Why military personnel fail to keep medical appointments

Failure to keep medical appointments, commonly referred to as 'Did Not Attend' (DNA), is a frequent problem in both primary and secondary health care and leads to a waste of valuable resources. Although the reasons for DNA within the general population are well documented, little is known about this behaviour amongst people serving in the armed forces. In this paper we report the findings of a questionnaire-based study investigating the reasons why military personnel fail to keep hospital appointments.

A postal questionnaire asking questions about the reasons for not attending the appointment and how they perceived the condition for which treatment had been sought, were sent to 167 military patients known to have missed appointments in either a hospital outpatient department or regional rehabilitation unit. 162 controls, who attended appointments, were also sent a questionnaire asking them about factors leading to their appointment and how they perceived the condition that they attended the appointment for. Illness perception was measured using a previously validated Illness perception Questionnaire (IPQ-R). The controls were matched by rank, gender and corps.

The overall response rate was 51.5%, with 46% response in the DNA group and 55% in the controls. A previous history of hospital DNA (though not DNA in primary care) and attempting to change the appointment date were associated with DNA (p = 0.01). Those who received a reminder about the appointment were less likely to DNA (p < or = 0.001). Although patients who perceived their condition to be less important were more likely to fail to attend their appointment (p = 0.01), illness perception as measured on the IPQ-R, was not associated with appointment attendance. The most frequent reasons cited for missed appointments were due to administrative problems, with many (38%) respondents being simply unaware that they had an appointment at all or believing that they had cancelled it (14%). Forgetting the appointment (8%) or mixing up the date (21%) were also cited by respondents as reasons for not attending. Only 11% of respondents gave reasons that were specific to a military population, most frequently being on exercise at the time of their appointment. Demographic differences such as age and gender, and practical factors such as appointment day, distance travelled, method of appointment notification, or type of hospital were not found to be associated with attendance.

The most common reasons for not attending appointments were due to administrative error and an inability amongst patients to recall the correct date of the appointment. Whilst efforts to improve attendance through various reminder systems have been found to be effective in the short term at least, improvements in the efficiency of appointment administration is likely to generate a reduction in DNA and in turn will reduce the wastage of resources.