Endoscopy 2006; 38(4): 427
DOI: 10.1055/s-2006-925279
Letter to the Editor
© Georg Thieme Verlag KG Stuttgart · New York

Causes of Non-Attendance at an Open-Access Endoscopy Outpatient Clinic

V. Tzias1 , E. Xirouchakis1 , N. Margetis1 , D. Kamberoglou1
  • 1Department of Gastrointestinal Endoscopy, 1st IKA Hospital, Athens, Greece
Further Information

Publication History

Publication Date:
05 May 2006 (online)

We read with interest the article by Adams et al. concerning nonattendance at outpatient endoscopy clinics [1]. The results of a study we conducted in our own department may also be of interest in this connection. Due to the convenience of the service [2] [3], the majority of patients who require gastroenterological assessment in Greece are usually referred to an outpatient endoscopy department. In Greece, endoscopy services are offered by both the Greek national health-care system and by the Hellenic Social Security Institute (Idroma Koinonikon Asphaliseon, IKA). A considerable nonattendance rate, mainly involving upper gastrointestinal endoscopies, is observed in both systems. The result is that the number of endoscopies conducted in each department can vary by up to 60 % from day to day, since the nonattending patients usually do not cancel their appointments. This is frustrating for the staff and services concerned, especially since the main problem is that the demand for endoscopy appointments far exceeds the existing departments’ capacity. Long waiting lists are therefore quite usual, and there is considerable pressure for early appointments. The end result are further delays - plus, of course, increased financial costs, since the IKA is obliged to pay private health-care providers for endoscopic examinations.

The study was conducted in our hospital, which belongs to the IKA system, and covered a 6-month period from September 2004 to March 2005. Any patient referred by a doctor affiliated to the Social Security Institute was entitled to make an appointment at our outpatient endoscopy unit. Two days before the date of the appointment, we contacted all of the patients by phone in order to assess whether they would attend. Those who answered negatively were given a questionnaire, which examined the following parameters: age, sex, indication for endoscopy, referral source (gastroenterologist, physician, family practitioner, surgeon, other), reason for nonattendance, time between referral and appointment, and history of previous endoscopies.

The total number of outpatient upper gastrointestinal endoscopy procedures scheduled during the 6-month period was 810. A total of 351 patients (43 %) did not intend to show up for their appointments. In all, 292 patients (125 men, 167 women; mean age 56.5 years) answered the questionnaire, a response rate of 85.4 %. Friday was the most frequent day for nonattending (n = 82, 28 %) followed by Monday (n = 69, 23 %), Wednesday (n = 59, 20 %), Thursday (n = 49, 16 %), and Tuesday (n = 33, 11 %). The mean time between referral and appointment was 57.6 days. Ninety patients (31 %) had a history of previous endoscopy. A total of 184 patients (63 %) were referred by gastroenterologists, 76 (26 %) by physicians or family practitioners, 20 (7 %) by surgeons, and 12 (4 %) by other types of specialist. The indications for endoscopy were: epigastric pain (n = 120, 41 %), burning (n = 29, 10 %), epigastric pain and burning (n = 50, 17 %), reflux symptoms (n = 26, 9 %), vomiting (n = 26, 9 %), anemia (n = 15, 5 %), and other causes (n = 26, 9 %). The major reason for not attending, stated by 181 patients (62 %), was the long time between the referral and the date of the appointment, with 38 (13 %) mentioning fear for the procedure.

The rate of nonattendance in this series was much higher in comparison with the study conducted in Australia [1], which reported only a 12.2 % rate of nonattendance. Another study in Ireland [4] reported a 14 % nonattendance rate.

The waiting time was the most important reason for nonattendance in our study. Nonattendees in the Australian study [1] had a longer waiting time between referral and the procedure (83.5 ± 62.2 days) - much higher than in our study, in which the mean waiting time was 57.6 days. Another further finding in our study was that patients referred by gastroenterologists were the ones most likely not to attend. A possible explanation for this might be that due to the long waiting lists, the patients might have returned to their physicians, who in turn might have offered a private-sector solution. Although Friday was the most frequent day of nonattendance, the difference between Friday and the other days was not statistically significant.

Confirming the appointment by phoning the patient appears to be a good way of reducing the nonattendance rate at present [5]. This approach had considerable success in Ireland (where the nonattendance rate fell to 5.7 %) [4], and moderate success in Australia (where the nonattendance rate fell to 9 %) [1]. Better validation of the patients’ symptoms and establishment of the indications for endoscopy, as well as closer collaboration with the referring physicians, might further improve the situation.

Competing interests: None

References

  • 1 Adams L A, Pawlik J, Forbes G M. Nonattendance at outpatient endoscopy.  Endoscopy. 2004;  36 402-404
  • 2 Charles R J, Cooper G S, Wong R C. et al . Effectiveness of open-access endoscopy in routine primary-care practice.  Gastrointest Endosc. 2003;  57 183-186
  • 3 Kerrigan D D, Brown S R, Hutchinson G H. Open access gastroscopy: too much to swallow?.  BMJ. 1990;  300 374-376
  • 4 Murdock A, Rodgers C, Lindsay H. et al . Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic.  J R Soc Med. 2002;  95 284-286
  • 5 Lee C S, McCormick P A. Telephone reminders to reduce non-attendance rate for endoscopy.  J R Soc Med. 2003;  96 547-548

E. Xirouchakis, M. D.

Dept. of Gastrointestinal Endoscopy, 1st IKA Hospital

Zaimi Street, 15127 Melissia, Athens, Greece

Fax: +30-2106138459

Email: elmoxir@yahoo.gr

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