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Out-patient appointments: a necessary evil? a literature review and survey of patient attendance records

  • Reuven Manfred Magnes (a1)
Abstract
Aims and Method

To describe the effect of a postal reminder system on UK adult psychiatry clinic attendance. A literature review was completed and a serial cross-sectional survey of patient attendance records in an inner-city psychiatric hospital during 2006 and 2007 was undertaken.

Results

A simple postal prompt reduces non-attendance by up to 50% and data from the serial cross-sectional survey of attendance records (n=36) powered at 77% supported this finding. Postal prompts in the survey accounted for 30% improvement in the variance (r 2 ).

Clinical Implications

A simple postal prompt that takes less than 30 s to read, sent up to 2 weeks prior to the appointment improves attendance by up to 50% and is useful for maintaining standards of excellence.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Hamilton, W., Round, A. & Sharp, D. (2002) Patient, hospital, and general practitioner characteristics associated with non-attendance: a cohort study. British Journal of General Practice, 52, 317319.
Hawker, D. S. J. (2007) Increasing initial attendance at mental health outpatient clinics: opt-in systems and other interventions. Psychiatric Bulletin, 31, 179182.
Jarman, B. (1983) Identification of underprivileged areas. BMJ (Clinical Research Edition), 286, 17051709.
Killaspy, H., Banjeree, S., King, M., et al (2000) Prospective controlled study of psychiatric out-patient non-attendance. British Journal of Psychiatry, 176, 160165.
McIvor, R. & Ek, E. (2004) Non-attendance rates among patients attending different grades of psychiatrist and a clinical psychologist within a community mental health clinic. Psychiatric Bulletin, 28, 57.
Reda, S. & Makhoul, S. (2001) Prompts to encourage appointment attendance for people with serious mental illness. Cochrane Database of Systematic Reviews, 2, CD002085.
Rusius, C.W. (1995) Improving outpatient attendance using postal appointment reminders. Psychiatric Bulletin, 19, 291292.
Sharp, D. J. & Hamilton, W. (2001) Non attendance at general practice and outpatient clinics. BMJ, 323, 10811082.
Swinscow, T. D.V. (1997) Correlation and regression. In Statistics at Square One (9th edn). BMJ Publishing Group (http://www.bmj.com/collections/statsbk/11.dtl).
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Out-patient appointments: a necessary evil? a literature review and survey of patient attendance records

  • Reuven Manfred Magnes (a1)
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eLetters

Outpatients: a necessary evil?

MacDara H McCauley, Consultant Psychiatrist
10 February 2009

Recently, Magnes (Vol 32, no 12, 458-60.2008) wrote a survey of patient attendance posing the question, "Is outpatients a necessary evil?". Frequently, when discussing the role of outpatients the focus of the articles is concerned with attendance( Mitchell & Selmes 2007, Kelly 2008)

We would suggest that research addressing other aspects of the role of outpatients would greatly benefit psychiatry. It should be noted that some have (Killaspy 2007) queried the need for outpatients. This need wasrobustly defended.(Holloway, 2008).

We believe that the following issues could be considered;What is the purpose of outpatients? Possible responses;1. Review mental state, adherence, risk etc.2. Opportunity for the patients questions.3. Update the GP-other services involved.4. Consider referral to other members of MDT/services.How often should we see patients and for how long? Furthermore, guidance re appropriate discharge procedures would be very helpful.

Finally, we would like to echo Holloway's suggestion that "a more nuanced discussion" re that 'necessary evil'is urgently required.

MITCHELL,A.J. & SELMES T.(2007)Why don't patients attend their appointments? Maintaining engagement with psychiatric services. Advances in Psychiatric Treatment,13, 423-434.

KELLY, B.D.(2008)Internal audit of attendances at a psychiatry outpatient clinic.Irish Journal of Psychological Medicine,25,136-140.

KILLASPY,H.(2007) Why do psychiatrists have difficulty disengaging with the out-patient clinic? Invited commentary on: Why don't patients attend their appointments? Advances in Psychiatric Treatment,13, 435-437.

HOLLOWAY,F(2008) Engaging with the outpatient clinic:don't throw the baby out with the bath water. Advances in Psychiatric Treatment,14,159-160.

Curtis Obadan Senior House Officer in Psychiatry, Mater/UCD Rotational training scheme. MacDara McCauley Consultant Psychiatrist, St. Brigid's Hospital Ardee, Co Louth, Ireland.
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Conflict of interest: None Declared

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