Educational associations with missed GP appointments for patients under 35 years old: administrative data linkage study.

Ross McQueenie, David A Ellis, Michael Fleming, Philip Wilson, Andrea E Williamson* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
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There is an evidence gap about whether levels of engagement with public services such as schools and health care affect people across the lifespan. Data on missed patient appointments from a nationally representative sample of Scottish general practices (GP) (2013-2016) were probabilistically linked to secondary school pupil data. We tested whether school attendance, exclusions (2007-2011) or lower educational attainment (2007-2016) was associated with an increased risk of missing general practice appointments.
Methods: School attendance data were classified into quartiles of possible days attended for years we had data. School exclusions were derived as a categorical variable of 'ever excluded'. Attainment data were categorised via the Scottish Credit and Qualifications Framework (SCQF) level 3 or 6; a cumulative measure of attainment on leaving school. The associations between school attendance, exclusions and attainment and risk of missing medical appointments were investigated using negative binomial models, offset by number of GP appointments made and controlling for potential confounders.
Results: 112,534 patients (all aged under 35) had GP appointment and retrospective school attendance and exclusion data, and a subset of 66,967 also had attainment data available. Patients who had lower attendance, had been excluded from school or had lower educational attainment had an increased risk of missing GP appointments (all rate ratios > 1.40).
Conclusions: This study provides the first evidence from a population-representative sample in a high-income country that increased numbers of missed appointments in health care are associated with reduced school attendance, higher levels of school exclusion and lower educational attainment. Insights into the epidemiology of missingness across public services can support future research,
Original languageEnglish
Article number219
Number of pages7
JournalBMC medicine
Issue number1
Early online date27 Sept 2021
Publication statusPublished - 27 Sept 2021

Bibliographical note

Thank you to all the GP practices who participated in this study and for strategic support from Ellen Lynch (Health and Social Care Analytical Services, Scottish Government). The general practice data expertise of Dave Kelly (Albasoft) was invaluable. Thanks also to the eDRIS team who facilitated the safe use of our data in the Safehaven, especially Dionysis Vragkos and colleagues at ScotXed for the education data.
This study was funded by a grant from Chief Scientist Office, Scottish Government (reference CZH/4/1118) with Safe Haven and data linkage costs supported in lieu by the DSLS at Scottish Government. The funding sources for this analysis had no influence over study design, data collection, data analysis, data interpretation, the writing of the report, or the decision to submit for publication. All authors confirm they had full access to all the data in the study if required, and the corresponding author had final responsibility for the decision to submit for publication


  • Missed appointments
  • engagement in health care
  • education attendance
  • school exclusions
  • general practice
  • primary care
  • public health
  • life course


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