Non-attendance at outpatient clinic appointments by children with cerebral palsy
Simon P Paget1,2, Sarah McIntyre3, Shona Goldsmith3
1Faculty of Medicine and Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Insights
One in eight outpatient appointments for children with cerebral palsy (CP) are missed. Factors like older age, socioeconomic disadvantage, and prior missed appointments increase non-attendance risks.
Area of Science:
- Pediatric Healthcare
- Public Health
- Cerebral Palsy Research
Background:
- Outpatient clinic non-attendance is a significant issue in pediatric healthcare.
- Children with cerebral palsy (CP) often require regular specialized outpatient services.
- Understanding non-attendance patterns in this population is crucial for service optimization.
Purpose of the Study:
- To identify key factors contributing to missed outpatient appointments among children with cerebral palsy (CP).
- To analyze the association between sociodemographic, clinical, and care process variables and appointment non-attendance.
Main Methods:
- Retrospective cohort study utilizing data from the NSW/Australian Capital Territory CP Register.
- Analysis of 50,121 scheduled outpatient appointments for 1395 children with CP between 2012 and 2019.
- Multivariate logistic regression with generalized estimating equations to assess factors influencing non-attendance.
Main Results:
- 12% of scheduled outpatient appointments for children with CP were not attended.
- Non-attendance rates increased annually by 5.6%.
- Factors associated with increased non-attendance included older age, socioeconomic disadvantage, previous non-attendance, and recent appointment rescheduling or cancellations.
Conclusions:
- A substantial proportion of outpatient appointments for children with CP are missed, with a rising trend.
- Targeted interventions are needed to address barriers faced by children with CP, particularly those from disadvantaged backgrounds or with a history of non-attendance.
- Improving access to care for children with CP requires addressing modifiable factors related to appointment scheduling and attendance.
Aim:
To determine factors that influence non-attendance at outpatient clinics by children with cerebral palsy (CP).
Method:
This was a retrospective cohort study of 1395 children with CP (59.6% male; born 2005 to 2017) identified from the New South Wales (NSW)/Australian Capital Territory CP Register, who had scheduled appointments at outpatient clinics at two NSW tertiary paediatric hospitals between 2012 and 2019. Associations between sociodemographic, clinical, and process-of-care factors and non-attendance were examined using multivariate logistic regression with generalized estimating equations.
Results:
A total of 5773 (12%) of 50 121 scheduled outpatient days were not attended. Non-attendance increased over time (average increase 5.6% per year, 95% confidence interval [CI]: 3.7-7.3). Older children aged 5 to 9 years (adjusted odds ratio [aOR] 1.11; 95% CI: 1.02-1.22) and 10 to 14 years (aOR 1.17; 95% CI: 1.03-1.34), socioeconomic disadvantage (aOR 1.29; 95% CI: 1.11-1.50), previous non-attendance (aOR 1.38; 95% CI: 1.23-1.53), and recent rescheduled or cancelled appointments (aOR 1.08; 95% CI: 1.01-1.16) were associated with increased likelihood of non-attendance.
Interpretation:
One in eight outpatient appointments for children with CP were not attended. Non-attendance was associated with increasing age, socioeconomic disadvantage, previous non-attendance, and recent rescheduled or cancelled appointments. Identifying specific barriers and interventions to improve access to outpatient services for these groups is needed.
What This Paper Adds:
Twelve per cent of scheduled appointments for children with cerebral palsy are not attended. Proportions of appointments not attended has increased over the last decade. Increasing age and socioeconomic disadvantage increase the likelihood of non-attendance. Previous non-attendance and recent cancelled or rescheduled appointments increase the likelihood of further non-attendance.
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