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'Getting to clinic study': A mixed methods study of families who fail to attend hospital outpatient clinics
Carey-Ann Christie-Johnston1, Rachel O'Loughlin2,3, Harriet Hiscock2,3,4
1Centre for Community Child Health, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
Insights
Many parents miss paediatric appointments because they don't receive reminders or have trouble rescheduling. Improving hospital communication systems and offering easier rescheduling options, like text messaging, can significantly boost clinic attendance.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Patient Adherence
Background:
- High rates of non-attendance at pediatric hospital outpatient clinics are a significant concern.
- Understanding parent-reported reasons for missed appointments is crucial for improving healthcare access.
Purpose of the Study:
- To identify modifiable system and parent factors contributing to missed pediatric outpatient appointments.
- To gather parent perspectives on potential changes to reduce non-attendance rates.
Main Methods:
- Qualitative interviews were conducted with 50 parents of children (aged 0-18) who missed scheduled appointments.
- Participants were from a tertiary children's hospital in Melbourne, Australia.
Main Results:
- Key reasons for non-attendance included not receiving appointment letters (26%) or text reminders (32%), and difficulties rescheduling (22%).
- Parents suggested flexible clinic hours, shorter wait times, affordable parking, and text-based rescheduling as solutions.
Conclusions:
- System errors in hospital communication, such as incorrect contact details and lack of consistent reminders, are primary drivers of missed pediatric appointments.
- Addressing these communication breakdowns and implementing parent-suggested changes like text rescheduling can improve clinic attendance.
Aim:
Non-attendance rates at paediatric hospital outpatient clinics are high; however, parent-reported reasons for non-attendance are poorly understood. We aimed to identify: (i) modifiable system and parent factors that prevent parents from attending paediatric outpatient clinic appointments with their child; and (ii) parent views on changes that could be made to reduce non-attendance.
Methods:
Interviews were conducted with a random sample of parents of children aged 0-18 years who did not attend scheduled new or review outpatient clinic appointments at a metro, tertiary children's hospital in Melbourne, between 1 May and 31 July 2017. Families were excluded if the principal investigator had previously cared for the child in clinic.
Results:
A total of 50 parents completed an interview. Common factors related to non-attendance were reported as not receiving an appointment letter (n = 13, 26%) or text reminder (n = 16, 32%); and difficulties making changes to scheduled appointments (n = 11, 22%). Parents suggested a number of ways hospitals could reduce non-attendance, including flexible clinic times, reduced waiting periods, cheaper parking, consistent text reminders of upcoming appointment and, overwhelmingly, the ability to reschedule via text, removing the need to telephone the hospital.
Conclusions:
The principal reasons families struggle to attend appointments is being unaware of appointments, not receiving letters or text reminders. The lack of correct contact details held by the hospital's electronic medical record suggest systems errors in communication are impacting attendance rates of children in the clinics, and that addressing these internal issues may increase clinic attendance rates.
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