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Patients who miss their medical appointments increase health care costs for themselves and for clinics. The purpose of this qualitative, single exploratory case study was to explore strategies health care clinic managers use to reduce medical no-shows for patient-scheduled appointments. Change management theory guided the scope and analysis. The data collection included a single clinical operations manager who have strategies to mitigate no-shows for patient-scheduled appointments participated in a semistructured interview in southeastern Virginia, the direct observation of 2 office workers in their natural setting of scheduling appointments, and for methodological triangulation, a review of organizational archival documents about missed medical appointments. Member checking was used to strengthen the credibility and trustworthiness of analyses, which were carried out using Yin's 5-step analysis process. Major themes were forgetfulness and high deductible plan; minor themes were lead-time and inclement weather that lead to no-shows. This study explored the strategies necessary to reduce costs and increase revenues; it could free funds to provide services to patients, such as education and counseling support. The findings from this study could contribute to social change by adding new knowledge or informing the strategies to reduce medical no-shows. These findings may also benefit organizational worth and increase community health.

Clients experiences in attempting to access counselling help have rarely been studied. As such, a full and clear understanding of clients experiences with accessing services, as well as identification of the barriers encountered by clients and clients ideas about what would make accessing more comfortable, have eluded researchers. Typically, the research focus has been quantitative investigations of the no-show phenomenon, whereby clients fail to arrive at pre-booked counselling appointments. Such studies have left 24% of the variance in the unexplained "other" category. More recently, researchers have begun to question whether or not mental health stigma impacts counselling attendance. The present study sought to describe the experience of individuals who self identified as having booked a counselling appointment within the previous 8-months and then had failed to attend. A basic interpretive qualitative research design (Merriam, 2002) was employed for the purpose of describing and understanding this phenomenon, with special emphasis given to identifying possible barriers to accessing counselling. Interviews with four middle class Caucasian adults aged 27-33; two of whom had accessed counselling previously and two of whom had not, were conducted. Transcripts were analyzed in terms of a shared meaning and descriptive categories (Kearney, 2001). Findings revealed that stigma, self-stigma, several fears, and some counselling practices functioned as barriers. However, participants also expressed positive emotions associated with reaching out and accessing counselling help and a desire for information about what to expect in counselling, whether they had accessed previously or not. The beginnings of a pattern associated with accessing counselling are discussed and implications for counselling practice and future research are described.

Clients experiences in attempting to access counselling help have rarely been studied. As such, a full and clear understanding of clients experiences with accessing services, as well as identification of the barriers encountered by clients and clients ideas about what would make accessing more comfortable, have eluded researchers. Typically, the research focus has been quantitative investigations of the no-show phenomenon, whereby clients fail to arrive at pre-booked counselling appointments. Such studies have left 24% of the variance in the unexplained "other" category. More recently, researchers have begun to question whether or not mental health stigma impacts counselling attendance. The present study sought to describe the experience of individuals who self identified as having booked a counselling appointment within the previous 8-months and then had failed to attend. A basic interpretive qualitative research design (Merriam, 2002) was employed for the purpose of describing and understanding this phenomenon, with special emphasis given to identifying possible barriers to accessing counselling. Interviews with four middle class Caucasian adults aged 27-33; two of whom had accessed counselling previously and two of whom had not, were conducted. Transcripts were analyzed in terms of a shared meaning and descriptive categories (Kearney, 2001). Findings revealed that stigma, self-stigma, several fears, and some counselling practices functioned as barriers. However, participants also expressed positive emotions associated with reaching out and accessing counselling help and a desire for information about what to expect in counselling, whether they had accessed previously or not. The beginnings of a pattern associated with accessing counselling are discussed and implications for counselling practice and future research are described.

BACKGROUND: There is a need to identify the populations at high risk of nonadherence to outpatient lung cancer appointments in order to reduce the delay from diagnosis to treatment. The patient navigation system, which helps patients with barriers navigate the health care system, was examined to see if the correct high-risk groups were being addressed. METHODS: A case-control study with 195 subjects from the lung cancer clinics at Boston Medical Center (BMC) was conducted examining three nonadherence case groups: no-shows (n=40), cancelations (n=64) and combined (n=20). Nonadherence was defined as any patient who was a no-show for at least one appointment or who canceled more than one appointment over the three month study period. The combined group incorporated both of these factors. The patients were stratified by 10 patient characteristics, including patient navigation. Odds ratios (ORs) and 95% confidence intervals (CIs) were used for the analysis. A second analysis was done on patients in the patient navigation program (n=33) to determine if the high risk groups identified were being addressed. This was done using ORs and 95% CIs. RESULTS: This study has shown that there are certain patient groups in the lung cancer clinics at BMC that are at higher risk of being nonadherent to lung cancer outpatient appointments. Among those are Hispanic/Latino patients, Spanish and Haitian Creole speaking patients, small cell lung cancer (SCLC) patients, and those patients who have Medicaid, and with late stage lung cancer patients at significantly higher risk (no-shows: OR-5.26 (1.85, 14.95), cancelations: OR-2.49 (1.12, 5.54), combined: OR-12.49 (1.48, 105.46)). Patients in the patient navigation system were also found to be at significantly higher risk of nonadherence (no-shows: OR-3.85 (1.72, 8.65), cancelations: OR-4.13 (1.89, 9.00), combined: OR-5.15 (1.93, 13.72)) than those not in the program. Some patients were also found to be at significantly decreased odds of nonadherence, including those who were: 1000-1999 days post diagnosis (no-shows: OR-0.14 (0.03, 0.59), cancelations: OR-0.20 (0.06, 0.65), combined: OR-0.07 (0.01, 0.64)); 2000-2999 days post diagnosis (no-shows: OR-0.09 (0.01, 0.80), cancelations: OR-0.06 (0.01, 0.50)); aged 71-75 (cancelations: OR-0.25 (0.08, 0.79)). The subset analysis with the patient navigation data yielded no statistically significant results. CONCLUSIONS: The study identified high-risk populations within the total lung cancer population at BMC that should be addressed by the patient navigation program. This study demonstrated that while the program does have its flaws, it is decreasing the odds of nonadherence of many of the high-risk populations.

Abstract Missed appointment, referred to as “no-shows,” are appointments that were not attended or previously cancelled at least 24-hours prior to the scheduled time. Missed appointments negatively impact patients as well as health care systems. According to Ullah et al. (2018), the financial impact of missed appointments on the healthcare system is more than $150 billion a year. Also, patients with chronic health problems (who are noncompliant with their scheduled appointments) may cause their conditions to worsen. Researchers have implemented several strategies to reduce the negative effects of no-shows. The purpose of this literature review was to explore the effectiveness of appointment reminders. The question driving this literature review was whether the implementation of appointment reminders via other means were more effective in reducing no-show rates, compared to the standard appointment reminder via telephone call. An electronic search was conducted using CINAHL and PubMed. Inclusion criteria consisted of English language, peer-reviewed, academic journal articles published from 2017 to the present. A variety of articles were found, and five of those were critiqued for this review. The literature was synthesized using the John Hopkins Nursing Evidence-Based Practice Model. The key finding of this review is that telephone calls are the most efficient and feasible form of appointment reminders (Lance et al., 2021 & Lavin et al., 2017). Since phone bills are a normal expense for most businesses, health systems should be able to implement the use of this strategy. Keywords: appointment adherence, no-show, missed appointments, appointment attendance

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No-show appointments, also referred to as missed appointments, occur 23% to 34% annually in general practice care settings. Missed appointments can lead to reduction in appointment availability, decrease in provider/staff productivity, patient/provider discordance, disruption in continuity of care, and reduced quality of care. There is a gap in the nursing literature regarding effective interventions to reduce missed appointments. The purpose of this quality improvement, secondary analysis project was to determine whether implementation of an evidence-based no-show, nurse-led intervention would reduce missed appointment rates in a family medicine practice. The health belief model and the plan, do, study, act model guided this no-show project. Convenience sampled, password-secured quantitative data from nurse practitioner schedules were analyzed using a check-sheet tool and spreadsheet software. Data showed that after implementation of the evidence-based, nurse-led interventions, there was a reduction of no-shows with a decline from 23.5% in September and November 2017 to 17% in September and November 2018. Results of this no-show project might promote positive social change by increasing awareness of evidence-based interventions that are effective for reducing missed appointments in primary care practices.

[pt] O não comparecimento (no-show) dos pacientes a consultas agendadas tem um impacto significativo nos sistemas de saúde. Apesar do crescimento da pesquisa científica sobre os fatores que influenciam o no-show, não há uma síntese atual do estado da arte neste tema, e até à data, nenhuma revisão sistemática que englobe todas as especialidades. Assim, na tentativa de preencher esta lacuna, esta dissertação tem como intuito realizar uma revisão sistemática com três objetivos: (i) análise das características dos estudos segundo a metodologia empregada, continente, especialidade clínica, variáveis dependentes e taxas de no-show; (ii) síntese dos resultados sobre quais os fatores que afetam significativamente as taxas de não comparecimento; (iii) comparação desta análise com pesquisas anteriores. Utilizando a base de dados Scopus, 724 artigos foram encontrados, e destes, 105 selecionados para análise. A literatura indica que o no-show de pacientes não acontece aleatoriamente, e compreender as características que estão relacionadas à perda de compromissos agendados é importante para o desenvolvimento de melhorias no que tange ao comparecimento, além de possibilitar o uso dessas informações nas práticas de programação de agendamento. Concluiu-se que a taxa média de no-show foi de 23 por cento e que é mais comum entre os pacientes: jovens; de baixo nível sócioeconômico; que residem a uma distância elevada da clínica; que tem plano de saúde público ou nenhum plano; e que são atendidos por médicos menos experientes. Têm-se como os fatores mais significativos, a data de agendamento distante da data da consulta e o aumento de histórico prévio de consultas perdidas. / [en] The failure to attend to scheduled appointments (no-show) has a significant impact on healthcare systems. Despite the growing of scientific research on the factors that influence no-show, there is not a current summary of the state of art in this area, and systematic review covering all medical fields. In order to fill this gap, this dissertation has the intention to conduct a systematic literature review with three goals: (i) to summarize the characteristics of the studies according to methodology, country, clinical specialty, dependents variables, and no-show rates; (ii) to gather and integrate the results of the factors that significantly affect the non-attendance rates; (iii) to compare this analysis with previous researches. The literature indicates that the no-show does not happens randomly, and to understand the characteristics related to missed appointments is important to improve attendance, allowing the use of this information in scheduling practices. Using the Scopus database, 724 articles were reviewed and 105 selected for analysis. The average no-show rate was 23 percent, and it is most common in patients: younger, low socioeconomic level, greater distance from home to the clinic, with public health insurance or no insurance, and attended by less experienced provider. The most significant factors are high lead time and high rates of previously missed appointment.

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