Influence of patient financial account status on orthodontic appointment attendance

To test the null hypothesis that the financial status of a patient's orthodontic contract and other patient and appointment characteristics have no influence on appointment attendance.

During a 6-week period, the last appointment of each active, non-Medicaid patient (n = 538) was recorded as either kept or missed. The financial status of the patient's contract, age, sex, method by which the appointment was made, and the type of appointment scheduled were recorded. Associations between each of these factors and appointment attendance were evaluated using chi(2) analysis. In the case of patients who missed their appointment, attendance at the subsequent reappointment was also evaluated.

The overall appointment failure rate was 12.3%. Males (16.2%) were significantly more likely than females (9.5%) to miss appointments (P = .02). Also, appointments made by postcard (28.2%) were more likely to be missed than those made in person (11.8%) or by phone (6.5%) (P = .003). The most significant factor affecting appointment attendance was the patient's financial status (P = .0001). Patients with accounts that were overdue (33.3%) or in collections (28.6%) were more likely to miss appointments than those whose accounts were current (10.5%). Of patients who missed their appointment (n = 66), 30% also missed the subsequent reappointment.

The null hypothesis was rejected. Patients with delinquent financial accounts were three times as likely to miss an orthodontic appointment as those whose contracts were current. Increased rates of missed orthodontic appointments were also found for males, patients scheduled by mailing a postcard, and patients who had missed their previous appointment.