No-Shows in Outpatient Medical Institutions in Germany – A Pilot Study about Explanations of Patients Why they Missed their Appointment
Science Journal of Public Health
Volume 2, Issue 3, May 2014, Pages: 238-242
Received: May 10, 2014;
Accepted: May 20, 2014;
Published: May 30, 2014
Views 3215 Downloads 247
Wolfgang Frank, Practice for Neurology and Psychiatry, Luebecker Str. 20, D-23611 Bad Schwartau, Germany
Erich Kasten, Medical School Hamburg, University of Applied Science, Am Kaiserkai 1, D-20457 Hamburg, Germany
Patients, who miss an appointment in medical institutions (so called “no-shows”) cause a significant damage to the health care system. We asked 181 patients (65% female, 35% male; average age 43.7 y.) how often they missed appointments in the past 12 months. The questionnaire’s reliability was r = 0.76. We recorded 2,778 events. 3.13% of the appointment were missed and 0.43% came much too late. Most common reasons were forgetfulness and confusion of dates. Severity of pain and health-limitations correlated positive with punctuality. Among the no-shows were significantly more unemployed subjects than people with an occupation. There was no significant difference between pensioners and unemployed participants. Only 25% found memory aids such as letters, phone calls or short text messages helpful before the appointment. 60% of patients agreed to pay a fee of max. 1.- € for such a service. As charge for doctor’s loss of income due to the missed appointment a payment between 10.- € and 20.- € was judged to be appropriate. Two groups of "persons of risk" have been identified: 1. non-working people and 2. patients with poor memory. Both groups valued reminders for the appointment positively.
No-Shows in Outpatient Medical Institutions in Germany – A Pilot Study about Explanations of Patients Why they Missed their Appointment, Science Journal of Public Health.
Vol. 2, No. 3,
2014, pp. 238-242.
Barron WM. Failed appointments. Who misses them, why they are missed, and what can be done. Prim Care. 1980; 7: 563–574.
Belardi FG, Weir S, Craig FW. A controlled trial of an advanced access appointment system in a residency family medicine center. Fam Med. 2004; 36(5): 341–345. I. S. Jacobs and C. P. Bean, “Fine particles, thin films and exchange anisotropy,” in Mag-netism, vol. III, G. T. Rado and H. Suhl, Eds. New York: Academic, 1963, pp. 271–350.
Bigby J, Giblin J, Pappius EM, Goldman L. Appointment reminders to re-duce no-show rate. JAMA. 1983; 250(13): 1742–1745.
Bigby JA, Pappius E, Cook EF, Goldman L. Medical consequences of missed appoint-ments. Arch Intern Med. 1984; 144(6): 1163–1166.
Cashman SB, Savageau JA, Lemay CA, Ferguson W. Patient health status and appointment keeping in an urban community health center. J Health Care Poor Underserved. 2004; 15(3): 474–488.
Gatrad AR. A completed audit to re-duce hospital outpatients non-attendance rates. Arch Dis Childhood. 2000; 82: 59–61.
Goldman L, Freidin R, Cook F, Eigner J, Grich P. A multivariate ap-proach to the prediction of no-show behavior in a pri-mary care center. Arch Intern Med. 1982; 142(3): 563–567.
Hagerman GA. Testing the mailed appointment reminder in family practice. J Fam Pract. 1978; 7(1): 199–201.
Hashim MJ, Franks P, Fis-cella K. Effectiveness of telephone reminders in improv-ing rate of appointment kept at an outpatient clinic: A randomized controlled trial. J Am Board Fam Pract. 2001; 14(3): 193–196.
Hurtado AV, Greenlick MR, Colombo TJ. Determinants of medical care utilization: Failure to keep appointments. Med Care. 1973; 11(6): 189–198.
Izard T. Managing the habitual no-show patient. Fam Pract Manag. 2005; 12(2): 65–66.
Johnson, B.J., Mold, J.W.& Pontious, J.M. Reduction and Management of No-Shows by Family Medicine Residency Practice Exemplars. Annals of Family Medicine. 2007; 5: 534-539
Lacy, N.L., Paulman, A., Reuter, M.D. & Lovejoy, B. Why We Don’t Come: Patient Perceptions on No-Shows. Annals of Family Medicine. 2004; 2: 541-545.
Lehmann TN, Aebi A, Lehmann D, Balandraux Olivet M, Stalder H. Missed appointments at a Swiss university outpatient clinic. Public Health. 2007; 121(10): 790-799.
Macha-ria WM, Leon G, Roewe BH, Stephenson BJ, Haynes RB. An overview of interventions to improve compliance with appointment keeping for medical services. JAMA. 1992; 267:1813–1817.
Milne RG, Horne M, Torsney B. SMS reminders in the UK national health service: an evaluation of its impact on "no-shows" at hospital out-patient clinics. Health Care Manage Rev. 2006; 31(2): 130-136.
Moore CG, Wilson-Witherspoon P, Probst JC. Time and money: effects of no-shows at a family practice residency clinic. Fam Med. 2001; 33: 522–527.
Moser SE. Effectiveness of post card appointment reminders. Fam Pract Res J. 1994; 14: 281–288.
Neal RD, Hussain-Gambles M, Allgar VL, Lawlor DA, Dempsey O. Reasons for and conse-quences of missed appointments in general practice in the UK: Questionnaire survey and prospective review of medical records. BMC Fam Pract. 2005; 6: 47.
O’Brien G, Lazebnik R. Telephone call re-minders and attendance in an adolescent clinic. Pediatrics. 1998; 101: e6.
Okotie OT, Patel N, Gonzalez CM. The effect of patient arrival time on over-all wait time and utilization of physician and examination room resources in the outpatient urology clinic. Adv Urol. 2008: 507436.
Quattlebaum TG, Darden PM, Sperry JB. Effectiveness of computer-generated appointment reminders. Pediatrics. 1991; 88(4): 801–805.
Satiani B, Miller S, Patel D. No-show rates in the vascular laboratory: analysis and possible solutions. J Vasc Interv Radiol. 2009; 20(1): 87-91.
Smoller JW, McLean RY, Otto MW, Pol-lack MH. How do clinicians respond to patients who miss appointments? J Clin Psych. 1998; 59: 330–340.
Vardy DA, Freud T, Shvartzman P, Sherf M, Spilberg O, Goldfarb D, Mor-Yosef S. Introduc-ing co-payment for consultant specialist services. Isr Med Assoc J. 2006; 8(8): 558-562.