Researchers investigated the impact of missing primary care medical appointments on the risk of death in patients with long-term conditions.
Several previous studies have looked at the underlying reasons behind patients missing medical appointments. These can be related to patient factors or to the medical practice arrangements. However, less is known about the impact of missing medical appointments on patient health outcomes and risk of premature death.
Increasing numbers of patients have multiple long-term conditions
With ageing populations, an increasing number of individuals have one or more long-term physical or mental health conditions. It is important that these patients are reviewed regularly by healthcare professionals in primary care clinics. Those who repeatedly miss appointments may be at risk of poor health outcomes or premature death. Researchers in Scotland investigated the impact of missing primary care medical appointments on the risk of death in patients with multiple long-term conditions. They recently reported their findings in BMC Medical.
The researchers tracked information on over 500,000 patients from routinely collected data in Scottish primary care clinics between 2013-2016. The researchers generated information on medical appointments attendance and the number of long-term conditions. They linked this data to death records in a 16 month follow-up period.
Patients with long-term conditions missing appointments have increased risk of death
After a detailed statistical analysis, the researchers found that patients with a greater number of long-term conditions had an increased risk of missing medical appointments. This was particularly seen amongst patients who had mental health conditions.
Patients who repeatedly missed appointments were at a greater risk of death within the following year. Those with long-term physical conditions who missed two or more appointments per year had a threefold increase in all-cause mortality compared to those who missed no appointments.
Patients with mental-health conditions (but no physical conditions) who missed more than two appointments per year had an eight times greater risk of death during the follow-up period compared to those who missed no appointments. These patients died prematurely, often from suicide.
Missing appointments is an especially important issue for mental health conditions
The researchers concluded that repeatedly, missed medical appointments are an important marker of risk for all-cause mortality, particularly in patients with mental health conditions. The present appointment systems may not work well for these patients and healthcare professionals should look at developing alternatives. It is also important to ensure that mental health services are readily available and easy for patients to access.
Professor Philip Wilson, one of the authors of the study, commented, “These findings are crucially important for [general practitioners] wishing to identify patients at high risk of premature death. For people with physical conditions missed appointments are a strong independent risk factor for dying in the near future.” He added that for patients with mental health conditions, missing appointments was a strong marker for premature death from non-natural causes such as suicide.
Written by Julie McShane, Medical Writer
- McQueenie R, Ellis DA, McConnachie A, et al. Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study. BMC Medicine 2019 17 (2). Doi:10.1186/s12916-018-1234-0.
- Press release. Lancaster University 10 Jan 2019. How missing appointments increases the risk of death.