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

Ross McQueenie; David A. Ellis; Alex McConnachie; Philip Wilson; Andrea E. Williamson

doi:10.1186/s12916-018-1234-0

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

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79 Citations (Scopus)

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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 language	English
Article number	2
Number of pages	9
Journal	BMC medicine
Volume	17
DOIs	https://doi.org/10.1186/s12916-018-1234-0
Publication status	Published - 11 Jan 2019

Bibliographical 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.

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12916-018-1234-0Licence: CC BY

Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
Final published version, 536 KBLicence: CC BY

Cite this

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

abstract = "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{\textquoteright}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.",

keywords = "missed appointments, primary care, health utilisation, health promotion, health inequalities, social vulnerability, administrative data, long-term conditions, morbidity, mortality, Missed appointments",

author = "Ross McQueenie and Ellis, {David A.} and Alex McConnachie and Philip Wilson and Williamson, {Andrea E.}",

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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doi = "10.1186/s12916-018-1234-0",

language = "English",

volume = "17",

journal = "BMC medicine ",

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TY - JOUR

T1 - Morbidity, mortality and missed appointments in healthcare

T2 - a national retrospective data linkage study

AU - McQueenie, Ross

AU - Ellis, David A.

AU - McConnachie, Alex

AU - Wilson, Philip

AU - Williamson, Andrea E.

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.

PY - 2019/1/11

Y1 - 2019/1/11

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.

AB - 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.

KW - missed appointments

KW - primary care

KW - health utilisation

KW - health promotion

KW - health inequalities

KW - social vulnerability

KW - administrative data

KW - long-term conditions

KW - morbidity

KW - mortality

KW - Missed appointments

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U2 - 10.1186/s12916-018-1234-0

DO - 10.1186/s12916-018-1234-0

M3 - Article

SN - 1741-7015

VL - 17

JO - BMC medicine

JF - BMC medicine

M1 - 2

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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Philip Wilson

Royal College of General Practitioners Health Services Research Paper of the Year Award

Cite this

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

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Profiles

Philip Wilson

Prizes

Royal College of General Practitioners Health Services Research Paper of the Year Award

Cite this