranial surgery); those who had been transferred to another hospital (compared to those sent home); those who had been referred for further medical treatment before the appointment; a shorter time interval between discharge and follow-up appointment; and finally, if the patient’s home was further away from the hospital. Patients who undergo intracranial surgery are a very heterogeneous group with different needs. Neuropsychological follow-up after surgery may be important for some patients (the better-functioning and/or those with cognitive complaints) but perhaps not for others (those with more severe prognoses and/or no complaints). We provide suggestions which should increase attendance in those who could benefit from follow-up neuropsychological assessment.     

口腔门急诊患者退号原因的调查分析

目的了解退号人群的特点,分析退号原因,提出改进措施,降低门急诊患者退号率,提高患者就诊服务质量。方法通过立意抽样的方法,采用自行设计的问卷,对2010年4月-6月门诊退号量及具体原因进行调查分析。结果 2010年4-6月门急诊平均退号率为5.72%,原因主要包括患者挂号后因自身原因未能按时就诊、患者因主观意愿而挂错号、更改复诊时间、患者忘记自己的报销方式或忘记带报销证件、候诊时间过长。结论加强各科室疾病宣传力度,建立健全挂号及退号制度,同时提高挂号员口腔医学专业知识水平及岗位技能,减少工作失误,是降低退号率的有效对策。     

Who defaults from colposcopy? A multi-centre,population-based,prospective cohort study of predictors of non-attendance for follow-up among women with low-grade abnormal cervical cytology

Objective

The success of cervical screening relies on women with abnormal cervical cytology attending for follow-up by colposcopy and related procedures. Failure to attend for colposcopy, however, is a common problem in many countries. The objective of this study was to identify factors associated with non-attendance at an initial colposcopy examination among women with low-grade abnormal cervical cytology.

Study design

A cohort study was conducted within one arm of a multi-centre population-based randomised controlled trial nested within the UK NHS Cervical Screening Programmes. The trial recruited women aged 20–59 years with recent low-grade cervical cytology; women randomised to immediate referral for colposcopy were included in the current analysis (n = 2213). At trial recruitment, women completed a socio-demographic and lifestyle questionnaire; 1693 women in the colposcopy arm were also invited to complete a psychosocial questionnaire, including the Hospital Anxiety and Depression Scale. Women were sent up to two colposcopy appointments. A telephone number was provided to reschedule if necessary. Defaulters were defined as those who failed to attend after two appointments. Logistic regression methods were used to compute multivariate odds ratios (OR) to identify variables significantly associated with default.

Results

148 women defaulted (6.7%, 95%CI 5.7–7.8%). In multivariate analysis, risk of default was significantly raised in those not in paid employment (OR = 2.70, 95%CI 1.64–4.43) and current smokers (OR = 1.62, 95%CI 1.12–2.34). Default risk deceased with increasing age and level of post-school education/training and was lower in women with children (OR = 0.59, 95%CI 0.35–0.98). Among the sub-group invited to complete psychosocial questionnaires, women who were not worried about having cervical cancer were significantly more likely to default (multivariate OR = 1.56, 95%CI 1.04–2.35). Anxiety and depression were not significantly associated with default.

Conclusions

Women at highest risk of default from colposcopy are younger, not in paid employment, smoke, lack post-school education, have not had children and are not worried about having cervical cancer. Findings such as these could inform the development of tools to predict the likelihood that an individual woman will default from follow-up. Interventions to minimise default also deserve consideration, but a better understanding of reasons for default is needed to inform intervention development.     

Increasing the Attendance Rate for First Appointments at Child and Family Psychiatry Clinics: An Opt-in System

Non-attendance for first outpatient appointments at Child Mental Health Clinics is a common problem affecting efficient use of resources, as well as staff morale. This study demonstrates that requiring families to confirm that they want an appointment, in order to receive one, significantly improves the attendance rate for first appointments, compared to two other commonly used procedures: a reminder letter before the appointment is sent, and a standard appointment letter. Furthermore, this procedure did not appear to reduce accessibility to the service.     

The impact of common variables on non-attendance at a radiology centre in Singapore

IntroductionWith the increasing demand for medical imaging, non-attendance inhibits private and public radiology practices in Singapore from providing timely care and achieving maximal efficiency. Missed radiological appointments adversely affect clinical and economic outcomes and strain the finite healthcare resources. We examined the prevalence and predictors of patient non-attendance for radiological services at a regional public hospital in Singapore and compared them against other medical imaging centres globally.MethodsOutpatient records of patients who were scheduled for specialised medical imaging obtained from Radiological Information System (RIS) were retrospectively reviewed. Analysed variables include patient demographics, radiology modalities, visit statuses and appointment lead times where Pearson's chi-square test and Fisher's exact test were used for categorical variables, and independent sample t-test was used for continuous variables. The association between each patient characteristic and non-attendance status was assessed using Binary Logistics Regression. Variables that showed statistical significance in univariate analysis were included in the multivariate logistic regression model to identify the independent risk factors associated with non-attendance.ResultsAmong the 59,748 outpatient appointments with medical imaging requests, 15.5% did not turn up for their appointments. Logistic regression indicated that patient's age, ethnicity, subsidy status, house ownership, living vicinity to regional hospital cluster, appointment wait times, appointment hours and appointment months were significant factors associated with the failure to attend scheduled radiological examinations.ConclusionEven though predictors of non-attendance remained consistent across medical imaging centres worldwide, Singapore reported a higher prevalence of missed appointments calling for future exploratory studies to understand the population's health-seeking behaviours and ordering patterns of clinicians.Implications for practiceComparison and identification of these predictors will assist in the design of targeted interventions that may improve patient's adherence and utilisation of imaging services.     

Monitoring of activities in Danish office-based psychiatry

On January 1, 1996, 16 psychiatric specialists in Danish office-based psychiatry initiated a monitoring programme in which they register the activities in their private psychiatric practices. The variables include, e.g. date of referral, date of first contact, date of discharge, dates of contacts during treatment period, sex and age of patient, geographical code, type of treatment, and diagnoses. Data are, on a regular basis, transferred to the epidemiological research institution, Department of Psychiatric Demography in Aarhus, Denmark. Following the audit principles, once a year each participant receives his own statistics compared with the whole group's statistics for quality assurance purposes. Besides this the monitoring database is used for different epidemiological research projects and, as the project runs, more epidemiological studies will be possible. On 31 December 1998, 22 psychiatrists participated. The group is interested in contact with both Danish and international psychiatrists working in office-based psychiatry. For this please contact: Jens Thimmer, Østergade 28, 6950 Ringkøbing, Denmark.     

Potential impact of text message reminders on non-attendance at outpatient clinics

Background  Non-attendance at outpatient clinic leads to significant time wasting and inefficient use of resources. Aims  To establish the magnitude of the problem of clinic non-attendance and to ascertain the potential impact of a simple strategy to reduce inefficiency in Irish healthcare. Methods  The number of patients due to attend general surgical clinic in a single year was ascertained. Telephone questionnaire of 97 patients who failed to attend was performed. A survey of potential impact of text message reminder was conducted. Results  Appointments were sent to 18,362 patients. Of these, 31% (n = 5692) were new to clinic. The rate of non-attendance was 16.8% (n = 3085). Varied reasons were given for non-attendance. Text message reminder would encourage 51% of those surveyed to attend or cancel in advance. Conclusion  The rate of non-attendance is 17%. A reminder would eradicate more than half of non-attendance, allowing significantly more new patients to be seen, translating to more efficient use of clinic time.     

Population screening for low bone mineral density: Do non-attenders have a lower risk of osteoporosis?

Poor compliance may be detrimental to the effectiveness of a screening programme if those at greatest risk of the disease do not attend. Therefore we undertook a study to test whether non-attenders to a screening programme for low bone density, a risk factor for osteoporosis, were at a differential risk of low bone density compared with attenders. Seven hundred and eighty-nine women aged 45–49 years living within 32 km of Aberdeen were selected at random from the Community Health Index and invited to attend for screening for low bone density as a risk of factor for osteoporosis. Attenders and non-attenders were surveyed regarding their risk factors for osteoporosis. Non-attenders were significantly heavier than attenders. In addition, 6 non-attenders who subsequently chose to attend had significantly higher body weight and bone mineral density, at Ward's triangle, than initial attenders. Non-attenders to a screening service for bone density may be at lower risk of developing osteoporosis. Non-attendance, therefore, would not be detrimental to the cost-effectiveness of a screening service for bone density. However, this study indicates there is a potential for response bias in studies of bone density and osteoporosis.