Roberts Kinley, Callanan Ian, Tubridy Niall
Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland.
Int J Health Care Qual Assur. 2011;24(5):406-12. doi: 10.1108/09526861111139214.
This paper aims to determine the reasons why patients miss clinic appointments and to ascertain patients' views on the implementation of reminder systems and penalty fees to reduce the rates of did not attend (DNAs). Overall, the paper seeks to establish novel ways to run a more efficient out-patient department (OPD) service to improve waiting times and access for patients to limited neurology resources.
DESIGN/METHODOLOGY/APPROACH: A questionnaire-based study was approved by the audit committee and was offered to 204 out-patients attending the neurology clinics over a three-month period (July to September 2009). The patients' demographic details and non-attendance records were reviewed. The paper aimed to ascertain, from the patients' perspective, why people failed to attend clinic appointments. Each participant was asked their views on how they felt their public hospital service might reduce the number of DNAs at their neurology OPD.
A total of 204 patients took part. Participants had a mean age of 31 years (range 25-75 years) with a modal peak in the 26 to 35 age bracket. Almost 10 per cent of those surveyed admitted to missing a hospital out-patient appointment in the past. The most common reason was that they simply "forgot" (28 per cent). DNA rates by age range were proportionally similar to the overall age profile of attenders. Over 55 per cent said they would like a pre-appointment reminder via a mobile telephone text message, 19 per cent preferred a pre-appointment telephone call, and 19 per cent an e-mail. Of those surveyed, 47 per cent said they would be willing to pay a fee on booking that could be refunded on attending for their appointment. The majority of these felt Euro 20 was the most appropriate amount (39 per cent). The rate of acceptance for various fee amounts was uniform across age ranges. Over half (52 per cent) said that they would agree to a "buddy" system whereby the appointment reminder was sent to the patient but also a nominated friend or relative.
ORIGINALITY/VALUE: Non-attendance rates at the neurology clinics in our institution are high with almost 10 per cent of attendees admitting to missing an appointment. One of the main reasons why people did not attend was because they simply "forgot" that they had an appointment and the patients favoured a text messaging reminder system to help reduce non-attendance. Almost half of the respondents said that they would be willing to pay a refundable booking fee.
本文旨在确定患者错过门诊预约的原因，并了解患者对实施提醒系统和收取罚款以降低未到诊（DNA）率的看法。总体而言，本文旨在探寻新方法，以运营更高效的门诊部（OPD）服务，改善等待时间，并让患者更易获取有限的神经科资源。
设计/方法/途径：一项基于问卷调查的研究获得审计委员会批准，在三个月期间（2009年7月至9月）向204名前往神经科门诊的患者发放问卷。审查了患者的人口统计学细节和未到诊记录。本文旨在从患者角度确定人们未按时就诊的原因。每位参与者都被问及他们认为公立医院服务如何减少神经科OPD的未到诊人数。
共有204名患者参与。参与者的平均年龄为31岁（范围25 - 75岁），26至35岁年龄组人数最多。近10%的受访者承认过去错过过医院门诊预约。最常见的原因是他们只是“忘记了”（28%）。按年龄范围划分的DNA率与就诊者的总体年龄分布比例相似。超过55%的人表示希望通过手机短信获得预约前提醒，19%的人更喜欢预约前电话提醒，19%的人希望通过电子邮件提醒。在受访者中，47%的人表示愿意在预约时支付一笔费用，若按时就诊可退还。其中大多数人认为20欧元是最合适的金额（39%）。不同金额费用的接受率在各年龄组中一致。超过一半（52%）的人表示他们会同意一种“伙伴”系统，即预约提醒不仅发送给患者，还发送给指定的朋友或亲属。
原创性/价值：我们机构神经科门诊的未到诊率很高，近10%的就诊者承认错过预约。人们未就诊的主要原因之一是他们只是简单地“忘记”了有预约，患者倾向于使用短信提醒系统来帮助减少未到诊情况。近一半的受访者表示愿意支付可退还的预约费用。
