Sutton Coldfield Group Practice Patient Participation Group, Sutton Coldfield, United Kingdom.
Sutton Coldfield Group Practice, Sutton Coldfield, United Kingdom.
Fam Pract. 2023 Feb 9;40(1):16-22. doi: 10.1093/fampra/cmac064.
Scalable, positive, behaviourally informed interventions may help people remember to attend their primary care appointment or cancel in good time, but have not yet been implemented long term.
To examine effects of social norms and making active commitments on missed and cancelled appointments in primary care over 12 months and explore implementation factors.
A mixed-methods design evaluation and implementation study led by a Patient Participation Group (PPG) member in a large GP practice in the West Midlands.
Following a 6-month baseline, waiting room notices were redesigned to emphasise positive social norms for desired behaviours. When booking appointments, receptionists were trained to invite patients to (i) verbally actively commit to cancelling if needed; (ii) write down their own appointment details. Monthly missed appointments (MAs) and cancellations were statistically compared with baseline averages and seasonally equivalent months. To explore implementation, reception staff completed a knowledge, attitude, and behaviour questionnaire at 9 months, analysed descriptively. Study team field notes were thematically analysed.
Across 12 intervention months there was a mean of 37.67 fewer MAs per month (20% reduction) and 102.66 more cancellations (21.07% increase) compared with 6-month baseline means [MAs t(11) = -6.15, P < 0.001; cancellations t(11) = 3.637, P = 0.004] with statistically significant differences in seasonally equivalent months [MAs t(5) = -4.65, P = 0.006; cancellations t(5) = 3.263, P = 0.022]. Receptionists (n = 12) reported implementing the strategies except when facing pressures; knowledge and attitudes varied.
Behaviourally informed interventions reduced primary care MAs longer term; PPGs and practice teams can work together on quality improvement projects with support from leaders to prioritise and embed new practices.
可扩展、积极、基于行为的干预措施可能有助于人们记住参加初级保健预约或及时取消预约，但这些措施尚未长期实施。
在 12 个月内，通过社会规范和积极承诺来检查对初级保健中错过和取消预约的影响，并探讨实施因素。
由西英格兰地区一家大型全科医生诊所的患者参与小组（PPG）成员领导的混合方法设计评估和实施研究。
在 6 个月的基线期后，重新设计候诊室通知以强调对所需行为的积极社会规范。在预约时，接待员接受培训，邀请患者（i）如果需要，口头积极承诺取消；（ii）写下自己的预约细节。每月错过的预约（MA）和取消与基线平均值和季节性等效月份进行统计比较。为了探索实施情况，接待员在 9 个月时完成了一份知识、态度和行为问卷，并进行了描述性分析。研究小组的现场记录进行了主题分析。
在 12 个干预月中，与 6 个月基线平均值相比，每月平均 MA 减少了 37.67 次（减少 20%），取消次数增加了 102.66 次（增加 21.07%）[MA t(11) = -6.15，P < 0.001；取消 t(11) = 3.637，P = 0.004]，季节性等效月份的差异具有统计学意义[MA t(5) = -4.65，P = 0.006；取消 t(5) = 3.263，P = 0.022]。接待员（n = 12）报告实施了这些策略，但在面临压力时除外；知识和态度存在差异。
基于行为的干预措施长期减少了初级保健 MA；PPG 和实践团队可以在领导的支持下，共同开展质量改进项目，优先考虑并嵌入新实践。
