Physician ability to predict appointment-keeping behavior of prenatal patients

Prenatal appointment-keeping is considered an important component of adequate prenatal care. Interventions designed to increase the frequency with which patients keep prenatal appointments would be most effective if directed toward patients at greatest risk of missing prenatal appointments; however, it is difficult to identify this population of patients. The purpose of this study was to determine whether physicians could accurately predict the appointment-keeping behavior of their prenatal patients.

A simple questionnaire was completed by physicians at the time of the initial visit for prenatal care. On these surveys, physicians made predictions concerning each patients's subsequent appointment-keeping behavior. At the conclusion of prenatal care, predictions were compared with actual appointment-keeping as determined by chart audits.

More than one half (57%) of patients kept at least 80% of their scheduled appointments. Physicians predicted fair to poor appointment-keeping for 23% of the patients, but 43% of all patients met the criteria for fair to poor appointment-keeping. There was no correlation between physician predictions and actual appointment-keeping. The physician's sex, level of training, and degree of certainty about his or her predictions had no impact on the accuracy of the predictions. In identifying patients at high risk of missing appointments, physician predictions had a sensitivity of 26%, a specificity of 79%, and a positive predictive value of only 47%.

Physician prediction was not found to be an accurate method of identifying patients at risk for missing appointments.