Health Informatics, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
BMJ Open. 2021 Aug 18;11(8):e046596. doi: 10.1136/bmjopen-2020-046596.
Missed hospital appointments pose a major challenge for healthcare systems. There is a lack of information about drivers of missed hospital appointments in non-Western countries and extent of variability between different types of clinics. The aim was to evaluate the rate and predictors of missed hospital appointments and variability in drivers between multiple outpatient clinics.
Outpatient clinics in the Royal hospital (tertiary referral hospital in Oman) between 2014 and 2018.
All patients with a scheduled outpatient clinic appointment (N=7 69 118).
Retrospective cross-sectional analysis.
A missed appointment was defined as a patient who did not show up for the scheduled hospital appointment without notifying or asking for the appointment to be cancelled or rescheduled. The outcomes were the rate and predictors of missed hospital appointments overall and variations by clinic. Conditional logistic regression compared patients who attended and those who missed their appointment.
The overall rate of missed hospital appointments was 22.3%, which varied between clinics (14.0% for Oncology and 30.3% for Urology). Important predictors were age, sex, service costs, patient's residence distance from hospital, waiting time and appointment day and season. Substantive variability between clinics in ORs for a missed appointment was present for predictors such as service costs and waiting time. Patients aged 81-90 in the Diabetes and Endocrine clinic had an adjusted OR of 0.53 for missed appointments (95% CI 0.37 to 0.74) while those in Obstetrics and Gynaecology had OR of 1.70 (95% CI 1.11 to 2.59). Adjusted ORs for longer waiting times (>120 days) were 2.22 (95% CI 2.10 to 2.34) in Urology but 1.26 (95% CI 1.18 to 1.36) in Oncology.
Predictors of a missed appointment varied between clinics in their effects. Interventions to reduce the rate of missed appointments should consider these factors and be tailored to clinic.
医院预约失约对医疗系统构成了重大挑战。在非西方国家，关于医院预约失约的驱动因素以及不同类型诊所之间的差异程度，相关信息十分匮乏。本研究旨在评估多家门诊诊所中预约失约的发生率和预测因素以及驱动因素的差异程度。
2014 年至 2018 年期间，阿曼皇家医院（三级转诊医院）的门诊诊所。
所有预约门诊就诊的患者（N=769118）。
回顾性横断面分析。
失约定义为患者未按计划到医院就诊，既未通知取消或重新安排预约，也未出现。结果为总体预约失约率和预测因素以及按诊所分类的变化。条件逻辑回归比较了就诊患者和失约患者。
总体预约失约率为 22.3%，不同诊所之间存在差异（肿瘤科为 14.0%，泌尿科为 30.3%）。重要的预测因素包括年龄、性别、服务费用、患者居住地与医院的距离、等待时间以及预约日期和季节。在服务费用和等待时间等预测因素方面，诊所之间存在明显的失约几率的实质性差异。糖尿病和内分泌科 81-90 岁的患者预约失约的调整比值比（OR）为 0.53（95%可信区间 0.37 至 0.74），而妇产科的 OR 为 1.70（95%可信区间 1.11 至 2.59）。等待时间较长（>120 天）的调整 OR 在泌尿科为 2.22（95%可信区间 2.10 至 2.34），而在肿瘤科为 1.26（95%可信区间 1.18 至 1.36）。
预约失约的预测因素在不同诊所的影响程度存在差异。为降低预约失约率而采取的干预措施应考虑这些因素，并根据诊所进行调整。
