Greenup E P, Best D, Page M, Potts B
Clinical Excellence Queensland, Queensland Health, Level 2, 15 Butterfield Street, Herston, Qld 4006, Australia. Email:
Menzies School of Health Research, Brisbane, Qld 4000, Australia. Email:
Aust Health Rev. 2020 Sep;44(5):657-660. doi: 10.1071/AH19127.
Objective This study investigated the provision of public specialist out-patient services in Queensland delivered in traditional hospital settings (in person) or through a two-way synchronous videoconferencing session (telehealth). Rates of attendance between these delivery methods were compared to detect any difference in rates of non-attendance among patients. Methods An extract of all specialist out-patient appointments reported in Queensland Health's corporate patient administration systems between 1 July 2017 and 30 June 2018 was obtained (n = 2921702). Variables including how the service was delivered and whether the patient attended were captured for each event. Results No reduction in non-attendance was observed in the telehealth patient group (9.1%) compared with in-person service delivery (9.1% vs 7.9% respectively; = 113.56, P < 0.001, relative risk = 1.15). Discussion The study found no evidence that telehealth is effective at reducing rates of non-attendance in a specialist out-patient setting. This supports existing findings that most non-attendance is the result of forgetfulness or confusion with appointment details, to which telehealth appointments are also vulnerable. What is known about the topic? Non-attendance of out-patient appointments remains a persistent and costly problem for public and private providers of health services. Forgetting or being confused about appointment details are the most commonly reported reasons for patient non-attendance. What does this paper add? Telehealth models of care are increasingly being offered by health service providers, reducing travel requirements to all patients, particularly those in regional and remote settings. However, telehealth models of care do not address the most common reasons for patient non-attendance and telehealth patients are not less likely to miss their appointments. What are the implications for practitioners? Suggestions that telehealth models of care can reduce rates of non-attendance should be treated with caution by health service administrators and clinicians. More timely appointment reminders and easier processes to cancel or reschedule appointments remain the most effective techniques for reducing non-attendance.
目的 本研究调查了昆士兰州在传统医院环境（亲自就诊）或通过双向同步视频会议（远程医疗）提供的公共专科门诊服务。比较了这两种服务提供方式的就诊率，以检测患者未就诊率的差异。方法 获取了2017年7月1日至2018年6月30日昆士兰卫生部门企业患者管理系统中报告的所有专科门诊预约记录（n = 2921702）。记录每次预约的变量，包括服务提供方式以及患者是否就诊。结果 与亲自就诊服务（分别为9.1%和7.9%；χ² = 113.56，P < 0.001，相对风险 = 1.15）相比，远程医疗患者组的未就诊率没有降低（9.1%）。讨论 该研究没有发现证据表明远程医疗在降低专科门诊环境中的未就诊率方面有效。这支持了现有研究结果，即大多数未就诊是由于忘记或混淆预约细节导致的，远程医疗预约也容易出现这种情况。关于该主题已知的信息是什么？门诊预约未就诊对于公共和私立医疗服务提供者来说仍然是一个持续存在且成本高昂的问题。忘记或混淆预约细节是患者未就诊最常见的原因。本文补充了什么？医疗服务提供者越来越多地提供远程医疗护理模式，减少了所有患者的出行需求，特别是那些在地区和偏远地区的患者。然而，远程医疗护理模式并没有解决患者未就诊的最常见原因，远程医疗患者错过预约的可能性并不更低。对从业者有什么影响？医疗服务管理人员和临床医生应谨慎对待远程医疗护理模式可以降低未就诊率的建议。更及时的预约提醒以及更便捷的取消或重新安排预约流程仍然是降低未就诊率最有效的方法。
