A Profile of Patients Who Fail to Keep Appointments in a Veterans Affairs Primary Care Clinic

Missed medical appointments (“no-shows”) affect both staff and other patients who are unable to make timely appointments. No-shows can be prevented through interventions that target those most at risk to miss appointments. Young age, low socioeconomic status, a history of missed appointments, psychosocial problems, and longer wait times are some predictors that previously have been associated with higher no-show rates.

To determine predictors for outpatient appointment no-shows in primary care clinics of the Veterans Affairs Nebraska-Western Iowa Health Care System.

The study included 69,908 noncancelled primary care appointments between January 1, 2012 and December 31, 2013 among patients residing in ZIP codes within the Veterans Affairs Nebraska-Western Iowa Health Care System Service Area. Age, sex, race, presence of a mental health diagnosis, previous no-show rate in the past 2 years, appointment wait time, distance to clinic, and neighborhood deprivation index were extracted or measured for each patient.

In log-binomial models accounting for clustering by ZIP code, the strongest predictors of no-shows were age between 20 and 39 (OR compared to 60+: 3.87, 95% CI, 3.48-4.31) or between 40 and 59 (OR compared to 60+: 2.23, 95% CI, 2.05-2.43), black (OR compared to white: 2.14, 95% CI, 1.98-2.31) or other nonwhite race (OR compared to white: 1.35, 95% CI, 1.17- 1.56), male sex (OR compared to female: 1.30, 95% CI, 1.16-1.45), and presence versus absence of mental health diagnosis (OR: 1.16, 95% CI, 1.09-1.24).

These findings show that individuals who are younger, nonwhite, male, or have been diagnosed with mental health issues are more likely to no-show. Interventions to improve compliance could be targeted at these individuals in order to decrease the burden of no-shows on health care systems.