Examining Non-attendance of Doctor's Appointments at a Community Clinic in Saskatoon

Objective: To quantify the degree of non-attendance of medical appointments, as well as to identify the social reasons behind the missed appointments, at an inner-city primary care clinic.

Design: Retrospective chart review and survey.

Setting: Inner-city clinic in Saskatoon, Sask, serving a primarily low-income and First Nations population.

Participants: Patients with appointments in the clinic between January 2016 and June 2016.

Main Outcome Measures: Number of non-attended clinic appointments and the reasons for missed appointments.

Results: Of the 1976 booked appointments during the study period, 487 (24.6%) appointments were not attended. Among the patients with walk-in appointments, 123 (15.5%) of them left the clinic before seeing a physician. New patients had a high rate of non-attendance (44.4% did not show up to appointments). Among those who did not attend an appointment, 19.9% of them missed more than 1 appointment; 77.8% of missed appointments were made more than a week in advance of the appointment, and 51.7% of those who missed an appointment saw a physician at the clinic at a later date (18.5 days later on average). The most common reasons for non-attendance were forgetting the appointment or feeling too sick to attend. Social determinants such as transportation were also found to play a role in non-attendance. Most survey participants stated that a telephone call reminder would aid them in keeping their appointments.

Conclusion: Non-attendance is a multifactorial issue that causes a considerable waste of resources, limits the provision of preventive care, and negatively affects patient health. As forgetting was found to be a frequent cause of missed appointments, introducing a telephone reminder system might be an affordable and effective first measure to address non-attendance. Factors associated with poverty and other social determinants of health also affect attendance and are more challenging to address.