A Profile of Patients Who Fail to Keep Appointments in a Veterans Affairs Primary Care Clinic

BACKGROUND: Missed medical appointments (“no-shows”) affect both staff and other patients who are unable to make timely appointments. No-shows can be prevented through interventions that target those most at risk to miss appointments. Young age, low socioeconomic status, a history of missed appointments, psychosocial problems, and longer wait times are some predictors that previously have been associated with higher no-show rates. OBJECTIVE: To determine predictors for outpatient appointment no-shows in primary care clinics of the Veterans Affairs Nebraska-Western Iowa Health Care System. METHODS: The study included 69,908 noncancelled primary care appointments between January 1, 2012 and December 31, 2013 among patients residing in ZIP codes within the Veterans Affairs Nebraska-Western Iowa Health Care System Service Area. Age, sex, race, presence of a mental health diagnosis, previous no-show rate in the past 2 years, appointment wait time, distance to clinic, and neighborhood deprivation index were extracted or measured for each patient. RESULTS: In log-binomial models accounting for clustering by ZIP code, the strongest predictors of no-shows were age between 20 and 39 (OR compared to 60+: 3.87, 95% CI, 3.48-4.31) or between 40 and 59 (OR compared to 60+: 2.23, 95% CI, 2.05-2.43), black (OR compared to white: 2.14, 95% CI, 1.98-2.31) or other nonwhite race (OR compared to white: 1.35, 95% CI, 1.17- 1.56), male sex (OR compared to female: 1.30, 95% CI, 1.16-1.45), and presence versus absence of mental health diagnosis (OR: 1.16, 95% CI, 1.09-1.24). CONCLUSION: These findings show that individuals who are younger, nonwhite, male, or have been diagnosed with mental health issues are more likely to no-show. Interventions to improve compliance could be targeted at these individuals in order to decrease the burden of no-shows on health care systems.