青少年门诊的失约情况：8年会诊的描述性分析
Missed appointments in an adolescent outpatient clinic: descriptive analyses of consultations over 8 years.
作者信息
Chariatte Vincent, Michaud Pierre-André, Berchtold André, Akré Christina, Suris Joan-Carles
机构信息
Research Group on Adolescent Health, Institute of Social and Preventive Medicine, University Hospital Center of Vaud and University of Lausanne, Bugnon 17, CH-1005 Lausanne, Switzerland.
出版信息
Swiss Med Wkly. 2007 Dec 1;137(47-48):677-81. doi: 10.4414/smw.2007.12050.
QUESTION UNDER STUDY
Missed appointments represent an important medical and economical issue. Few studies on the subject are reported in the literature, particularly regarding adolescents. Our aim was to characterize missed and cancelled appointments in a multidisciplinary outpatient clinic for adolescents, to assess the effectiveness of a policy aimed at reducing missed appointments by introducing payment for those missed appointments not cancelled in advance, and to compare the rates between staff and resident physicians.
METHODS
A total of 32,816 consultations (representing 35 patients aged 12-20 years, 82.4% females) between 1999 and 200 were analysed.
RESULTS
The missed appointment rate was 11.8% whilst another 10.9% were cancellations. Females cancelled more than males (11.3% vs. 8.4%, AOR 1.31, 99% CI 1.08-1.59), but there was no difference for missed appointments (11.6% vs. 12.3%, AOR 0.88, 99% CI 0.61-1.08). April and June to October (vacation months) were associated with more missed appointments. Globally mornings had higher rates of missed appointments than afternoons (13.6% vs. 11.2%, AOR 1.25, 99% CI 1.11-1.40). There was a slight difference in missed appointment rates between staff physicians and residents (10.4%; 11.8%, AOR 1.20, 99% CI 1.08-1.33). Missed appointment rates before and after the new policy on missed appointments were similar (1999-2003: 11.9%; 2004-2006: 11.6%, AOR 0.96, 99% CI 0.83-1.10). Conversely, cancellation rates increased from 8.4% (1999-2003) to 14.5% (2004-2006) (AOR 1.83, 99% CI 1.63-2.05).
CONCLUSION
Attendance rates among adolescents show variations depending on vacation and school hours. Being attentive to these factors could help prevent missed appointments. Although having to pay for missed appointments does not increase attendance, it increases cancellations with the advantage that the appointment can be rescheduled.
研究问题
失约是一个重要的医学和经济问题。文献中关于该主题的研究较少，尤其是针对青少年的研究。我们的目的是描述青少年多学科门诊中的失约和取消预约情况，评估一项旨在通过对未提前取消的失约预约收取费用来减少失约的政策的有效性，并比较工作人员医生和住院医生之间的失约率。
方法
分析了1999年至200[此处年份似乎有误，推测可能是2009之类的完整年份]年间的32816次会诊（代表35名年龄在12 - 20岁的患者，82.4%为女性）。
结果
失约率为11.8%，另有10.9%为取消预约。女性取消预约的比例高于男性（11.3%对8.4%，调整后比值比1.31，99%置信区间1.08 - 1.59），但失约情况无差异（11.6%对12.3%，调整后比值比0.88，99%置信区间0.61 - 1.08）。4月以及6月至10月（假期月份）的失约情况更多。总体而言，上午的失约率高于下午（13.6%对11.2%，调整后比值比1.25，99%置信区间1.11 - 1.40）。工作人员医生和住院医生的失约率略有差异（10.4%；11.8%，调整后比值比1.20，99%置信区间1.08 - 1.33）。新的失约预约政策实施前后的失约率相似（1999 - 2003年：11.9%；2004 - 2006年：11.6%，调整后比值比0.96，99%置信区间0.83 - 1.10）。相反，取消预约率从8.4%（1999 - 2003年）增至14.5%（2004 - 2006年）（调整后比值比1.83，99%置信区间1.63 - 2.05）。
结论
青少年的就诊率因假期和上课时间而有所不同。关注这些因素有助于防止失约。虽然对失约预约收费并不会提高就诊率，但会增加取消预约的情况，好处是预约可以重新安排。
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