EMBARGOED UNTIL 31 MAY 2002

Patient 'apathy' could cost NHS £300m a year

New research published in the June Journal of the Royal Society of Medicine suggests that up to 62% of missed outpatient appointments are due to 'apathy', with nearly a third of non-attendees simply forgetting to turn up. The survey, carried out by Dr Tony Tham and colleagues at the Ulster Hospital in Belfast, followed up patients who had missed appointments at a gastroenterology clinic. The authors compare their results with other research in the UK and abroad and give their pragmatic solution for tackling the problem.

What it costs to miss an appointment
Money: The cost per missed session has been estimated at £65; about £300 million a year in England alone.
Time: Staff and equipment time is wasted, and other patients have to wait longer to see a doctor.
Health: Missing an appointment can also mean missing vital treatment, diagnosis or monitoring, and may lead to long term health problems.

Why people don't turn up
The survey showed that on average, 14% of patients did not keep their clinic appointments. A quarter of those who had missed an appointment during the seven months of the survey had missed at least one other appointment in the past. 26% of respondents gave no reason at all for not coming to the clinic, while 30% "forgot". Although "clerical errors" and "fear of medical staff" were given as reasons by a minority of patients, the authors suggest that "a fundamental cause of non-attendance...was apathy" in 62% of cases.

Solutions to the problem
People fail to turn up to medical appointments across all specialties, and the problem is even worse in the US, where one group of researchers found the average rate of non-attendance to be between 13-26%. The authors argue that solutions which work in some studies, such as phoning patients with reminders or getting them to make and confirm their own appointments, are unlikely to work long-term across all kinds of outpatient clinics, and are themselves a drain on resources. They suggest that clinics should expect a certain amount of patient apathy and "'overbook' to take this into account" - at least until the government is closer to its aim of introducing electronic booking across the NHS. "Whether electronic booking will reduce non-attendance rates remains to be seen," Dr Tham and his colleagues conclude.

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