Missed outpatient appointments: Who's missing out and Why?

Area of Science:

• Urology
• Healthcare Access
• Health Services Research

Background:

• Missed outpatient appointments (no-shows) impact healthcare access, efficiency, and patient outcomes.
• Pediatric subspecialty care, like urology, faces unique challenges due to travel and coordination demands.
• Limited data compare no-show predictors between pediatric and adult urology or include patient-reported reasons.

Purpose of the Study:

• To compare predictors of missed appointments in pediatric versus adult urology.
• To identify patient- and caregiver-reported barriers to attendance in pediatric urology.
• To inform interventions for improving appointment adherence in pediatric urology.

Main Methods:

• Retrospective review of 10,106 outpatient urology appointments (January-December 2024).
• Multivariable logistic regression to identify no-show predictors in full cohort and subgroups.
• Telephone interviews with 72 patients/caregivers who missed appointments to explore barriers.

Main Results:

• Pediatric patients had higher no-show rates (7% vs. 4%) and were more likely to miss appointments (OR 1.67).
• Factors associated with no-shows included governmental/lack of insurance, non-English preference, non-white race, and new patient visits.
• Pediatric no-shows linked to male gender, lower Childhood Opportunity Index, and follow-up status; common reasons were forgetting, transport, and family obligations.

Conclusions:

• Pediatric urology patients face higher no-show rates than adults, influenced by socioeconomic factors, geography, and family responsibilities.
• Interventions targeting communication, transportation, and structural access barriers are crucial.
• Improving adherence can enhance access to pediatric urology care, particularly in rural settings.