Patient Non-Attendance Appointment Study A mixed methods study to evaluate the problem of missed appointments at the Radiology outpatient department in King Fahad Specialist Hospital, Saudi Arabia, and the implementation and evaluation of an intervention to improve outpatient appointment attendance in this department.

Abstract

Aims: The aim of this study was to evaluate the prevalence of appointment non-attendance within the Radiology Department at King Fahad Specialist Hospital and to identify the factors contributing to missed appointments. In addition, the study investigated the reasons associated with non-attendance. As part of the study, an intervention that allowed patients to schedule appointments and receive reminders was developed, implemented, and evaluated in an effort to reduce non-attendance rates. Background: The issue of patients missing hospital appointments is widespread across various settings, with thousands of patients failing to attend appointments in all types of practices. Despite its prevalence, little is understood about which patients are likely to miss appointments and the reasons why. Healthcare professionals may perceive these patients in two contrasting ways: as a vulnerable group with various health issues and complex lifestyles or as a source of annoyance due to their frequent failure to attend appointments, which could have been allocated to patients requiring urgent medical attention. When patients fail to attend their scheduled appointments, it can have serious implications for both their health and the healthcare system. Missed appointments can disrupt the continuity of care, cause delays in treatment, harm the doctor–patient relationship, and increase healthcare costs. Patients who do not attend their appointments may miss out on important treatments or screenings for conditions, which can lead to poorer outcomes and uncontrolled chronic diseases. Additionally, missed appointments significantly contribute to treatment failure. The V economic impact of missed appointments is also significant, potentially leading to the inefficient use of healthcare resources and incurring both financial and social costs. Ultimately, the cost of missed appointments extends beyond financial implications and includes the loss of resources that could have been used to assist other patients. Given the impact of missed appointments, improving attendance offers a potentially economical means of reducing expenses for healthcare providers and enhancing patient outcomes. Consequently, hospitals are increasingly investing in postal, telephone, and Short Message Service (SMS) appointment reminder services, along with other approaches to reduce non-attendance. Design: The current study employed an embedded mixed methods design, selected as the most suitable mixed methods research approach for achieving the study's objectives. This design included a sequential element, where the qualitative findings and quantitative results informed the development and implementation of the intervention phase. This study was divided into three phases. Phase one involved extracting data from the patient case notes and appointment records stored in the hospital database. The Statistical Package for Social Sciences (SPSS v.23) tool was used to conduct descriptive and inferential statistical analysis of the patient data, focusing on demographic, clinical, or other relevant factors. Univariate, bivariate, and binary logistic regression tests were conducted to identify significant associations between independent variables and the dependent variable (the missed appointment) and to determine the significant predictors of the dependent variable. In the second phase of the study, semi-structured interviews were conducted to generate rich data for thematic analysis. Seventeen patients who had missed their appointments were interviewed to gather insights into the reasons behind their non-attendance. The final phase was the intervention phase, which was informed by the findings from the first and second phases of the study. In this final phase, the study compared post-intervention attendance rates with pre-intervention attendance rates (from phase one) to evaluate the impact of the intervention. The intervention improved the efficiency of a system that enabled patients to schedule their appointments and receive their preferred type of appointment reminders. Univariate and bivariate statistical tests were conducted to analyse the frequency and association of categorical variables with the dependent variable. Comparative analysis between pre- and post-intervention data was conducted using the chi-square (χ2) test of independence. Key variables from phase one associated with attendance status were also determined using binary logistics regression. Results: The findings from phase one of the study revealed that all independent variables were associated with patient attendance status. The logistic regression model suggested that the independent variables, i.e., age group, gender, marital status, education, and distance, were significant predictors of whether the patients would attend their appointments. In phase two, the reasons for missing appointments emerged under five themes: scheduling problems, inadequate knowledge about their health condition, physician–patient miscommunication, travel problems, and other reasons. In addition, patient-recommended VII strategies for reducing missed appointments were identified under two themes: the need for appointment reminders and improvements within the department. The evaluation of the intervention, developed and tested to improve appointment reminders and scheduling, found that only the age group variable was statistically significant in relation to the type of intervention method (phone call and SMS) and that marital status and distance were statistically significant in relation to attendance status in the inferential analysis. The comparative analysis of pre- and post-intervention data identified a few variables that were found to be statistically significantly associated with appointment attendance or non- attendance. Thesis contribution: This study advances mixed methods research in health management and health sciences by demonstrating how quantitative and qualitative approaches can be combined to address this specific research question. Its unique contribution lies in its focus on appointment non- attendance and the measures that can be taken to reduce non-attendance in radiology departments effectively.