Non-compliance with appointments amongst patients attending an Allergology Clinic, after implementation of an improvement plan.

BACKGROUND: Non-compliance is a common cause of failed medical action, contributing to absence of regular check-ups. Our group has already published studies that analyse the level of non-compliance with appointments amongst patients attending our Allergology clinic, and we have made proposals for improvement. OBJECTIVE: This article evaluates the results obtained three years after setting up and launching telephone reminders for patients' first appointments. METHODS: All patients who were given appointments for first and subsequent visits during 2005 were included. A total of 18215 appointments were studied (3115 first appointments and 15100 subsequent ones). Of these, there were 2479 missed appointments (438 first appointments and 2041 subsequent ones), corresponding to 2215 patients (412 first visits and 1803 subsequent ones), with a mean of 1.12 appointments/patient/year. RESULTS: The non-compliance rate was 13.61%. The most common non-compliers were men (14.11% missed appointments against 13.24% missed appointments in women) and in the age range 20-29 years and 30-39 years (16.46% and 15.28% non-compliance, respectively). The mean age of non-compliers was 34.55 +/- 14.73 years. We observed a significant number of patients who missed more than one appointment (5.12% of all non-compliers and 0.7% of all patients). Differences were found in the degree of non-compliance depending on the type of appointment (14.06% non-compliance with first visits and 13.52% with subsequent visits). We observed a significant increase in missed appointments during the Summer holidays; July and August showed the highest percentage of missed appointments for both the first visit (20.62% in July and 23.59% in August) and subsequent visits alike (16.14% in July and 14.23% in August). CONCLUSIONS: A slight reduction in non-compliance was observed after implementing the proposals made in our previous study. In view of the high costs incurred from missed appointments, the government should finance studies to reduce this problem. The causes of non-compliance may be difficult to control, including present access to the public health service. We must be alert to and/or take preventive measures in young patients and cases of previous non-compliance. The degree of non-compliance is a quality indicator, because it reduces the yield of appointments, and it evidences a lack of cohesion of patients with Primary Health Care Units for first appointments, and with Specialist Care Units for subsequent appointments. Once certain levels of attendance have been attained, it is difficult to achieve an effect on this point in order to improve attendance rates.

Non-compliance with appointments amongst patients attending an Allergology Clinic, after implementation of an improvement plan / Incumplimiento de citas concertadas en los pacientes de una consulta de alergología, tras la implantación de un ciclo de mejora

Background: Non-compliance is a common cause of failed medical action, contributing to absence of regular check-ups. Our group has already published studies that analyse the level of non-compliance with appointments amongst patients attending our Allergology clinic, and we have made proposals for improvement. Objective: This article evaluates the results obtained three years after setting up and launching telephone reminders for patients' first appointments. Methods: All patients who were given appointments for first and subsequent visits during 2005 were included. A total of 18215 appointments were studied (3115 first appointments and 15100 subsequent ones). Of these, there were 2479 missed appointments (438 first appointments and 2041 subsequent ones), corresponding to 2215 patients (412 first visits and 1803 subsequent ones), with a mean of 1.12 appointments/patient/year. Results: The non-compliance rate was 13.61 %. The most common non-compliers were men (14.11 % missed appointments against 13.24 % missed appointments in women) and in the age range 20-29 years and 30-39 years (16.46 % and 15.28 % non-compliance, respectively). The mean age of non-compliers was 34.55 ± 14.73 years. We observed a significant number of patients who missed more than one appointment (5.12 % of all non-compliers and 0.7 % of all patients). Differences were found in the degree of non-compliance depending on the type of appointment (14.06 % non-compliance with first visits and 13.52 % with subsequent visits). We observed a significant increase in missed appointments during the Summer holidays; July and August showed the highest percentage of missed appointments for both the first visit (20.62 % in July and 23.59 % in August) and subsequent visits alike (16.14 % in July and 14.23 % in August). Conclusions: A slight reduction in non-compliance was observed after implementing the proposals made in our previous study. In view of the high costs incurred from missed appointments, the government should finance studies to reduce this problem. The causes of non-compliance may be difficult to control, including present access to the public health service. We must be alert to and/or take preventive measures in young patients and cases of previous non-compliance. The degree of non-compliance is a quality indicator, because it reduces the yield of appointments, and it evidences a lack of cohesion of patients with Primary Health Care Units for first appointments, and with Specialist Care Units for subsequent appointments. Once certain levels of attendance have been attained, it is difficult to achieve an effect on this point in order to improve attendance rates

Fundamento: El incumplimiento es una causa frecuente de fracaso de las actuaciones médicas, contribuyendo a ello la ausencia a los controles periódicos. Nuestro grupo con anterioridad ha publicado estudios en los que se analizaba el grado de incumplimiento a citas concertadas, de los pacientes citados en nuestra consulta de Alergología y se realizaban propuestas de mejora. Objetivo: En el presente artículo se evalúan los resultados obtenidos tras tres años desde su puesta en marcha, e introducción de recordar telefónicamente la fecha de la cita a los pacientes de primera vez. Métodos: Se incluyeron los pacientes citados en consulta que acudían por primera vez o a una visita sucesiva, durante todo el año 2005. Fueron objeto del estudio un total de 2.479 citaciones (438 por primera vez y 2.041 sucesivas) que no acudieron a la consulta, correspondientes a 2.215 pacientes (412 de primera visita y 1803 sucesivas), con una media de 1,12 citas/paciente/año. Eran 1391 (56,11%) mujeres y 1088 (43,89%) hombres, con una edad media de 34,55 ± 14.73 años. Resultados: Existió incumplimiento al 13,61% de las consultas. Los pacientes que incurrieron en el incumplimiento con más frecuencia fueron los hombres (14,11% de los citados frente al 13,24%) y las franjas de edades de los 20 a 30 años y de 30 a 40 años (16,46% y 15,28% de incumplimiento respectivamente). Encontramos un número importante de pacientes reincidentes en el incumplimiento (5,12% del total de pacientes incumplidores y 0,7% del total de pacientes citados). Se evidenciaron diferencias en el grado de incumplimiento de las citas en función de la consulta (14.06% incumplimiento en la primera consulta y 13.52% en las consultas sucesivas). Hemos encontrado un aumento significativo de las ausencias en la consulta durante el período vacacional estival, siendo los meses de julio y de agosto los que registraron mayor porcentaje de ausencias, tanto los de primera visita (20,62% en julio y 23,59% en agosto) como los de visitas sucesivas (16,14% en julio y 14,23% en agosto). Conclusiones: Se evidenció un discreto descenso en el incumplimiento, tras poner en marcha las medidas propuestas a raíz de nuestro anterior estudio. Debido a los elevados costes que las inasistencias suponen, es necesario que la administración financie estudios que permitan la disminución de las mismas. Quizá en las inasistencias jueguen papel motivos de difícil control, entre los que cabe barajar la actual accesibilidad a los servicios sanitarios públicos. Es preciso estar alerta y/o tomar medidas anticipatorias en pacientes jóvenes y con incumplimientos previos. El nivel de incumplimiento es un indicador de calidad, al disminuir el rendimiento de las consultas, y poner en evidencia una falta de adherencia de los ciudadanos con los Equipos de Atención Primaria para las primeras consultas, y para la Atención Especializada en las consultas sucesivas. Sobre él, es difícil incidir con el fin de mejorar los índices, una vez obtenidas determinadas cuotas