What is keeping appointments?

What is keeping appointments?

Yoriko Matsuoka, Kakuhiro Fukai

Abstract ：M issed appointments, no-shows, and treatment discontinuation can affect patients’ health worse
reducing clinical efficiency, and cause to increase risk factors of recurrence. This article aims toclarify causes and solutions for patients’appointment failures, based on the previous studies. As aresult, the most common reason for missed appointment is“ patients’forgetfulness” in various
healthcare facilities of both medical and dental settings. Here we try to consider what keeping
scheduled appointments is.
Key words : missed appointments, no-shows, treatment discontinuation, forgetfulness
1. Introduction

dentistry, treatment discontinuation would largely

Some patients repeatedly cancel their appoint-

determine the clinical outcome and its prognosis.

ments or discontinue their treatments at a certain

This is because, in many cases, patients need topoint such as improvement of chief complaint andreceive regular dental treatment for a relevant

symptoms. This can be seen, in spite of some dis-long term.

eases need to be treated or incomplete treatments

Since 1960s, in mainly medical fields, the pastfrom professionals’viewpoint. In medical as wellstudies have suggested causes and solutions foras dental settings, missed appointments and no-missed appointments1-7）. The current studies sug-shows, or treatment discontinuation will begest the importance of shared decision making as

adverse clinical outcome at many healthcare facili-

well8-9）. As relevant expressions of non-adherence

ties, and cause to affect patients’ health or towith scheduled appointments, the following terms

increase risk factors of recurrence. Especially inwere used: failed appointments, broken appointments, appointment breaking, missed appointments, cancelled appointments, unkept appoint-【著者連絡先】〒 341-0003 埼玉県三郷市彦成3-86
深井歯科医院・深井保健科学研究所
松岡順子
TEL&FAX： 048-957-3315
E-mail：yorikom@wg8.so-net.ne.jp

ments, non-attendance in titles of the previousstudies. This article tries to clarify causes and solutions for missed appointment, based on the previous literatures in both dental and medical settings.

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2. Determinants of Missed Appointments

3. Reasons for Missed Appointments

In 1979, Oppenheim GL., et al. showed the deter-

In case of chronic illnesses such as hypertension

minants as to appointment failures were classified

and diabetes mellitus, patients require lifelong self-

into four factors: process, patient, provider, andmanagement collaborating with health profession-1）

environment in medical fields . The process

als through long-term prescription refill, dietary orincludes the administrative elements: scheduling,exercise therapy. Regular attendance or checkupoffice waiting time, and adjusting appointment

is needed as for rehabilitation of coronary, dialysis,interval. Patient factors mean communication

dental caries or periodontal prevention, mainte-problems: misunderstanding or forgetfulness fornance after treatments as well. Whereas some

appointment date and time, preparing babysitters,

people are limited time schedule to visit healthlanguage or cultural differences. Providers involve

professionals. For instance, there is a case of afactors urging patients to keep their appointments

salesperson with irregular working time or of acontinuously. Environment affecting appointment

carpenter with working time controlling weather.

failures includes weather, time of day, and parking.

From patients’ viewpoint, their lifestyles repre-Meanwhile, Deyo RA., et al. in 1980, classified

sented occupational types is one of the barriers to

mainly eight groups as for the determinants ofattend dental and medical clinics.

appointment keeping behavior, modified Haynes’

In previous studies of medical field (Table1), theclassification2）. That is, the features are following

main reasons for appointment failure are personal

points: patient, provider, disease or reasons forones such as forgetting and misunderstanding toappointment, therapeutic regimen, patient-thera-attend from the results: 33% in dermatology outpa-

pist interaction, access, facility or administrativetient clinics in the hospital (1992), 30% in a gas-

process, and environment.

troenterology outpatient clinic (2002), over 40% in

Among elements of the determinants forgeneral practice (2005), and 32.9% in family prac-appointment failures, it is significantly related

tice clinic with various chronic illnesses (2006)13-

between age and missed appointments in a variety16). Especially, several studies suggest that it isof settings1-2，4）. Younger adults correlates withsignificantly correlated between increasing miss-higher rates of missed appointments, compareding rates caused by patients’with older ones. Especially, patients aged 45 or

longer appointment scheduling intervals1, 3, 6-7） .

older generally have lower rates of missed

Another reason is concerning personal or family:

10-11）

appointments

forgetting and. Gates and Colborn reported thatbeing too ill to attend, feeling better, relating topatients aged 15 to 34 had missed appointments

work, inpatient in another hospital, family commit-10）.

ment, and sudden bereavement13-16）. The others

Patients who have broken appointments tend toare administrative errors such as wrong dates

repeat this behavior in the future1-4）. Indeed, Gold-

written on appointment cards. It is more likely to

man L., et al. found that patients who had kept

miss appointments in case of patients with four orover 90% of previous appointments kept 85% of

more multiple chronic illnesses and diabetic

future appointments. While those who had kept

patients with poor metabolic control16-18）. Besides,

less than 60% of past appointments kept only 62%

Gunter-Hunt G., et al. examined the relationshipof future ones12）.

between missed appointments and patient satisfac-

over twice as high as those of 35 years or older

tion for arthritis treatments. They suggested that̶ 29 ̶

What is keeping appointments?

Table 1 Reasons and Solutions for Missed Appointments

patient satisfaction was significantly related tocompared with fixed ones. The most common rea-patient’s perception of benefits obtaining from clin-

son for orthodontic patients failing to keep appoint-

ical outcome, though patient satisfaction andments is forgetfulness, similar to medical cases.

appointment keeping behavior was not significant-

The others are illness, other commitments, trans-19）

portation troubles21-22）. 53.5% of patients missing toly correlated .

From 1980s in dentistry, researches for appoint-

attend have thought that they are nearing thement keeping adherence have been reported con-final stage of treatment21）. This result suggests

cerning mainly orthodontic and periodontal treat-patients’misunderstanding for the ongoing treat-ments20-23）. The success of orthodontic treatment

ment at present.

depends on the regular adjustment of appliances

In case of periodontal treatments, the results

and retention for a long period. Besides, regularconcerning reasons for failing appointments showdental attendance and checkups are required forthat forgetfulness (51.4%) is the most common rea-

periodontal treatments, maintenance of post treat-son, similar tendency with medical ones. The oth-ments, or prevention of oral diseases. A type ofers continue 19.1% of administrative errors, 14.7%

orthodontic appliances tends to affect attendingof illness, and 12.8% of problems getting off work23）.

discontinuation more often, especially in case ofpatients wearing headgear during a retention peri-

4. Solutions for Missed Appointments

od or only removable appliances in active treat-

Either in a medical or dental setting, one of the20）

ment . One of the reasons in this case is reflected

effective ways to improve appointment-keeping isthat if patients want to stop treatment, it is easier

telephone

to do so when they wear removable appliances

patient’s appointment at least one to three weeks

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toawareヘルスサイエンス・ヘルスケア

in advance 1-5, 24-25）. Through an Automated Appointment Conformation System using computer, theeffective results show the reduction of broken
appointment rates declining from 23.67% to 19.77%
in general dentistry or from 29.42% to 25.25% in
pediatric dentistry26）. Similarly, an automated telephone appointment reminder system is significantly more effective to improve appointment-keeping
in medical settings27）. It is, however, hard for somepatients to understand and operate practice computer appointment systems28）. This result suggeststhat it is necessary to develop simple and easy
ways to use for everyone, taking every possible
measure. Besides, in dentistry, even simple modification of recall and appointment cards would
obtain the effective results to improve keeping
appointments24）. This is, for instance, to rewrite
recall letter and appointment card with a shortmessage about reasons of recall necessities andurging patients to keep appointments and asking
them to cancel in advance if unable to visit.
5. Conclusion
The background of patients’forgetting for missed
appointments may contain some elements such asindividual value of teeth and treatments or preference, though forgetfulness is reported as the mostfrequent reason according to the abundant previous literatures. As a future topic, healthcare
providers would need to know several hidden reasons behind patients’behaviors of forgetting scheduled appointments with some scales.
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