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CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2020; 12(01): e67-e73
DOI: 10.1055/s-0040-1712171
Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

No-Show Rates and Associated Patient Factors in an Ophthalmology Resident Practice

Tavish Nanda
1   Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
,
Aijin Wang
2   Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
,
Luis M. Ducasse
1   Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
,
Royce W.S. Chen
1   Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
,
Jason Horowitz
1   Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
› Author Affiliations Funding None.
Further Information

Publication History

22 October 2019

13 April 2020

Publication Date:
22 June 2020 (online)

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Abstract

Background In resident family medicine practices, a >20% no-show rate is common, often resulting in suboptimal care. Few studies have evaluated resident ophthalmology practices in a similar fashion. The objective of this study was to determine no-show rates and factors related to missed appointments in a resident-based ophthalmology clinic.

Methods We reviewed 19,237 de-identified appointments over one academic year. Appointments were divided into general clinic visits and subspecialty visits (these two clinics function separately at our institution). The number of days between an appointment being made for a patient and the scheduled visit was defined as “lead time.” Each appointment was labeled “show” or “no-show.” Pertinent factors available in the analysis included lead time to appointment, patients age, month, time of day, practitioner training level (postgraduate years 2 to 4, fellow), and proximity to holiday. Subspecialty clinics included oculoplastics clinic, strabismus clinic, neuro-ophthalmology clinic, uveitis clinic, cornea clinic, glaucoma clinic, and retina clinic. Generalized linear mixed effects models were fit on the no-show status with these factors.

Results The overall no-show rate for general clinic was 31.4%. Longer lead time to appointment, younger age, afternoon appointments, new patients, December appointments, and lower residency level were associated with higher odds of no-show (p ≤ 0.05). The overall no-show rate for subspecialty clinic was 21.8%. Longer lead time to appointment, younger age, and lower residency level were associated with higher odds of no-show (p ≤ 0.05). Patients were significantly less likely to show up for retina clinic, oculoplastics clinic, and glaucoma clinic.

Conclusion The overall no-show rate in our clinic was on the higher end of reported no-show values from other specialties. Patient status and the lead time to appointment play a significant role in patient compliance. The significance of other factors (patient age, subspecialty, time of day, appointment month, and resident level) have been found in previous studies but are not consistent factors across all clinical environments.

Keywords

quality improvement - no-show rates - follow-up - appointment - scheduling - social services - revenue

Note

This study was presented, in part, at The Association for Vision and Research Annual Meeting 2019.


 

  • References

  • 1 Sharp DJ, Hamilton W. Non-attendance at general practices and outpatient clinics. BMJ 2001; 323 (7321): 1081-1082
    CrossrefPubMedGoogle Scholar
  • 2 Ferguson S, Kokesh J. Remote Otolaryngology Services: A Cost Comparison Study. AK: The Alaska Federal Health Care Network; 2005
    Google Scholar
  • 3 Rust CT, Gallups NH, Clark WS, Jones DS, Wilcox WD. Patient appointment failures in pediatric resident continuity clinics. Arch Pediatr Adolesc Med 1995; 149 (06) 693-695
    CrossrefPubMedGoogle Scholar
  • 4 Johnson BJ, Mold JW, Pontious JM. Reduction and management of no-shows by family medicine residency practice exemplars. Ann Fam Med 2007; 5 (06) 534-539
    CrossrefPubMedGoogle Scholar
  • 5 Bennett KJ, Baxley EG. The effect of a carve-out advanced access scheduling system on no-show rates. Fam Med 2009; 41 (01) 51-56
    PubMedGoogle Scholar
  • 6 Dreiher J, Goldbart A, Hershkovich J, Vardy DA, Cohen AD. Factors associated with non-attendance at pediatric allergy clinics. Pediatr Allergy Immunol 2008; 19 (06) 559-563
    CrossrefPubMedGoogle Scholar
  • 7 Cohen AD, Dreiher J, Vardy DA, Weitzman D. Nonattendance in a dermatology clinic--a large sample analysis. J Eur Acad Dermatol Venereol 2008; 22 (10) 1178-1183
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 Kheirkhah P, Feng Q, Travis LM, Tavakoli-Tabasi S, Sharafkhaneh A. Prevalence, predictors and economic consequences of no-shows. BMC Health Serv Res 2016; 16 (01) 13
    PubMedGoogle Scholar
  • 10 Hixon AL, Chapman RW, Nuovo J. Failure to keep clinic appointments: implications for residency education and productivity. Fam Med 1999; 31 (09) 627-630
    PubMedGoogle Scholar
  • 11 Weingarten N, Meyer DL, Schneid JA. Failed appointments in residency practices: who misses them and what providers are most affected?. J Am Board Fam Pract 1997; 10 (06) 407-411
    PubMedGoogle Scholar
  • 12 McMullen MJ, Netland PA. Lead time for appointment and the no-show rate in an ophthalmology clinic. Clin Ophthalmol 2015; 9: 513-516
    PubMedGoogle Scholar
  • 13 Daggy J, Lawley M, Willis D. , et al. Using no-show modeling to improve clinic performance. Health Informatics J 2010; 16 (04) 246-259
    CrossrefPubMedGoogle Scholar
  • 14 Moore CG, Wilson-Witherspoon P, Probst JC. Time and money: effects of no-shows at a family practice residency clinic. Fam Med 2001; 33 (07) 522-527
    PubMedGoogle Scholar
  • 15 Dantas LF, Fleck JL, Cyrino Oliveira FL, Hamacher S. No-shows in appointment scheduling - a systematic literature review. Health Policy 2018; 122 (04) 412-421
    CrossrefPubMedGoogle Scholar
  • 16 Norris JB, Kumar C, Chand S, Moskowitz H, Shade SA, Willis DR. An empirical investigation into factors affecting patient cancellations and no-shows at outpatient clinics. Decis Support Syst 2014; 57: 428-443
    CrossrefPubMedGoogle Scholar
  • 17 Kosoko O, Quigley HA, Vitale S, Enger C, Kerrigan L, Tielsch JM. Risk factors for noncompliance with glaucoma follow-up visits in a residents' eye clinic. Ophthalmology 1998; 105 (11) 2105-2111
    CrossrefPubMedGoogle Scholar
  • 18 Lee BW, Sathyan P, John RK, Singh K, Robin AL. Predictors of and barriers associated with poor follow-up in patients with glaucoma in South India. Arch Ophthalmol 2008; 126 (10) 1448-1454
    CrossrefPubMedGoogle Scholar
  • 19 Murakami Y, Lee BW, Duncan M. , et al. Racial and ethnic disparities in adherence to glaucoma follow-up visits in a county hospital population. Arch Ophthalmol 2011; 129 (07) 872-878
    CrossrefPubMedGoogle Scholar
  • 20 Kaplan-Lewis E, Percac-Lima S. No-show to primary care appointments: why patients do not come. J Prim Care Community Health 2013; 4 (04) 251-255
    CrossrefPubMedGoogle Scholar
  • 21 Taplin SH, Barlow WE, Ludman E. , et al. Testing reminder and motivational telephone calls to increase screening mammography: a randomized study. J Natl Cancer Inst 2000; 92 (03) 233-242
    CrossrefPubMedGoogle Scholar
  • 22 King A, David D, Jones HS, O'Brien C. Factors affecting non-attendance in an ophthalmic outpatient department. J R Soc Med 1995; 88 (02) 88-90
    PubMedGoogle Scholar
  • 23 Smith CM, Yawn BP. Factors associated with appointment keeping in a family practice residency clinic. J Fam Pract 1994; 38 (01) 25-29
    PubMedGoogle Scholar
  • 24 Hagerman GA. Testing the mailed appointment reminder in family practice. J Fam Pract 1978; 7 (01) 199-201
    PubMedGoogle Scholar
  • 25 Garuda SR, Javalgi RG, Talluri VS. Tackling no-show behavior: a market-driven approach. Health Mark Q 1998; 15 (04) 25-44
    PubMedGoogle Scholar
  • 26 Miller AJ, Chae E, Peterson E, Ko AB. Predictors of repeated “no-showing” to clinic appointments. Am J Otolaryngol 2015; 36 (03) 411-414
    CrossrefPubMedGoogle Scholar
  • 27 Hamilton W, Round A, Sharp D. Patient, hospital, and general practitioner characteristics associated with non-attendance: a cohort study. Br J Gen Pract 2002; 52 (477) 317-319
    PubMedGoogle Scholar
  • 28 Bean AG, Talaga J. Predicting appointment breaking. J Health Care Mark 1995; 15 (01) 29-34
    PubMedGoogle Scholar
  • 29 Bickler CB. Defaulted appointments in general practice. J R Coll Gen Pract 1985; 35 (270) 19-22
    PubMedGoogle Scholar
  • 30 Oppenheim GL, Bergman JJ, English EC. Failed appointments: a review. J Fam Pract 1979; 8 (04) 789-796
    PubMedGoogle Scholar
  • 31 Bottomley WW, Cotterill JA. An audit of the factors involved in new patient non-attendance in a dermatology out-patient department. Clin Exp Dermatol 1994; 19 (05) 399-400
    CrossrefPubMedGoogle Scholar
  • 32 Thompson AC, Thompson MO, Young DL. , et al. Barriers to follow-up and strategies to improve adherence to appointments for care of chronic eye diseases. Invest Ophthalmol Vis Sci 2015; 56 (08) 4324-4331
    CrossrefPubMedGoogle Scholar
  • 33 Schwartz GF. Compliance and persistency in glaucoma follow-up treatment. Curr Opin Ophthalmol 2005; 16 (02) 114-121
    CrossrefPubMedGoogle Scholar
  • 34 Kholdebarin R, Campbell RJ, Jin YP, Buys YM. , Canadian Compliance Study Group. Multicenter study of compliance and drop administration in glaucoma. Can J Ophthalmol 2008; 43 (04) 454-461
    CrossrefPubMedGoogle Scholar
  • 35 Potamitis T, Chell PB, Jones HS, Murray PI. Non-attendance at ophthalmology outpatient clinics. J R Soc Med 1994; 87 (10) 591-593
    PubMedGoogle Scholar
  • 36 Cialdini RB. The science of persuasion. Sci Am 2001; 284 (02) 76-81
    PubMedGoogle Scholar
  • 37 Brannan SO, Dewar C, Taggerty L, Clark S. The effect of short messaging service text on non-attendance in a general ophthalmology clinic. Scott Med J 2011; 56 (03) 148-150
    CrossrefPubMedGoogle Scholar
  • 38 Taylor NF, Bottrell J, Lawler K, Benjamin D. Mobile telephone short message service reminders can reduce nonattendance in physical therapy outpatient clinics: a randomized controlled trial. Arch Phys Med Rehabil 2012; 93 (01) 21-26
    CrossrefPubMedGoogle Scholar
  • 39 Dockery F, Rajkumar C, Chapman C, Bulpitt C, Nicholl C. The effect of reminder calls in reducing non-attendance rates at care of the elderly clinics. Postgrad Med J 2001; 77 (903) 37-39
    CrossrefPubMedGoogle Scholar
  • 40 Parikh A, Gupta K, Wilson AC, Fields K, Cosgrove NM, Kostis JB. The effectiveness of outpatient appointment reminder systems in reducing no-show rates. Am J Med 2010; 123 (06) 542-548
    CrossrefPubMedGoogle Scholar
  • 41 Fairhurst K, Sheikh A. Texting appointment reminders to repeated non-attenders in primary care: randomised controlled study. Qual Saf Health Care 2008; 17 (05) 373-376
    CrossrefPubMedGoogle Scholar
  • 42 Hasvold PE, Wootton R. Use of telephone and SMS reminders to improve attendance at hospital appointments: a systematic review. J Telemed Telecare 2011; 17 (07) 358-364
    CrossrefPubMedGoogle Scholar
  • 43 Roberts N, Meade K, Partridge M. The effect of telephone reminders on attendance in respiratory outpatient clinics. J Health Serv Res Policy 2007; 12 (02) 69-72
    CrossrefPubMedGoogle Scholar
  • 44 Koshy E, Car J, Majeed A. Effectiveness of mobile-phone short message service (SMS) reminders for ophthalmology outpatient appointments: observational study. BMC Ophthalmol 2008; 8 (01) 9
    CrossrefPubMedGoogle Scholar
  • 45 Roth JP, Kula Jr TJ, Glaros A, Kula K. Effect of a computer-generated telephone reminder system on appointment attendance. In Seminars in orthodontics 2004 Sep 1 (Vol. 10, No. 3, pp. 190–193). WB Saunders. Available at: https://www.televox.com/downloads/Case_Study_Seminars_in_Orthodontics.pdf . Accessed April 24, 2020
    PubMedGoogle Scholar