Pillai R, Bhangu N, Narayanan M, Yoong W
Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK.
J Obstet Gynaecol. 2012 Feb;32(2):156-8. doi: 10.3109/01443615.2011.635228.
Missed outpatient appointments result in the inefficient utilisation of resources and have secondary effects on the health of the non-attenders, as well as on other patients who have to wait longer for their appointments. The first part of the study involved retrospective analysis of trends of non-attendance based on a computerised database of all gynaecology appointments over 12 months. The second comprised a prospective case-control study in which women who missed their gynaecology outpatient appointments (index cases) over 2 months were compared with patients who attended the same clinics matched for indication for referral (control cases). The overall non-attendance rate over 12 months was 16.1%, of whom 42% were recurrent non-attenders. Data from 105 defaulters were compared with 105 non-defaulters who attended the same clinics. Defaulters were significantly younger, single or separated and were more likely to be 'follow-ups' rather than new cases (all p < 0.05). Longer intervals between the appointment letter and actual appointment date was significantly related to non-attendance (p = 0.01) and there was a trend to a greater degree of smoking and alcohol ingestion in the defaulter group (p = 0.059). Comparison of other variables such as severity of symptoms, parity, source of referral and fluency of English did not reach statistical significance (p > 0.05). This prospective study has demonstrated certain profiles which are common to defaulters and which can be used to develop strategies to minimise non-attendance. Examples include reducing the time interval between sending the appointment letter and actual appointment date and selectively over-booking younger, single women who smoke.
门诊预约失约导致资源利用效率低下，对未就诊者的健康产生次生影响，也会对其他必须等待更长时间才能就诊的患者产生影响。该研究的第一部分涉及基于一个12个月内所有妇科预约的计算机数据库，对失约趋势进行回顾性分析。第二部分是一项前瞻性病例对照研究，将超过2个月未就诊的妇科门诊患者（索引病例）与因相同转诊指征而在同一诊所就诊的患者（对照病例）进行比较。12个月内的总体失约率为16.1%，其中42%为反复失约者。将105名失约者的数据与在同一诊所就诊的105名非失约者的数据进行比较。失约者明显更年轻，单身或分居，更有可能是“复诊患者”而非新病例（所有p<0.05）。预约信发出日期与实际预约日期之间的间隔较长与失约显著相关（p=0.01），失约者组中吸烟和饮酒程度较高有一定趋势（p=0.059）。对其他变量如症状严重程度、产次、转诊来源和英语流利程度的比较未达到统计学显著性（p>0.05）。这项前瞻性研究表明了失约者共有的某些特征，可用于制定策略以尽量减少失约情况。例如，缩短预约信发出日期与实际预约日期之间的时间间隔，以及对吸烟的年轻单身女性进行选择性超额预约。
