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Abstract

No-shows for scheduled appointments are a frequent occurrence, creating unused appointment slots and reducing patient quality of care and access to services while increasing loss to follow-up and medical costs. The aim of our study was to determine the factors that lead to patients missing their dental appointments in Eastern Province Military Hospitals, Kingdom of Saudi Arabia. The study population included military personnel and their families attending the dental clinics of these hospitals. In our study, the percentage of missed appointments was 58.1%, while 54.4% of participants canceled dental appointments in the past. Thirty-six percent preferred morning appointments while 56% preferred an afternoon appointment and were likely to miss a morning appointment if given one. The most common reasons for missing an appointment were forgetting about it (24.3%) and the inability to get time off either from work or school (15.4%); 1.5% of patients stated they had a bad dental experience and feared dental treatment while the unavailability of transport accounted for 0.7% of patients. Of the reasons given for canceling an appointment, the inability to get time off from work/school was the most common (22.1%) while a dislike for treatment was the least common (0.7%). Canceling an appointment was significantly correlated with missing an appointment among the surveyed sample (P=0.00). In our research, 60.3% of participants still relied on their personal diary to remember appointments, which could be a reason for the high rate of missed appointments. Fifty-nine percent of respondents felt that missing an appointment was important to them, while 72% stated that missed appointments could affect the work of the clinic but still believed that automatic appointments should be given to patients who missed them and a change be made accordingly. Since major factors included a lack of a reminder message and appointments scheduled at inconvenient timings, some steps that can help reduce the frequency of missed appointments include sending a reminder message to patients, giving preference to their schedules for appointments, giving patients shorter appointments, reducing intervals between subsequent appointments, and educating patients regarding the treatment plan, to reduce anxiety.
Received 02/09/2018
Review began 03/09/2018
Review ended 03/14/2018
Published 03/21/2018
© Copyright 2018
Shabbir et al. This is an open access
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Why Do Patients Miss Dental Appointments
in Eastern Province Military Hospitals,
Kingdom of Saudi Arabia?
Ambreen Shabbir , Mohammad Alzahrani , Areej Abu Khalid
1. Pathology, Prince Sultan Military College of Health Sciences, Dhahran, KSA 2. Vice Dean for
Development and Quality, Department of Dental and Oral Health, Prince Sultan Military College of
Health Sciences, Dhahran. 3. Chairperson, Department of Dental and Oral Health, Prince Sultan Military
College of Health Sciences, Dhahran, Kingdom of Saudi Arabia
Corresponding author: Ambreen Shabbir, drambreen2018@gmail.com
Disclosures can be found in Additional Information at the end of the article
Abstract
No-shows for scheduled appointments are a frequent occurrence, creating unused appointment
slots and reducing patient quality of care and access to services while increasing loss to follow-
up and medical costs. The aim of our study was to determine the factors that lead to patients
missing their dental appointments in Eastern Province Military Hospitals, Kingdom of Saudi
Arabia. The study population included military personnel and their families attending the
dental clinics of these hospitals. In our study, the percentage of missed appointments was
58.1%, while 54.4% of participants canceled dental appointments in the past. Thirty-six percent
preferred morning appointments while 56% preferred an afternoon appointment and were
likely to miss a morning appointment if given one. The most common reasons for missing an
appointment were forgetting about it (24.3%) and the inability to get time off either from work
or school (15.4%); 1.5% of patients stated they had a bad dental experience and feared dental
treatment while the unavailability of transport accounted for 0.7% of patients. Of the reasons
given for canceling an appointment, the inability to get time off from work/school was the most
common (22.1%) while a dislike for treatment was the least common (0.7%). Canceling an
appointment was significantly correlated with missing an appointment among the surveyed
sample (P=0.00). In our research, 60.3% of participants still relied on their personal diary to
remember appointments, which could be a reason for the high rate of missed appointments.
Fifty-nine percent of respondents felt that missing an appointment was important to them,
while 72% stated that missed appointments could affect the work of the clinic but still believed
that automatic appointments should be given to patients who missed them and a change be
made accordingly. Since major factors included a lack of a reminder message and appointments
scheduled at inconvenient timings, some steps that can help reduce the frequency of missed
appointments include sending a reminder message to patients, giving preference to their
schedules for appointments, giving patients shorter appointments, reducing intervals between
subsequent appointments, and educating patients regarding the treatment plan, to reduce
anxiety.
Categories: Other, Epidemiology/Public Health
Keywords: missed dental appointments, eastern province military hospital, kingdom of saudi arabia
Introduction
Although general medicine and surgery suffer from non-attendance, it is especially prevalent
1 2 3
Open Access Original
Article DOI: 10.7759/cureus.2355
How to cite this article
Shabbir A, Alzahrani M, Abu khalid A (March 21, 2018) Why Do Patients Miss Dental Appointments in
Eastern Province Military Hospitals, Kingdom of Saudi Arabia?. Cureus 10(3): e2355. DOI
10.7759/cureus.2355
in dental practice [1], causing detrimental effects on its outcome and revenue [2-3]. Patients
may miss their dental appointments for several reasons. Even if the reason is justifiable from
the patient’s point of view, it still has a negative impact on the clinic, which eventually trickles
down to the entire health system. The impact of missed dental appointments is not as simple as
it appears, as the patient not only denies dental care to himself but others as well [4]. At the
same time, they interrupt their continuity of care, affect workflow, waste resources, and reduce
population-wide access to care [1,5-6].
The economic effect alone of dental patients missing their appointments was estimated at
around 65 pounds per appointment according to a study conducted in the United Kingdom in
1997. The same study stated that out of 14-million patients seen in outpatient dental clinics per
year, the national rate of nonattendance at appointments was around 12%, which cost the
health ministry around 300 million pounds per year [7]. The resources employed by the dental
clinic remain idle and underutilized while the dentist waits for the patient to show up and the
next patient in line has to wait longer [3]. From the patient’s perspective, if the diagnosis of a
particular problem is delayed due to a missed appointment, it delays treatment, thus
threatening the patient’s dental health [6].
Most investigations related to causal factors for missing dental appointments have had low
response rates (30% to 40%) and are difficult to interpret [7]. However, some common reasons
that previous studies have unearthed include unforeseen circumstances, fear of dental
treatment, lack of travel facilities, laziness, and forgetfulness [4]. The average non-attendance
rate at outpatient clinics in the United Kingdom was reported to be 12%, out of which 30%
claimed forgetfulness and 8% no longer felt the need for treatment. One participant revealed
that he failed to attend his appointment due to a fear of being seen by a junior doctor, who he
believed was inexperienced, while another participant pointed out that he was previously
mistreated by the management at the clinic [7]. Similar research conducted at the Kuwait
University Dental Center suggested that most no-show dental appointments were significantly
influenced by the complexity of the treatment planned, concluding that fear plays an important
role in this regard, as most patients were afraid of complex procedures (root canals and
extractions), the frequency of which is relatively low compared to regular check-ups [8].
Many patients in Saudi Arabia miss dental appointments each year, which has a significant
impact on its health care system as well as the individual clinics [6]. No-shows not only reduce
access to care but also interrupt the continuity of care and effective disease management for
patients [1]. Studies conducted previously in Saudi Arabia focused more on the consequences of
missed dental appointments and concentrated on college students and demographics such as
gender. However, to devise a solution to this problem, it must be understood from a broader
perspective in Saudi Arabia [6]. This research aimed at finding out the factors responsible for
patients missing their dental appointments so preventive steps could be taken in order to
reduce its devastating consequences in Eastern Province Military Hospitals, Kingdom of Saudi
Arabia.
Materials And Methods
The study was conducted after receiving approval from the Research Ethics Committee, Prince
Sultan Military College of Health Sciences, in Dhahran. Our target population was military
officers and their families who came for their dental checkups and treatment at Armed Forces
Hospital in Jubail, King Fahd Military Medical Complex in Dhahran, and Air Base Hospital in
Dhahran. A total of 150 patients visiting the dental clinics were selected at random. The
method for collecting data was through a self-administered questionnaire (Appendix A), which
was used by researchers at King Saud University in Riyadh [9] after obtaining permission from
them and was developed according to the questions mentioned in the article. For those patients
2018 Shabbir et al. Cureus 10(3): e2355. DOI 10.7759/cureus.2355 2 of 12
who preferred answering in Arabic, the questionnaire was translated into Arabic as well. The
questionnaires were handed out to patients at different times of the day and were collected
once filled out. Options in the questionnaire had several category choices of "yes/no/do not
know." A tickbox layout was used to provide appropriate answers. After collecting the
questionnaires from the patients, the answers were coded and entered into an Excel sheet and
submitted to a statistician for analysis. The distributions of all qualitative variables (i.e.,
closed-ended)/values of the sample were examined with frequency tables. Comparison tables
were calculated to find an association wherever necessary, and for comparing variables, we
used the chi-square test and McNemar’s test.
Inclusion criteria
Literate patients (male/female) who are attending military hospitals in the Eastern Province
were included in this study.
Exclusion criteria
Dental staff and patients who could not read or write were excluded from the study.
Results
A total of 150 questionnaires were distributed, of which 136 were received, giving us a response
rate of 90.6%. Thirty-six percent of participants were males, 64% were females, 35.3% were
students, and 46.3% were employed, as depicted in Table 1.
Demographic variable
Gender Frequency %
Male 49 36
Female 87 64
Occupation Frequency %
Student 48 35.3
Employed 63 46.3
Age Group Frequency %
12–15 years 5 3.6
16–19 years 22 16
>20 years 110 80
TABLE 1: Distribution of the sample by age, gender, and occupation
We found that 60.3% respondents used their diaries and 5.9% relied on their memory for
remembering their dental appointments, as seen in Table 2.
2018 Shabbir et al. Cureus 10(3): e2355. DOI 10.7759/cureus.2355 3 of 12
Method of Remembering Dental Appointment Date Frequency %
Diary 82 60.3
Calendar 14 10.3
Memory 8 5.9
Another person 4 2.9
Mobile 2 1.5
TABLE 2: Distribution of the sample by methods used for remembering appointments
When asked for the reasons why they previously canceled their dental appointments, 22.1%
patients answered that they were unable to get time off from work/school and 24.3% admitted
to forgetting their appointment, as tabulated in Table 3.
Reason for Cancelation of the appointment Number %
Inconvenient timing 8 5.9
Unable to get off work/school 30 22.1
Unable to get transport 12 8.8
Sickness 2 1.5
Fear of treatment 2 1.5
Dislike of treatment 1 0.7
Reason for missing the appointment
Forgetfulness 33 24.3
Unable to get time off work 21 15.4
School 7 5.1
Unable to get transport 1 0.7
Sickness 2 1.5
Fear of treatment 2 1.5
TABLE 3: Patients’ reasons for canceling and missing dental appointments
The association between missed and cancelled appointments is shown in Table 4, with chi-
square = 14.10 (p = 0.00). The associations between cancelled appointments and gender, missed
2018 Shabbir et al. Cureus 10(3): e2355. DOI 10.7759/cureus.2355 4 of 12
appointments and gender, and missed appointments and age group were calculated but did not
give a significant p-value (chi-square = 0.22, p = 0.64; chi-square = 1.57, p = 0.21; chi-square =
1.79, p = 0.41, respectively).
Have you ever missed an appointment at this
clinic?
Yes No Total
Have you ever canceled an appointment at this
clinic?
Yes
54 20 74
73.0% 27.0% 100.0%
No
25 36 61
41.0% 59.0% 100.0%
Total
79 56 135
58.5% 41.5% 100.0%
TABLE 4: Association between missed and canceled appointments
chi-square = 14.10, p = 0.00
We recorded the participants' responses about the consequences of missed appointments in
Table 5.
2018 Shabbir et al. Cureus 10(3): e2355. DOI 10.7759/cureus.2355 5 of 12
Should Another Appointment Automatically Be
Sent?
Patients Who Missed
an Appointment
Patients Who Never
Missed an Appointment Total
Yes 106 79 57 136
No 30 56 80 136
Do not know 0 0 0
Total 136 136 136
When Should an Appointment Be Sent? Frequency %
No answer provided 33 24
After the first missed appointment 69 50.3
After every missed appointment 35 25.5
Total 137 99.5
If you fail to attend an appointment without prior
notification does it matter to you?
Yes No Don’t
know
81 29 26
Do you think missing an appointment affects the
clinic?
Yes No Don’t
know
99 12 24
TABLE 5: Response to the consequences of missed appointments among the
surveyed sample
Seventy-nine patients who had previously missed a dental appointment believed that another
appointment should automatically be given to a patient once he/she misses an appointment,
while 80 patients who never missed an appointment answered in the negative. When asked if
missing an appointment affects the clinic, 99 patients who had previously missed an
appointment answered in the affirmative, while only 12 respondents who had never missed
dental appointments said it did not affect the clinic.
Discussion
No-shows for scheduled appointments are a frequent occurrence, creating unused appointment
slots, reducing patient quality of care and access to services, while increasing loss to follow-up
and medical costs [1]. The study purpose was identifying factors that lead to patients missing
their dental appointments in Eastern Province Military Hospitals, Dhahran. In our research, the
percentage of missed appointments was found to be 58.1%, which is higher than the 24.8%
reported in a study conducted in Riyadh, Saudi Arabia [9] and the 36.8% reported in a study in
India [4]. Our study calculated 54.4% of the participants who canceled dental appointments in
the past, which is higher than the 40.5% in Dr. Salwa Alsadhan’s study [9]. Out of our study
population, 36% of patients preferred morning appointments, while 56% preferred afternoon
2018 Shabbir et al. Cureus 10(3): e2355. DOI 10.7759/cureus.2355 6 of 12
appointments, which means that if these patients (56%) were given a morning appointment,
they would most likely miss it, as their preference was an afternoon appointment.
The most common reasons for missing an appointment were forgetting about it (24.3%) and the
inability to get time off either from work or school (15.4%), which is consistent with the
findings of most of the previous studies [9-13]. In our research, we found that only 1.5% of
patients feared dental treatment, while the unavailability of transport accounted for 0.7% of
missed appointments. Dr. Salwa Alsadhan's study identified 9.1% of patients claiming lack of
transport as the reason for missing their dental appointment [9]. For canceling an appointment,
inability to get time off from work/school was the most common reason (22.1%), which is
similar to a number of studies [9,14] but different from a study done in 1991, which stated
illness to be the most common reason [15]. Dislike of treatment for the cancelation of an
appointment was the least common (0.7%) in our study while being most prevalent in a study
conducted in the United Arab Emirates [16]. The association between canceling and missing an
appointment (Table 4) was found to be statistically significant (p=0.00), which might indicate
that patients who canceled their appointments were more likely to miss an appointment (73%)
compared to patients who never canceled their appointments (41%). In our research, 60.3% of
participants still relied on their personal diary to remember appointments (Table 2), which
could be a reason for the high rate of missed appointments, as 24.3% stated they forgot their
appointment (Table 3). Studies suggested a high percentage of individuals making a mental
note of their dental appointments [9]. It would be reasonable to assume that missed
appointment rates could be reduced if patients were advised to use their mobile
phones/computers to record and remember their appointments and if reminder
messages/confirmation calls were sent to patients a day prior to their appointment [2,4,9,11].
However, some studies point out that the effect of reminder calls is not confirmatory [12], thus
underlining the importance of further, large sample studies.
In our study, females were found to cancel and miss dental appointments more than males
although the differences were insignificant (p = 0.64 and p = 0.21, respectively). These numbers
differ from a study [17] that suggested males having a higher missed appointment frequency
while others suggested females miss more appointments [14].
Fifty-nine percent of respondents felt that missing an appointment was important to them,
while 72% stated that it could affect the work of the clinic but still believed that automatic
appointments should be given to patients who missed their appointments and a charge be made
for such missed appointments (Table 5), which has been suggested by some researchers [18-19].
In dental practice, missing appointments can disrupt the patients’ treatment to a large extent.
For example, orthodontic treatment relies on regularly adjusting appliances and monitoring
the progress of occlusal changes, whereas the early detection and treatment of carious lesions
and gingival and periodontal disease demand regular dental visits, and missing appointments
can seriously limit treatment efficiency. Therefore, to control missed and canceled
appointments, the dental team must educate the patient on their first visit and cautiously
communicate the importance of maintaining the appointment schedule and its effect on
treatment outcomes. The patient should also be told how and when they can inform the clinic
in case they were unable to make it to their appointment [20].
Future studies should focus on the methods that can reduce or eliminate missed and canceled
appointments and encourage patients’ attendance in order to enhance the treatment outcome
in addition to improving the economics and quality of dental practice.
Conclusions
2018 Shabbir et al. Cureus 10(3): e2355. DOI 10.7759/cureus.2355 7 of 12
Our study identified a high percentage of patients who miss their dental appointments in the
Eastern Province Military Hospitals, Kingdom of Saudi Arabia, causing not only detrimental
effects for the patient community but also a wastage of resources at military hospitals. Since
the major reasons found were a lack of reminder message and appointments scheduled at
inconvenient timings, steps to reduce the frequency of missed appointments should include
sending reminder messages to patients, giving preference to their schedules for appointments,
giving them shorter appointments, reducing the intervals between subsequent appointments,
and educating them regarding the treatment plan to reduce anxiety. Our study sample was
small and centered around military hospitals, which may not be representative of the entire
population. New studies should be conducted with a larger representative sample size to
investigate factors responsible for no-shows so that steps can be taken to prevent them.
Appendices
Appendix A
C O N F I D E N T I A L
Dear Patients:
Please take a few minutes to answer this questionnaire about the following study titled
‘‘Why Patients Miss Dental Appointments in the Eastern Province Military Hospitals, Kingdom
of Saudi Arabia.”
“Participation is optional and opting not to participate in this survey shall not in any way affect
your professional status or relationship with the students. The intent of this survey is harmless
and the information provided will remain strictly confidential and will never be used for
purposes other than the intended purpose of this study.
Thank you for your cooperation.
Principal Investigators:
Dr. Ambreen Shabbir
Lt. Col./Dr. Mohammad Al Zahrani
Prince Sultan Military College of Health Sciences,
Department of Dental and Oral Health,
Dhahran, 31932
Cell phone 966556966683
Phone 966-3-8440000, Ex. 6756
Fax# 966-3-840-5577
Questionnaire:
2018 Shabbir et al. Cureus 10(3): e2355. DOI 10.7759/cureus.2355 8 of 12
We would be grateful if you would take a few minutes and complete this questionnaire.
Please tick the appropriate box.
1. Age: ______________________
2. Gender: Male Female
3. Occupation: Student Employee Other (specify) ____________
4. Education: Illiterate Elementary Intermediate
Secondary University and above
5. How do you remember your appointment date?
Diary
Mobile
Calendar
Memory
Another person
Other (specify) ______________________________________________________
6. Have you ever had to cancel an appointment at this clinic? Yes No
If the answer is no to Q6, please skip Q7.
7. Reasons for canceling an appointment (you can choose more than one answer)
Inconvenient timing
Unable to get off work/school
Unable to get transport
Sickness
Fear of treatment
Dislike of treatment
Other reasons (please specify) _______________________________________
8. Have you ever failed to attend an appointment at this clinic without prior notification?
Yes No
2018 Shabbir et al. Cureus 10(3): e2355. DOI 10.7759/cureus.2355 9 of 12
If the answer is no to Q8 then please skip Q9.
9. Reasons for failing to attend an appointment (you can choose more than one answer)
Forgetfulness
Unable to get time from work/school
Unable to get transport
Sickness
Fear of treatment
Dislike toward treatment
Other reasons (specify)_____________________________
10. If a patient fails to attend an appointment, do you think that another appointment should
automatically be sent to them? Yes No
11. If yes, when do you recommend should an appointment be sent?
After the first missed appointment
After every missed appointment
12. If you fail to attend an appointment without prior notification:
Does it matter to you? Yes No Don’t know
Do you think it affects the clinic? Yes No Don’t know
13. If you need to change an appointment, how much notice do you think should be acceptable
to the hospital/clinic?
At least 24 hours before appointment time
Less than a week
One week
More than a week
14. What is your preferred time for attending an appointment?
Early morning
Late morning
2018 Shabbir et al. Cureus 10(3): e2355. DOI 10.7759/cureus.2355 10 of 12
Early afternoon
Late afternoon
No preference
15. How do you think a patient who misses his/her appointment should be dealt with?
Do not give him/her new appointment before 6 months.
Put him/her on the waiting list.
They should not be given any further appointments at all.
Thank you for your cooperation in completing this questionnaire.
Additional Information
Disclosures
Human subjects: Consent was obtained by all participants in this study. Institutional Review
Board (IRB), Prince Sultan Military College of Health Sciences, Dhahran, KSA. issued approval
RU-2016-SGP-009. We are pleased to inform you that student graduation project with details
mentioned below was reviewed with no further comments. Title: Why patients miss dental
appointments? Application #: RU-2016-SGP-009 Funding source: Non-funded Principal
investigator: Col. Mohammad Alzahrani and Dr. Ambreen Shabbir . Animal subjects: All
authors have confirmed that this study did not involve animal subjects or tissue. Conf licts of
interest: In compliance with the ICMJE uniform disclosure form, all authors declare the
following: Payment/services info: All authors have declared that no financial support was
received from any organization for the submitted work. Financial relationships: All authors
have declared that they have no financial relationships at present or within the previous three
years with any organizations that might have an interest in the submitted work. Other
relationships: All authors have declared that there are no other relationships or activities that
could appear to have influenced the submitted work.
Acknowledgements
We would like to thank Armed Forces Hospital in Jubail, King Fahd Military Medical Complex in
Dhahran, and Airbase Hospital in Dhahran for allowing us to conduct research in their dental
departments. We would also like to extend our appreciation to Mr. Zachariah Arulananathacn
for the analysis of study data.
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Article
Introduction Failed patient attendance in a university dental clinic is detrimental to the student learning experience, the university as a business, and to members of the public awaiting urgent dental treatment. Purpose This study aimed to identify the demographic, appointment characteristics, and time‐related factors associated with patient attendance in a university dental clinic from 2015 to 2019. Methods A 5‐year retrospective analysis was conducted in 2020 on data extracted from the Griffith University Dental Clinic patient management system. Following data cleaning and categorization, the dataset was downloaded into SPSS for statistical analysis. Frequencies, odds ratio, and chi squared were used to determine the demographic and time‐related factors of patients who had completed, cancelled, and failed to attend (FTA) appointments. Results A total of 23.4% of appointments were cancelled, and 6.6% were FTA. Demographics associated with cancellations include females, adults aged 25 to 44, and private paying patients. FTA were higher in young adults aged 19 to 24, low to mid‐range socioeconomic status (SES) and those eligible for publicly funded dental treatment. Mondays and Fridays experienced the greatest number of FTA and cancellations, respectively. Emergency appointments had the greatest attendance rates and endodontic procedures the lowest. Conclusion The loss of clinical teaching hours, resources, and revenue necessitates the implementation of targeted strategies to minimize cancellations and FTA based on demographic and appointment characteristics that may render individual as high risk for failed attendance.
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Purpose: Missed appointments in outpatient registration pose challenges for hospital administrators, especially in the context of China's shortage of medical resources. Previous studies have identified factors that affect healthcare access via traditional appointment systems. Few studies, however, have specifically investigated Internet appointment systems. Therefore, this study explored the key factors related to missed appointments made on the Internet appointment system of a general hospital in Jinan, Shandong Province. Methods: Online appointment data were collected from the outpatient department of a general hospital in Jinan from September 2017 to February 2018. Logistic regression was used to analyze the relative importance of eight variables: gender, age, interval between scheduling and appointment, day of the week, physician's academic rank, appointment fee, previous missed appointments, and clinical department. Results: A total of 48,777 online appointment records were collected, which included a 15% no-show rate. The key factors associated with no-shows included age, interval between scheduling and appointment, previous missed appointments, and clinical department. No significant relationships were found between no-shows and gender, day of the week, and appointment fee. Conclusion: No-show rates were influenced by many factors. Based on this study's findings, targeted measures can be taken to decrease no-show frequency and improve medical efficiency.
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Unkept outpatient appointments are a drain on resources. In a prospective study we asked non-attenders at a gastroenterology clinic why they had missed their appointment. 103 patients missed their appointment (14% of the total invited); 3 had died. The remaining 100 were asked to complete questionnaires, 68 by mail (43 returned) and 32 by telephone (30 successful); the response rate was thus 73%. 49 of the respondents were new patients, 6 of them with urgent referrals. The explanations for non-attendance by the 73 patients were: forgot to attend or to cancel (30%); no reason (26%); clerical errors (10%); felt better (8%), fearful of being seen by junior doctor (3%); inpatient in another hospital (3%); miscellaneous other (20%). 13 (27%) of the review patients had not kept one or more previous appointments. The non-attendance rates for different clinics ranged from 10% to 25% (average 14%). A substantial number of non-attenders claimed to have forgotten their appointment or to cancel it. If, as we surmise, this reflects apathy, no strategy to improve attendance is likely to have great impact. Since the non-attendance rate is reasonably constant, it can be taken into account when patients are booked.
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Introduction: Missed appointments are an issue which have been very commonly noticed but overlooked in Indian dental society. Almost every dentist, general or specialized, private or public, has faced this problem in routine practice but very less research has been conducted on this issue in Asian countries. Aim: The aim of this study was to determine the frequency and distribution of missed dental appointments among children and the reasons behind the non-attendance in department of paediatric and preventive dentistry. Materials and methods: Patients under 15 years of age who reported during the period March through August 2014 were included in this study. Attendance data and demographical data for patients was obtained from patient records and the hospital database. The type of treatment patients were to receive was gathered from the appointment diaries of staff, postgraduate students and undergraduates. A structured questionnaire regarding the most frequent reasons given by patients for not attending the scheduled appointment was also prepared. The data were analysed using descriptive analysis. Results: Of the total 2294 patients 886 patients failed to come on their scheduled appointment. Percentage of patients who missed their appointments was 38.6%. A 38.2% of them required primary teeth pulp therapy. No significant differences was found between genders regarding the prevalence of missed dental appointments. Only 40% dentist witnessed that the most common reason for their patients to miss dental appointment was "no leave from school". Illness was the second frequent excuse heard by dentists (5/20= 25%) from their patients and attendants. Conclusion: Missed dental appointment was found to be a common issue in paediatric age group. Counseling and motivation is required to be done at first dental visit to reduce the chances of missed appointment.
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Objective: Evaluate an NHS in- and out-of-hours urgent dental service (UDS) including both a telephone triage provider (TTP) and a sole clinical provider (CP) using a quality framework. Basic research design: Analysis of activity and patient experience data. Main outcome measures: Ratio of volume of services to activity provided; distance and time travelled; appropriateness of referrals and treatments; equity of utilisation; patient experience; cost per patient. Results: Almost all calls (96.6%) to the TTP were answered within 60 seconds and of people referred to the CP 96.0% needed treatment. Proportionately more people from deprived areas used the TTP. Highest utilisation of the TTP was by people aged 20 to 44 years and lowest was by people over 54 years. Cost per patient utilising the TTP was 5.06 pound. Of the available appointments provided by the CP, 90.9% were booked the TTP. Travel time to the CP was less than 30 minutes for 78.0% of patients. Of treatments provided, 77.9% were clinical interventions and 18.1% were prescription only. Proportionately more people from deprived areas attended the CP. Highest utilisation was by people aged 20 to 44 years and lowest by people over 54 years. Nearly half (47.0%) of those attending reported they did not have a dentist. There was a high level of patient satisfaction. Cost per course of treatment at the CP was 67.41 pound. Conclusion: Overall the UDS provided a high quality service in line with Maxwell's dimensions of quality. Timely advice and treatment was provided with high levels of patient satisfaction with the CP. Comparison with other urgent dental service models would determine the relative efficiency of the UDS.
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Patient no-shows for scheduled primary care appointments are common. Unused appointment slots reduce patient quality of care, access to services and provider productivity while increasing loss to follow-up and medical costs. This paper describes patterns of no-show variation by patient age, gender, appointment age, and type of appointment request for six individual service lines in the United States Veterans Health Administration (VHA). This retrospective observational descriptive project examined 25,050,479 VHA appointments contained in individual-level records for eight years (FY07-FY14) for 555,183 patients. Multifactor analysis of variance (ANOVA) was performed, with no-show rate as the dependent variable, and gender, age group, appointment age, new patient status, and service line as factors. The analyses revealed that males had higher no-show rates than females to age 65, at which point males and females exhibited similar rates. The average no-show rates decreased with age until 75-79, whereupon rates increased. As appointment age increased, males and new patients had increasing no-show rates. Younger patients are especially prone to no-show as appointment age increases. These findings provide novel information to healthcare practitioners and management scientists to more accurately characterize no-show and attendance rates and the impact of certain patient factors. Future general population data could determine whether findings from VHA data generalize to others.
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Objectives To determine the frequency of missed and cancelled orthodontic appointments in the dental college in Riyadh, Saudi Arabia besides the assessment of the factors that may influence the patients’ attendance to their appointments. Methods Self administrated questionnaires were handed by the receptionist in the waiting room to all booked patients undergoing active treatment in the orthodontic clinic. The questionnaire included questions pertaining to socio-demographic characteristics, methods of remembering appointments and reasons for cancelling and missing appointments. Results Of the surveyed sample, 27.8% relied on their memory to remember their appointments and 24.2% used their computers or mobiles as a means of reminders. Of the respondents, 24.8% stated that they have missed an appointment and 40.5% had to cancel one. When asked about the reasons for missing an appointment, the highest percentage of the patients missed an appointment due to forgetfulness followed by inability to get time off from work/school. For cancelling an appointment the highest percentage stated that they were unable to get time off to come to their appointment. Cancelling an appointment was found to be significantly correlated with missing an appointment among the surveyed sample (P < 0.0001). Conclusions Around one fourth of the patients attending the orthodontic clinics missed their appointments and the most frequent reasons were forgetfulness and inability to get time off from work/school. No differences were found in missed appointments between both genders and different age groups.
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Non-Attended appointments in health care facilities create inefficiencies and loss of clinical productivity: clinical teaching hours are reduced, impacting students' ability to meet the competencies necessary for professional registration. The aim of this study was to assess demographic and time-related factors for patient non-Attendance at a dental school clinic in Australia. Appointment data were extracted from the patient management system for the years 2011 and 2012. Data included the status of appointment (attended, cancelled, or failed to attend [FTA]) and an array of demographic and time-related factors. Multinomial logistic regression was conducted to assess relationships between these factors and appointment status. Attendance rates were also compared by year following implementation of a short message service (SMS) reminder at the beginning of 2012. The results showed that, of 58,622 appointments booked with students during 2011 and 2012, 68% of patients attended, 23% cancelled, and 9% were FTA. The percentage of non-Attended (cancelled or FTA) appointments differed by demographic and time-related factors. Females were 7% less likely to be FTA, those aged 16-24 years were five times more likely to be FTA, and early morning appointments were 18% less likely to be cancelled and FTA. With the SMS reminder system, the odds of a cancellation were 15% higher, but FTAs were 14% lower (both were statistically significant differences). This study found that failing to attend an appointment was significantly related to a number of factors. Clinical scheduling and reminder systems may need to take these factors into account to decrease the number of teaching hours lost due to patients' missing their appointments.
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The aim of this study was to determine the prevalence of missed dental appointments in the U.A.E and to assess the factors involved. Random sample of 155 patients and 50 dentists was selected and data was collected from these parties using questionnaires. Analysis of data from these questionnaires provided information regarding the prevalence of this issue and its causative factors. Appointment and financial data was then collected from two private clinics and compared with the data obtained from the dentist and patient questionnaires. On average, 22.5% of dental appointments in the U.A.E are missed. The most common reasons for missing dental appointments according to patients were fear of pain and having an emergency or circumstance. The most significant factors involved were patient age, patient income, patient education, presence of pain, and patient psychology. Results showed that missed dental appointments cause an average loss of AED 800 (USD 220) per day for a dental clinic. It was concluded that this rate of missed dental appointments was unacceptable because of its negative impact on all involved parties. The key in dealing with this issue lies in altering patient psychology during the first appointment and through the implementation of missed dental appointment policies.
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Objective Broken appointments cause adverse outcomes in healthcare systems: They interrupt continuity of care, waste resources, affect workflow, and reduce population-wide access to care. A better understanding of dental appointment-keeping behavior would support efforts toward designing novel interventions aimed at reducing rates of broken appointments.Methods The authors conducted a conceptual review of quantitative and qualitative research on dental appointment-keeping in the United States.ResultsResearch in this area is limited. Providers tend to use a blunt instrument to improve appointment-keeping: a system of reminder calls. There is evidence that patients with higher rates of broken dental appointments are the very ones who are most in need of care. Appointment-keeping barriers are multifactorial and related to social issues. They can be described as falling into three overlapping categories: psychological barriers, structural barriers, and health literacy barriers.Conclusions Appointment-keeping interventions could simultaneously address social factors that exacerbate illness and improve workflow and finances. There arises an opportunity to design innovative patient-centered interventions tailored to particular barriers.