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Why patients miss appointments

Non‐attendance for appointments increases the cost of delivering care, reduces available appointments and increases waiting times for other patients.  

It also has consequences for the person who has missed their appointment.  According to the authors of this paper on non-attendance by diabetes patients, "People with diabetes who do not attend clinic appointments tend to have poorer glycaemic control, more complications, more frequent hospital admissions and increased all‐cause mortality".

So why do patients miss appointments?  

The study involved people with diabetes who had previously failed to attend clinic appointments.  It found three main causes of missed appointments:
  • Practical barriers.  These can include work and family commitments, and difficulties in travelling to appointments, particularly via public transport.  Participants suggested that a wider range of appointment times and having fewer, longer appointments that addressed various aspects of their care would make it easier for them to attend. 
  • Value of appointments.  Participants mentioned aspects of appointments that put them off attending.  Some were fearful of hearing bad news.  Others felt reprimanded if they had not maintained "self-management" regimes.  Others felt that they were not listened to.
  • Perceived impact of diabetes.  The majority of participants felt that their diabetes had very little effect on their day to day lives.  Some showed very little understanding of their condition, and one could not say which type of diabetes she had.  
The authors suggest that their findings highlight the importance of psychological variables in predicting non‐attendance at diabetes appointments.  They state that "whilst interventions to improve attendance should address practical barriers…there may also be a need to take account of the underlying perceptions about diabetes, the emotional impact and perceived lack of value in attending appointments".

At a time when NHS strategies are focused more and more on "self-management" of long term conditions, these findings could have implications across a range of conditions and services.

You can download the report via our website.
Appointments evidence on tap

There is plenty of evidence on patient experience of appointments - in terms of trying to get an appointment, as well as missing one.  

This study asked people about appointments with GPs, against a national background suggesting that waiting times for GP appointments is a growing issue.  

This paper also looked at GP appointments, asking patients what they thought of a "telephone first" system.  Views ranged from enthusiasm to hostility.
This report looks at why people miss hospital appointments.  It calls for high quality administrative processes, including ensuring letters arrive on time, ensuring appointments are not routinely changed, and ensuring patient details are correct.
This just in…
New evidence on all aspects of patient experience and involvement is being published all the time.  Check out our top picks from recent reports:

Policy briefing, social care funding and mental health.
Achieving integrated care, 15 best practice actions.
Evaluating the return on patient engagement initiatives in medicines research and development, A literature review.
Free resources

Not a subscriber to the Patient Experience Library?  Don't worry - you can still get lots of free stuff from our website!  

Our quarterly Patient Experience magazine carries insightful comment from a range of contributors, as well as our top picks of recent reports on patient experience and patient/public involvement. 

Patient Experience in England is our annual overview of the evidence base, drawing on surveys and research from government bodies, health charities and academic institutions.  The evidence is broken down into manageable chunks, and research findings are grouped under key themes for ease of understanding. 

You can browse our Knowledge Maps to see how patient experience is being reported in your area.  

And if you want to wear your patient experience heart on your sleeve, you can download and print our posters and stick them on your wall.  Better still, post them to the Chief Executive of your local NHS Trust!
Do you know of a stand-out report on patient experience that people in CCG's, PALS teams and local Healthwatch should be reading?  If you do, and you'd like to see it featured in this newsletter, let us know! 
The Patient Experience Library offers unparalleled access to patient insight and experience with over 50,000 documents, including...
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  • Quality Accounts from health service providers
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