Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study

McQueenie, R., Ellis, D. A., McConnachie, A. , Wilson, P. and Williamson, A. E. (2019) Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study. BMC Medicine, 17, 2. (doi: 10.1186/s12916-018-1234-0) (PMID:30630493) (PMCID:PMC6329132)

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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.

Item Type:Articles
Glasgow Author(s) Enlighten ID:McConnachie, Professor Alex and McQueenie, Dr Ross and Wilson, Prof Philip and Ellis, Mr David and Williamson, Professor Andrea
Authors: McQueenie, R., Ellis, D. A., McConnachie, A., Wilson, P., and Williamson, A. E.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:BMC Medicine
Publisher:BioMed Central
ISSN (Online):1741-7015
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in BMC Medicine 17:2
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
678284Investigating the importance of serial missed appointments in the NHS: a linkage pathfinder project of general practice, health, social care and education data.Andrea WilliamsonOffice of the Chief Scientist (CSO)CZH/4/1118MVLS MED - UNDERGRADUATE SCHOOL