IMPROVING PEDIATRIC APPOINTMENT KEEPING WITH REMINDERS AND REDUCED RESPONSE REQUIREMENT

We evaluated the effectiveness of appointment reminders and a reduced response requirement for improving appointment keeping in a hospital ambulatory pediatric clinic. Participants received mailed and telephoned reminders along with a parking pass that reduced the time and effort required to attend the clinic. A multiple baseline analysis of 5,261 appointments over one fiscal year showed that the intervention increased the percentage of appointments kept and decreased the percentage of appointments broken in the continuity clinics of five pediatric health care providers. Social validation, consumer satisfaction, and cost-effectiveness measures, as well as an interrupted time-series analysis, all support the effectiveness of the intervention.     

Impact of Appointment Waiting Time on Attendance Rates at a Clinical Cancer Genetics Service

The increase in demand for clinical cancer genetics services has impacted the ability to provide services timeously. Given limited resources, this often results in extended appointment waiting times. Over the last 3 years, the Cancer Genetics Service at the National Cancer Centre Singapore has continued to experience a steady increase in demand for its service. Nevertheless, significant no-show rates have been reported. This study sought to determine whether an association exists between appointment waiting times and attendance rates. Data was gathered for all participants meeting inclusion criteria. Attendance rates and appointment waiting times were calculated. The relationship between mean waiting times for those who did and did not attend their scheduled appointments was evaluated using Welch’s t test and linear regression model. The results showed a significant difference in mean appointment waiting times between patients who did and did not attend (32.66 versus 43.50 days respectively; p?<?0.0001). Furthermore, patients who waited for longer than 37 days were significantly less likely to attend. No-show rates increased as the waiting time increased, at a rate of 19.60% per 20 days and 21.40% per 30 days. In conclusion, appointment waiting time is a significant predictor for patient attendance. Strategies to ensure patients receive an appointment within the necessary timeframe at the desired setting are important to ensure that individuals at increased cancer risk attend their appointments in order to manage their cancer risks effectively.     

"When no means no": can reactance augment the theory of planned behavior?

A longitudinal study examined women's clinic attendance for treatment and follow-up after having received an abnormal cervical screening result. Participants (N = 660) completed questionnaire measures of variables specified by the theory of planned behavior and J. Kuhl's (2000) measure of low volitional control--reactance--prior to receiving up to 3 subsequent appointments during the following 15 months. The theory of planned behavior was capable of predicting persistent attendance and discriminated women who kept all of their scheduled appointments from those who dropped out from treatment. Consideration of reactance enhanced prediction of behavior and discriminated between women who delayed appointment keeping and women who ceased attending.     

The relationship of personality to punctuality for a variety of types of appointment

The punctuality with which undergraduate students kept four distinct types of appointment was observed without their knowledge. Ss were asked to record, confidentially, the importance with which they regarded each appointment, using a 7-point scale. A frequency distribution of the proportion of appointments kept punctually approximated to a normal distribution (rather than the bimodal distribution predicted by ‘common sense’). Both punctuality and importance-rating were strongly affected by appointment type. Ss' scores on the P scale of the EPQ were inversely related to the importance they attributed to appointments, but showed little relationship to punctuality. Their scores on the E scale, on the other hand, were inversely related to punctuality for most types of appointment, but were not related to the importance attributed to appointments. Ss' N scores were positively related to punctuality for those appointments that were generally regarded as ‘extremely important’. A small interaction effect between gender of the Ss and type of appointment may have been due to the gender of the majority of the experimenters' collaborators. A principal-components analysis revealed a primary factor on which punctuality, importance-rating, E score and P score all load highly, i.e. a ‘concern for appointments’ factor.     

Using Web-Based Technology to Facilitate Client Engagement

To meet the needs of clients, mental health clinics must offer responsive, organized intake procedures. Clients who receive rapid intervention when they request therapy services are more likely to attend and benefit from therapy. The present study examined the effects of implementing a web-based scheduling program on treatment delays and first session attendance. Results indicated that the use of a web-based scheduling system significantly reduced the number of days clients waited for a first appointment and increased the number of kept appointments. Additionally, clients provided with an immediate response to their request for treatment successfully terminated from therapy after fewer sessions.     

Relationship of physicians' nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload

A field study of 28 residents in family practice was conducted. Physicians' self-reports of empathy, self-monitoring ability, and affective communication skill as well as their objectively measured nonverbal communication skills were examined as predictors of patient satisfaction, appointment noncompliance, and physician workload (schedule density). Physicians completed the Hogan Empathy Scale, Snyder Self-Monitoring Scale, Affective Communication Test, short form of the Profile of Nonverbal Sensitivity, and a nonverbal encoding task. Patient satisfaction with communication, affective care, and technical care was assessed using a 25-item, visit-specific satisfaction scale. Appointment records were used to determine the number of patients seen by each physician and the compliance of patients with scheduled appointments. Results indicated that the three self-report measures were unrelated to the measures of patient noncompliance and patient satisfaction, but self-reported affective communication ability was significantly correlated with physician workload. Objectively measured physician sensitivity to audio communication predicted patient compliance: More sensitive physicians experienced fewer unrescheduled appointment cancellations. Nonverbal encoding skill was significantly related to patient satisfaction with affective care and to physician workload.     

Path model of multidimensional compliance with cancer therapy

Patients newly diagnosed with hematologic malignancies were followed for a 6-month treatment period to assess compliance with three regimen requirements for cancer therapy: anti-neoplastic medication self-administered intermittently, supportive medication self-administered daily, and monthly clinic appointments. The effect on compliance of three intervention "packages" (some combination of education, shaping of pill-taking behavior, and home restructuring) and the extent that patient satisfaction, knowledge, and uncertainty about illness-related events mediated the effects of the interventions were also examined. Blood levels of the drugs and self-report measures indicated that compliance with daily pill taking was higher for each intervention group compared to a control group. Similar results were obtained for compliance with clinic appointments. No improvement in intermittent self-medication was found. Although each intervention package increased patient knowledge and satisfaction, path analyses demonstrated that knowledge did not affect any aspect of compliance, whereas satisfaction was associated with increased appointment keeping only. Daily pill taking was influenced directly by the behavioral components of the interventions. Uncertainty did not influence compliance but was associated with depression, which was negatively correlated with intermittent self-medication.     

Counseling dropout relative to client attractiveness,disturbance, and expected number of sessions

Participants were 12 counseling center psychologist and thir 257 college-student clients. Immediately after intake, clients indicated whether or not they would make an additional appointment, their reasons for not making another appointment, and the estimated number of sessions they would attend. Counselors rated clients' attractiveness and disturbance and estimated the number of sessions they would have with each client. Clients who did not make a second appointment were generally satisfied with the help they received in one session. Client estimates were more predictive than counselor estimates of actual number of sessions. Relative to less attractive and disturbed clients, more attractive and disturbed clients made and kept post-intake appointments.     

INCREASING APPOINTMENT KEEPING BY REDUCING THE CALL-APPOINTMENT INTERVAL

We examined the effect of reducing the interval between a patient's call for an appointment and the appointment itself. In Experiment 1, patients calling a family planning unit of a public health department were assigned appointments within either 1 or 3 weeks of their call. Data on patient “shows” and “no-shows” were recorded weekly for 6 weeks. Show rates for those in the 1-week appointment group were significantly higher than those in the 3-week group. In Experiment 2, patients were assigned to appointment dates either the next operating clinic day (next-day group) or 2 weeks from the call date (2-week group). Show rates for those in the next-day group were significantly better than show rates for patients in the 2-week group. Clinic productivity, time spent with patients, and consumer satisfaction were also assessed. Implications for appointment scheduling are discussed.     

Increasing Utilization of Cancer Genetic Counseling Services Using a Patient Navigator Model

Rarely has utilization of genetic counseling for Hereditary Breast and Ovarian Cancer (HBOC) been studied separately from utilization of testing. At Kaiser Permanente Colorado, consistently only 30% of all members referred for HBOC attend genetic counseling. To increase the volume of genetic counseling appointments, a patient navigator approach was pilot tested in a randomized-controlled trial over 3 months. A total of 125 members were referred for HBOC genetic counseling (55 randomized to PN, 70 randomized to usual care). Utilization of referrals for Navigator-assisted members was 44%, compared to 31% in the usual care arm (p=0.16). The patient navigator significantly decreased time to appointment, with over 80% of Navigator-assisted members seen for genetic counseling less than three months from referral date, compared to 32% in usual care (p=0.002). patient navigator assistance shortens time from referral to appointment for HBOC genetic counseling, and may increase utilization of such services.     

REDUCING NONCOMPLIANCE TO FOLLOW-UP APPOINTMENT KEEPING AT A FAMILY PRACTICE CENTER

In this study, we evaluated follow-up appointment keeping at a family practice center. To determine if noncompliance could be reduced, four treatments were implemented: no-treatment control, modified appointment card, free follow-up, and a reduced rate follow-up. Thereafter, the reduced rate follow-up was implemented again to determine the extent noncompliance could be reduced for all eligible patients. Incentives significantly increased follow-up appointment keeping, whereas the modified appointment card was ineffective. A cost analysis suggested that the no-treatment control and modified appointment card conditions were the least expensive, but also the least effective. The incentive conditions were more expensive, but the reduced rate condition generated the most net revenue. Questionnaire data suggested that the incentive conditions had an effect on noncompliance and may be considered for use in other medical settings.     

PROMPTS TO INCREASE ATTENDANCE IN A COMMUNITY MENTAL-HEALTH CENTER1

The effect of a brief appointment reminder for mental-health center applicants is reported. A standardized phone message was delivered by an administrative staff member one to three days before the appointment and a sequential experimental design alternating baseline and phone message conditions was used to assess the effects of the procedure. The no-show rate averages were 32%, 11%, 25%, and 14% respectively. The cost of the procedure was $162.00, which was totally recovered when only six appointments were kept. Since over 1000 patients were involved in the study, the return on the investment of $162.00 is considerable. Implications for this procedure are discussed for other community mental-health centers and for other community care-giving agencies.     

Factors Associated with First Session Nonattendance at a University-Based Family Therapy Clinic

Two hundred four consecutive psychotherapy initiators who called for an initial appointment at a university-based family therapy clinic during a one-year period were examined to see what factors influenced nonattendance. Researchers considered factors such as demographics, substance use, medical and psychiatric involvement, clinic practice, and constellation expected to attend. The 118 (58%) initiators who kept their appointment differed significantly from the 86 (42%) who did not in distance to the clinic, partner's age, number of children, marital status, employment, time of appointment, and therapeutic constellation. Divorce, unemployment, having a partner between the ages of 18–24, and having children were significant indicators of nonattendance. An appointment scheduled between 1:00 and 4:59 P.M., seeking conjoint psychotherapy, and living between 6 and 25 miles from the clinic were significant indicators of attendance. Implications for improving initial appointment attendance are presented.     

Does client self‐booking reduce ‘did not attends’ (DNAs) in a counselling service?

An important problem for our counselling service is the high number of clients who ‘did not attend’ (DNA) for their booked appointment. This paper aims to describe how we tackled this problem within our counselling service by using a Plan‐Do‐Study‐Act (PDSA) cycle (Langley, Nolan Norman and Provost, 1996). The results found that by devising a system whereby clients could self‐book their appointments we were able to reduce the DNA rate for first appointments from 31.70% to 2%. This has useful time and financial implications. We would expect that the self‐booking approach we have outlined here is adaptable for other counselling services.     

Making life easier with effort: Basic findings and applied research on response effort

Early basic research showed that increases in required response effort (or force) produced effects that resembled those produced by punishment. A recent study by Alling and Poling determined some subtle differences between the two behavior-change strategies, but also confirmed that increasing required effort is an effective response-reduction procedure with enduring effects. In this paper we summarize basic research on response effort and explore the role of effort in diverse applied areas including deceleration of aberrant behavior, attention deficit hyperactivity disorder, oral habits, health care appointment keeping, littering, indexes of functional disability, and problem solving. We conclude that renewed interest in response effort as an independent variable is justified because of its potent effects and because the political constraints imposed on punishment- and reinforcement-based procedures have yet to be imposed on procedures that entail manipulations of response effort.     

Effect of Daylight Saving Time on Punctuality for Medical Appointments

We studied the effect of the switch from daylight saving time to winter time on punctuality for medical appointments, thus allowing us to investigate the role of dynamic and analytic modes of time management in time‐based prospective memory tasks. Insofar as some authors assume that the dynamic mode of time management is based on rhythms, we hypothesised that the switch from daylight saving time would cause more disturbances when participants' everyday activity had a weak temporal structure. Results showed that after the switch, participants arrived early for their appointments, but this earliness was not higher for participants whose everyday activity had a low temporal structure than for participants with highly structured everyday activity. Nevertheless, compared to the time they planned to arrive, participants with low regularity of activity arrived earlier after the switch, suggesting that their temporal reference would the time fixed by themselves, rather than the appointment time. Copyright © 2016 John Wiley & Sons, Ltd.     

The impact of waiting-list times on client attendance for relationship counselling

The impact of waiting-list times on subsequent attendance for appointments has received extensive attention within the area of health, but hitherto has received relatively little interest from counselling services. Given the current pressure on all welfare agencies for accountability and efficient use of resources, counselling organisations need to consider resource usage and barriers to efficiency. A study was therefore made of one aspect of this issue: the impact of short v. long time-delays between initial referral and first appointment for relationship counselling. It was found that clients offered appointments within two weeks of referral were significandy more likely to attend for first appointment than were clients whose appointment came between 4 and 12 weeks post-referral. The implications of these results for organisational policy are discussed.     

Psychotherapy Appointment No-Shows: Clinicians’ Approaches

Missed psychotherapy appointments and eleventh hour cancellations contribute to financial burdens, reduced scheduling efficiency, and lowered effectiveness of the therapeutic services delivered. This paper attempts to explore more specific clinical process factors related to patient no-shows. Psychotherapists and their patients in the outpatient psychiatry department of a public safety-net hospital were surveyed to examine how frequently patients missed scheduled psychotherapy appointments and for what reasons. Clinicians with the lowest rates of patient no-shows (n = 12) were asked to discuss their approaches to psychotherapy attendance and provided clinical examples. Clinicians’ responses were thematically grouped into five aspects of negotiating missed appointments and no-shows. Clinicians identified the importance of improving patient motivation, developing a positive therapeutic alliance, setting an established treatment frame, communicating about no-shows throughout the course of treatment, and maintaining their own scheduling accountability as important factors in their approaches to managing patient non-attendance.     

Missed post-hospitalisation clinic appointment in a psychiatric hospital in Southeast Nigeria

ABSTRACT

Patients who have been attended to at psychiatric institutions sometimes fail to keep their scheduled appointments. This study was designed to assess the extent and determinants of missed first clinic appointments among recently discharged patients with schizophrenia. A total of 311 inpatients with a diagnosis of schizophrenia were participated in the study. The diagnosis of schizophrenia was confirmed using Munich version of the Composite International Diagnostic Interview. Socio-demographic and clinical data were collected using the socio-demographic questionnaire while analysis was done using SPSS (version 16). The rate of missed first outpatient appointment was found to be 25.7%. Missed appointment was associated with male gender, state of origin outside the study site, long distance from hospital to place of abode, longer appointment duration and illness severity at discharge. The findings in this study support the need for the introduction of community psychiatric services to improve patient access to services in Nigeria.     

The Effects of Prompts on Minority Children's Screening Attendance at a Community Mental Health Center

This study examined the impact of prompts upon the screening attendence rate at a children's community mental health center (CMHC) serving lower socioeconomic urban minority clients. Subjects (274 children under age 18 and their adult caretakers who contacted the CMHC for screening appointments) were assigned to one of three conditions: (a) a phone prompt one day before the appointment, (b) a letter prompt one to two days before the appointment, and (c) a no-intervention control group. Both phone and letter prompts produced significantly greater attendance than the no-intervention condition. The phone prompt group evidenced a tendency toward greater attendance than the letter prompt group. A cost analysis indicated that the phone prompt generated more net revenue than the other two conditions and had a lower total cost and per subject than the conditon. The data suggest that prompts can be effectively used by mental health facilities to engage minority clients in the intial phase of the treament process.