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Missed appointments and poor glycemic control: an opportunity to identify high-risk diabetic patients

Andrew J Karter1, Melissa M Parker, Howard H Moffet

  • 1Division of Research, Kaiser Permanente, Oakland, California 94612, USA. Andy.J.Karter@kp.org

Medical Care
|January 22, 2004
PubMed

Insights

Patients missing frequent medical appointments had poorer diabetes control, indicated by higher HbA1c levels. This highlights missed appointments as a potential risk indicator for suboptimal self-management and need for targeted care.

Area of Science:

  • Endocrinology
  • Diabetes Management
  • Health Services Research

Background:

  • Missed medical appointments disrupt healthcare continuity, monitoring, and increase costs.
  • Effective diabetes management requires consistent patient engagement and adherence.

Purpose of the Study:

  • To investigate the association between missed appointments and glycemic control (HbA1c) in a large managed care population of diabetic patients.

Main Methods:

  • Cross-sectional analysis of 84,040 diabetic patients from the Kaiser Permanente Northern California Diabetes Registry in 2000.
  • HbA1c levels were compared based on appointment adherence: none missed, 1-30% missed, and >30% missed.
  • Adjusted least-square mean estimates were used, stratified by diabetes therapy and controlling for demographic and clinical factors.

Main Results:

  • Twelve percent of patients missed over 30% of appointments.
  • Higher missed appointment rates correlated with significantly poorer glycemic control (adjusted mean HbA1c 0.70-0.79 points higher for >30% missed).
  • Patients missing >30% of appointments showed less daily self-monitoring of blood glucose and poorer medication adherence.

Conclusions:

  • Frequent missed appointments are linked to worse glycemic control and suboptimal diabetes self-management.
  • Missed appointment rates are easily measurable and can serve as a clinical criterion for identifying patients needing targeted case management.
  • Addressing appointment adherence is crucial for improving diabetes outcomes and healthcare efficiency.
Abstract

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