Into the Storm: a Mixed Methods Evaluation of Reasons for Non-attendance of Appointments in the Free Clinic Setting
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MEDICINE
Into the Storm: a Mixed Methods Evaluation of Reasons for Non-attendance of Appointments in the Free Clinic Setting Lydia K. Bedford 1 & Collin Weintraub 1 & Alan W. Dow 2 Accepted: 11 October 2020 # Springer Nature Switzerland AG 2020
Abstract Non-attendance of healthcare appointments impact individual health outcomes and the capacity and financial stability of clinics. While non-attendance of appointments has been associated with a variety of factors, interventions to increase attendance have had mixed success. The most widely used intervention, reminder systems like phone calls or text messages, generally improves attendance rates but is insufficient for many clinics as a sole intervention. This study of underresourced patients who did not attend appointments at two clinics for uninsured individuals describes the multifactorial, individualized, and interacting reasons for non-attendance among these methods: Forty-three patients were interviewed by phone within 3 weeks of missing a clinic appointment using a scripted interview based on the literature. Responses were coded and analyzed. For 57% of respondents, a competing priority such as work or caregiving was a reason for missing an appointment. Forgetting about the appointment was a barrier for 38% of participants despite reminder systems being in place. Contributions to non-attendance were identified through thematic analysis: emotional and physical exhaustion, prioritization of work over healthcare, unreliable transportation, financial stress, and being unaware of an appointment. These findings demonstrate the need to test multiple patient-centered interventions, particularly in the context of underresourced communities. Keywords Appointments and schedules . Health services accessibility . Medically uninsured . Vulnerable populations . Continuity of patient care . Primary care . Ambulatory care facilities . Reminder systems . Patient navigation
Introduction Non-attendance of scheduled medical appointments is a concern for medical providers and policy-makers (Fig. 1). Nonattendance is an indicator of a failure of access to healthcare as described by the conceptual framework of Aday and
This article is part of the Topical Collection on Medicine * Alan W. Dow [email protected] Lydia K. Bedford [email protected] Collin Weintraub [email protected] 1
School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
2
School of Medicine, Virginia Commonwealth University, Box 980071, 1301 E. Marshall, VA 23298-00071 Richmond, USA
Andersen [1]. Non-attendance has been associated with worse control of patients’ chronic disease, presumably through reductions in the continuity of care [2, 3]. It also can negatively impact the clinic’s population as a whole by reducing the availability of appointments to other patients who could have been scheduled during that time. Non-attendance also can have financial implications for clinics depending on the clinic’s care delivery model and payment sources [4]. Because a myriad of clinic, patient, a
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