A Comparative Survey of Missed Initial and Follow-Up Appointments to Psychiatric Specialties in the United Kingdom

Department of Liaison Psychiatry, Leicester General Hospital, UK.
Psychiatric Services (Impact Factor: 2.41). 07/2007; 58(6):868-71. DOI: 10.1176/appi.ps.58.6.868
Source: PubMed


Missed appointments are common in psychiatry. Nonattendance at the initial appointment may have different prognostic significance than nonattendance at subsequent appointments. This study examined the frequency of missed appointments among 9,511 initial outpatient appointments and 7,700 follow-up appointments across ten psychiatric subspecialties in a publicly funded mental health service in the United Kingdom.
The pooled missed appointment rate was 15.9%, higher than in previous studies on primary and secondary care attendance in the United Kingdom. Nonattendance was lowest on Fridays, in winter months, and in geriatric psychiatry and highest for substance abuse services and in community psychiatry. In most services, attendance improved after the initial appointment, but in psychosomatic medicine and geriatric psychiatry this pattern was reversed.
There was a low rate of missed appointments in geriatric psychiatry, rehabilitation psychiatry, cognitive-behavioral therapy, and psychosocial medicine. A high nonattendance rate was found among persons with drug and alcohol difficulties and to a lesser extent in general adult psychiatry. Future studies should consider initial and follow-up appointments as distinct.

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Available from: Alex J Mitchell, Sep 21, 2015
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    • "Therefore it may be speculated that prior physiatrists referred the cases who already have attended the clinical visits regularly. Various factors including an ethnic minority, lower socioeconomic status, lack of health insurance, low educational status, unemployment, single, a personality disorder or a substance use disorder have been associated with dropout (Mitchell and Selmes, 2007; Olfson et al., 2009). Additionally, not taking psychotropic medications, younger age and poor family support have been causative factors for nonattendance (Kruse et al., 2002). "
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    ABSTRACT: Dropout is a common problem in the treatment of psychiatric illnesses including bipolar disorders (BD). The aim of the present study is to investigate illness perceptions of dropout patients with BD. A cross sectional study was done on the participants who attended the Mood Disorder Outpatient Clinic at least 3 times from January 2003 through June 2008, and then failed to attend clinic till to the last one year, 2009, determined as dropout. Thirty-nine dropout patients and 39 attendent patients with BD were recruited for this study. A sociodemographic form and brief illness perception questionnaire were used to capture data. The main reasons of patients with BD for dropout were difficulties of transport (31%), to visit another doctor (26%), giving up drugs (13%) and low education level (59%) is significant for dropout patients. The dropout patients reported that their illness did not critically influence their lives, their treatment had failed to control their illnesses, they had no symptoms, and that their illness did not emotionally affect them. In conclusion, the nonattendance of patients with serious mental illness can result in non-compliance of therapeutic drug regimens, and a recurrence of the appearance symptoms. The perception of illness in dropout patients with BD may be important for understanding and preventing nonattendance. Copyright © 2015 Elsevier B.V. All rights reserved.
    Asian Journal of Psychiatry 04/2015; 15. DOI:10.1016/j.ajp.2015.04.006
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    • "social media sites and snowball techniques (Liamputtong, 2013). As reported by Mitchell and Selmes (2007), women with mental health disorders have often been reluctant to seek help for iatrogenic sexual problems; therefore, we did not recruit through health professionals or clinics. Women were screened using a brief emailed questionnaire to ensure inclusion criteria were met and to attempt to identify factors other than SSRIs, such as a recent illness or addition of a new medication, which may Psychology & Health 3 have impacted on sexual difficulties . "
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    ABSTRACT: Abstract A growing body of evidence has highlighted the sexual side effects of selective serotonin reuptake inhibitor (SSRI) medication. Whilst most of the research has focused on the prevalence and treatment of sexual difficulties, little is known about how patients cope with the SSRI related sexual side effects. The objective of this study was to explore women's experiences of coping with the sexual side effects of SSRI medication and interpretative phenomenological analysis (IPA) was employed for an in-depth exploratory study of a sample of ten women. Four broad themes emerged which are discussed under the following headings: searching, suffering in silence, trying to resolve and accepting what is. The themes provide an insight into the different strategies used by women to cope with the sexual side effects of SSRI medication and highlight the importance of contextualising these difficulties as part of an overall approach to improve the management and treatment of SSRI related sexual side effects.
    Psychology and Health 07/2014; 29(12):1-32. DOI:10.1080/08870446.2014.940951 · 2.13 Impact Factor
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    • "The fact that a higher percentage of patients in the substance abuse unit cancelled appointments following a text-message rather than a telephone reminder suggests that this particular group of patients may be more receptive to text-messaging than telephone reminders. It is well known that non-attendance rate among patients with mental disorders is high (up to 40%) [18,19], predominantly among patients with alcohol and drug abuse (18-36%) [20]. This is probably linked to the fact that patients suffering from substance abuse or mental disorders in general may have increased socio-economic difficulties and impairment complicating their regular access to care [18,21]. "
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    ABSTRACT: Background Telephone or text-message reminders have been shown to significantly reduce the rate of missed appointments in different medical settings. Since text-messaging is less resource-demanding, we tested the hypothesis that text-message reminders would be as effective as telephone reminders in an academic primary care clinic. Methods A randomized controlled non-inferiority trial was conducted in the academic primary care division of the Geneva University Hospitals between November 2010 and April 2011. Patients registered for an appointment at the clinic, and for whom a cell phone number was available, were randomly selected to receive a text-message or a telephone call reminder 24 hours before the planned appointment. Patients were included each time they had an appointment. The main outcome was the rate of unexplained missed appointments. Appointments were not missed if they were cancelled or re-scheduled before or independently from the intervention. We defined non-inferiority as a difference below 2% in the rate of missed appointments and powered the study accordingly. A satisfaction survey was conducted among a random sample of 900 patients (response rate 41%). Results 6450 patients were included, 3285 in the text-message group and 3165 in the telephone group. The rate of missed appointments was similar in the text-message group (11.7%, 95% CI: 10.6-12.8) and in the telephone group (10.2%, 95% CI: 9.2-11.3 p = 0.07). However, only text message reminders were cost-effective. No patient reported any disturbance by any type of reminder in the satisfaction survey. Three quarters of surveyed patients recommended its regular implementation in the clinic. Conclusions Text-message reminders are equivalent to telephone reminders in reducing the proportion of missed appointments in an academic primary care clinic and are more cost-effective. Both types of reminders are well accepted by patients.
    BMC Health Services Research 04/2013; 13(1):125. DOI:10.1186/1472-6963-13-125 · 1.71 Impact Factor
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