Akter Shahinoor, Doran Frances, Avila Catharine, Nancarrow Susan
Centre for Equity and Health System, ICDDR,B, Bangladesh.
School of Health and Human Sciences, Southern Cross University, Australia.
Australas Med J. 2014 May 31;7(5):218-26. doi: 10.4066/AMJ.2014.2056. eCollection 2014.
Non-attendance at health appointments reduces health service efficiency, is costly to services, and can risk patient health. Reminder systems are widely used to overcome forgetfulness, the most common reason for non-attendance; however, other factors, such as patient demographics and service accessibility, may also affect attendance rates.
There is limited primary research on the reasons for patient non-attendance in the Australian healthcare setting, although the success of preventative health initiatives requires ongoing monitoring of patients. This study aims to improve our understanding of the Australian experience by examining staff perspectives.
This qualitative study explored staff perspectives of the reasons for non-attendance in a large, regional general practice super clinic, which has a low socioeconomic catchment, and serves a large Aboriginal population.
The practical barriers to attendance of travel, cost, and waiting times had largely been overcome with transport provision, free medical care and responsive appointment times, but paradoxically, these were seen to devalue allocated appointments and reinforce the expectations of "on-demand" health care. For Aboriginal patients specifically, a distrust of authority, combined with poor health literacy was perceived to impact negatively on the uptake of diagnostic tests, filling of prescriptions, health monitoring, and adherence to medication.
The results suggest a complex interplay between poor health literacy and low patient self-worth; a funding system that encourages "five-minute medicine and prevents doctors getting to the root cause of patient problems or having the ability to provide health education.
不按时赴约就诊会降低医疗服务效率，增加服务成本，并可能危及患者健康。提醒系统被广泛用于克服健忘这一最常见的未就诊原因；然而，其他因素，如患者人口统计学特征和服务可及性，也可能影响就诊率。
尽管预防性健康倡议的成功需要对患者进行持续监测，但在澳大利亚医疗环境中，关于患者未就诊原因的初步研究有限。本研究旨在通过考察工作人员的观点来增进我们对澳大利亚情况的了解。
这项定性研究探讨了一家大型区域综合诊疗超级诊所工作人员对未就诊原因的看法，该诊所服务于社会经济水平较低的人群，且有大量原住民人口。
出行、费用和等待时间等实际就诊障碍在提供交通、免费医疗和灵活预约时间后已基本得到克服，但矛盾的是，这些措施被认为降低了已预约就诊的价值，并强化了对“按需”医疗服务的期望。特别是对于原住民患者，对权威的不信任与健康素养低下被认为对诊断检查的接受、处方的填写、健康监测以及药物依从性产生了负面影响。
结果表明，健康素养低下与患者自我价值感低之间存在复杂的相互作用；一种鼓励“五分钟诊疗”且阻碍医生深入了解患者问题根源或提供健康教育能力的资金系统。
