Morbidity, mortality and missed appointments in healthcare

a national retrospective data linkage study

Ross McQueenie (Corresponding Author), David A. Ellis, Alex McConnachie, Philip Wilson, Andrea E. Williamson

Research output: Contribution to journalArticle

2 Citations (Scopus)
4 Downloads (Pure)

Abstract

Background
Recently, studies have examined the underlying patient and practice factors for missed appointments, but less is known about the impact on patient health. People with one or more long-term conditions who fail to attend appointments may be at risk of premature death. This is the first study to examine the effect of missed primary healthcare appointments on all-cause mortality in those with long-term mental and physical health conditions.

Methods
We used a large, nationwide retrospective cohort (n = 824,374) extracted from routinely collected general practice data across Scotland over a 3-year period from September 2013 until September 2016. This data encompasses appointment history for approximately 15% of the Scottish population, and was linked to Scottish deaths records for patients who had died within a 16-month follow-up period. We generated appointment attendance history, number of long-term conditions and prescriptions data for patients. These factors were used in negative binomial and Cox’s proportional hazards modelling to examine the risk of missing appointments and all-cause mortality.

Results
Patients with a greater number of long-term conditions had an increased risk of missing general practice appointments despite controlling for number of appointments made, particularly among patients with mental health conditions. These patients were at significantly greater risk of all-cause mortality, and showed a dose-based response with increasing number of missed appointments. Patients with long-term mental health conditions who missed more than two appointments per year had a greater than 8-fold increase in risk of all-cause mortality compared with those who missed no appointments. These patients died prematurely, commonly from non-natural external factors such as suicide.

Conclusions
Missed appointments represent a significant risk marker for all-cause mortality, particularly in patients with mental health conditions. For these patients, existing primary healthcare appointment systems are ineffective. Future interventions should be developed with a particular focus on increasing attendance by these patients.
Original languageEnglish
Article number2
Number of pages9
JournalBMC medicine
Volume17
DOIs
Publication statusPublished - 11 Jan 2019

Fingerprint

Information Storage and Retrieval
Appointments and Schedules
Morbidity
Delivery of Health Care
Mortality
Mental Health
General Practice
Primary Health Care
Premature Mortality
Death Certificates
Scotland
Suicide
Prescriptions
History

Keywords

  • missed appointments
  • primary care
  • health utilisation
  • health promotion
  • health inequalities
  • social vulnerability
  • administrative data
  • long-term conditions
  • morbidity
  • mortality
  • Missed appointments

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Morbidity, mortality and missed appointments in healthcare : a national retrospective data linkage study. / McQueenie, Ross (Corresponding Author); Ellis, David A.; McConnachie, Alex; Wilson, Philip; Williamson, Andrea E.

In: BMC medicine , Vol. 17, 2, 11.01.2019.

Research output: Contribution to journalArticle

McQueenie, Ross ; Ellis, David A. ; McConnachie, Alex ; Wilson, Philip ; Williamson, Andrea E. / Morbidity, mortality and missed appointments in healthcare : a national retrospective data linkage study. In: BMC medicine . 2019 ; Vol. 17.
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note = "Acknowledgments We thank all practices who participated in this study. The authors acknowledge funding from the Scottish Government Chief Scientist Office (CZH/4/41118). We acknowledge strategic support from Ellen Lynch (Health and Social Care Analytical Services, Scottish Government) and the general practice data expertise of Dave Kelly (Albasoft). Funding This study was supported by a Scottish Government Chief Scientist Office research grant (CZH/4/41118) with Safe Haven and data linkage costs supported in lieu by the DSLS at Scottish Government. These funding bodies had no role in the design of the study, nor in the collection, analysis and interpretation of data, nor in writing the manuscript.",
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N1 - Acknowledgments We thank all practices who participated in this study. The authors acknowledge funding from the Scottish Government Chief Scientist Office (CZH/4/41118). We acknowledge strategic support from Ellen Lynch (Health and Social Care Analytical Services, Scottish Government) and the general practice data expertise of Dave Kelly (Albasoft). Funding This study was supported by a Scottish Government Chief Scientist Office research grant (CZH/4/41118) with Safe Haven and data linkage costs supported in lieu by the DSLS at Scottish Government. These funding bodies had no role in the design of the study, nor in the collection, analysis and interpretation of data, nor in writing the manuscript.

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N2 - BackgroundRecently, studies have examined the underlying patient and practice factors for missed appointments, but less is known about the impact on patient health. People with one or more long-term conditions who fail to attend appointments may be at risk of premature death. This is the first study to examine the effect of missed primary healthcare appointments on all-cause mortality in those with long-term mental and physical health conditions.MethodsWe used a large, nationwide retrospective cohort (n = 824,374) extracted from routinely collected general practice data across Scotland over a 3-year period from September 2013 until September 2016. This data encompasses appointment history for approximately 15% of the Scottish population, and was linked to Scottish deaths records for patients who had died within a 16-month follow-up period. We generated appointment attendance history, number of long-term conditions and prescriptions data for patients. These factors were used in negative binomial and Cox’s proportional hazards modelling to examine the risk of missing appointments and all-cause mortality.ResultsPatients with a greater number of long-term conditions had an increased risk of missing general practice appointments despite controlling for number of appointments made, particularly among patients with mental health conditions. These patients were at significantly greater risk of all-cause mortality, and showed a dose-based response with increasing number of missed appointments. Patients with long-term mental health conditions who missed more than two appointments per year had a greater than 8-fold increase in risk of all-cause mortality compared with those who missed no appointments. These patients died prematurely, commonly from non-natural external factors such as suicide.ConclusionsMissed appointments represent a significant risk marker for all-cause mortality, particularly in patients with mental health conditions. For these patients, existing primary healthcare appointment systems are ineffective. Future interventions should be developed with a particular focus on increasing attendance by these patients.

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