TY - JOUR

T1 - Morbidity, mortality and missed appointments in healthcare

T2 - a national retrospective data linkage study

AU - McQueenie, Ross

AU - Ellis, David Alexander

AU - McConnachie, Alex

AU - Wilson, Philip

AU - Williamson , Andrea

PY - 2019/1/11

Y1 - 2019/1/11

N2 - BackgroundRecently, studies have examined patient and practice factors underlying missed appointments, but less is known about the impact on patient health. People with one or more long-term conditions who fail to attend appointments may be at risk of premature death. This is the first study to examine the effect of missed primary healthcare appointments on all-cause mortality in those with long-term mental and physical health conditions.MethodsWe used a large, nationwide retrospective cohort (N=824,374) extracted from routinely collected general practice data across Scotland which was data linked to Scottish deaths records for patients who had died within a 16-month follow up period. We generated appointment attendance history, number of long-term conditions and prescriptions data for patients. These factors were used in negative binomial and Cox's proportional hazards modelling to examine risk of missing appointments and all- cause mortality.ResultsPatients with a greater number of long-term conditions had an increased risk of missing general practice appointments despite controlling for number of appointments made, particularly among patients with mental-health conditions. These patients were at significantly greater risk of all-cause mortality, and showed a dose-based response with increasing numbers of missed appointments. Patients with long-term mental- health conditions who missed more than two appointments per year had a greater than eight-fold increase in risk of all-cause mortality compared with those who missed no appointments. These patients died prematurely, commonly from non-natural external factors such as suicide.ConclusionsMissed appointments represent a significant risk marker for all-cause mortality, particularly in patients with mental health conditions. For these patients, existing primary healthcare appointment systems are ineffective. Future interventions should be carried out with particular focus on increasing attendance in these patients.

AB - BackgroundRecently, studies have examined patient and practice factors underlying missed appointments, but less is known about the impact on patient health. People with one or more long-term conditions who fail to attend appointments may be at risk of premature death. This is the first study to examine the effect of missed primary healthcare appointments on all-cause mortality in those with long-term mental and physical health conditions.MethodsWe used a large, nationwide retrospective cohort (N=824,374) extracted from routinely collected general practice data across Scotland which was data linked to Scottish deaths records for patients who had died within a 16-month follow up period. We generated appointment attendance history, number of long-term conditions and prescriptions data for patients. These factors were used in negative binomial and Cox's proportional hazards modelling to examine risk of missing appointments and all- cause mortality.ResultsPatients with a greater number of long-term conditions had an increased risk of missing general practice appointments despite controlling for number of appointments made, particularly among patients with mental-health conditions. These patients were at significantly greater risk of all-cause mortality, and showed a dose-based response with increasing numbers of missed appointments. Patients with long-term mental- health conditions who missed more than two appointments per year had a greater than eight-fold increase in risk of all-cause mortality compared with those who missed no appointments. These patients died prematurely, commonly from non-natural external factors such as suicide.ConclusionsMissed appointments represent a significant risk marker for all-cause mortality, particularly in patients with mental health conditions. For these patients, existing primary healthcare appointment systems are ineffective. Future interventions should be carried out with particular focus on increasing attendance in these patients.

KW - Missed appointments

KW - primary care

KW - health utilisation

KW - health promotion

KW - health inequalities

KW - social vulnerability

KW - administrative data

KW - long-term conditions

KW - morbidity

KW - mortality

U2 - 10.1186/s12916-018-1234-0

DO - 10.1186/s12916-018-1234-0

M3 - Journal article

VL - 17

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

M1 - 2

ER -