Factors related to the keeping of appointments by indigent clients.

Few recent studies address how situational variables and the characteristics of clients and organizations predict whether indigent clients will keep medical appointments. In this study at a southern urban charity hospital, lack of transportation was a main reason given for not keeping the last appointment at an internal medicine clinic. In contrast, clients who kept their last appointment had higher incomes; had visited the facility for pain, infection, or follow-up after hospitalization; and had been referred to the clinic less than two weeks before their appointment. Overall, whether appointments were kept or broken seemed to depend on the recency of medical attention and the perceived severity of a problem. Implementation of a system-wide discharge-planning system resulted in fewer broken appointments. Perceived communication difficulties with clinic personnel and long waits were important predictors of overall utilization. Decentralizing care through community health clinics and adopting a more holistic approach to care may improve utilization of health care facilities.