{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T21:48:19Z","timestamp":1725659299175},"reference-count":34,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J R Army Med Corps"],"published-print":{"date-parts":[[2008,3]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Failure to keep medical appointments, commonly referred to as \u2018Did Not Attend\u2019 (DNA), is a frequent problem in both primary and secondary health care and leads to a waste of valuable resources. Although the reasons for DNA within the general population are well documented, little is known about this behaviour amongst people serving in the armed forces. In this paper we report the findings of a questionnaire-based study investigating the reasons why military personnel fail to keep hospital appointments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A postal questionnaire asking questions about the reasons for not attending the appointment and how they perceived the condition for which treatment had been sought, were sent to 167 military patients known to have missed appointments in either a hospital outpatient department or regional rehabilitation unit. 162 controls, who attended appointments, were also sent a questionnaire asking them about factors leading to their appointment and how they perceived the condition that they attended the appointment for. Illness perception was measured using a previously validated Illness perception Questionnaire (IPQ-R). The controls were matched by rank, gender and corps.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall response rate was 51.5%, with 46% response in the DNA group and 55% in the controls.<\/jats:p><jats:p>A previous history of hospital DNA (though not DNA in primary care) and attempting to change the appointment date were associated with DNA (p=0.01). Those who received a reminder about the appointment were less likely to DNA (p=&lt;0.001). Although patients who perceived their condition to be less important were more likely to fail to attend their appointment (p=0.01), illness perception as measured on the IPQ-R, was not associated with appointment attendance.<\/jats:p><jats:p>The most frequent reasons cited for missed appointments were due to administrative problems, with many (38%) respondents being simply unaware that they had an appointment at all or believing that they had cancelled it (14%). Forgetting the appointment (8%) or mixing up the date (21%) were also cited by respondents as reasons for not attending. Only 11% of respondents gave reasons that were specific to a military population, most frequently being on exercise at the time of their appointment.<\/jats:p><jats:p>Demographic differences such as age and gender, and practical factors such as appointment day, distance travelled, method of appointment notification, or type of hospital were not found to be associated with attendance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The most common reasons for not attending appointments were due to administrative error and an inability amongst patients to recall the correct date of the appointment. Whilst efforts to improve attendance through various reminder systems have been found to be effective in the short term at least, improvements in the efficiency of appointment administration is likely to generate a reduction in DNA and in turn will reduce the wastage of resources.<\/jats:p><\/jats:sec>","DOI":"10.1136\/jramc-154-01-08","type":"journal-article","created":{"date-parts":[[2013,3,19]],"date-time":"2013-03-19T23:43:32Z","timestamp":1363736612000},"page":"26-30","source":"Crossref","is-referenced-by-count":7,"title":["Why Military Personnel Fail to Keep Medical Appointments"],"prefix":"10.1136","volume":"154","author":[{"given":"R","family":"Thornton","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Ballard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2008,3,1]]},"reference":[{"issue":"1","key":"ref_1","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1071\/AH030052","article-title":"Why outpatients fail to attend their scheduled appointments: a prospective comparison of differences between attenders and non-attenders","volume":"26","author":"Collins, J.; Santamaria, N.; Clayton, L.","year":"2003","unstructured":"Collins J, Santamaria N, Clayton L. Why outpatients fail to attend their scheduled appointments: a prospective comparison of differences between attenders and non-attenders. Aust Health Rev 2003;26(1):52-63.","journal-title":"Aust Health Rev"},{"key":"ref_2","first-page":"114","article-title":"for Health and Social Care. Reporting patient journeys: Hospital outpatient activity in 2003-04 and 2004-05 IC, 2006 Leeds","volume":"923","author":"[9 Aug","year":"1999","unstructured":"Information Centre for Health and Social Care. Reporting patient journeys: Hospital outpatient activity in 2003-04 and 2004-05 IC, 2006 Leeds. Available from: http:\/\/www.ic.nhs.uk\/pubs\/hesoutpatients2003to2005 \/outpatient\/file [Accessed 9 Aug 2006]. 3 Stone Palmer JH, Saxby PJ, Devargi VS. Reducing non-attendance at outpatients clinics. J RSM 1999; 923:114-118.","journal-title":"J RSM; 2006].3 Stone Palmer JH, Saxby PJ, Devargi VS. Reducing non-attendance at outpatients clinics"},{"issue":"5","key":"ref_3","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/0300-5712(94)90068-X","article-title":"Non-attendance at periodontal clinics: forgetting and administrative failure","volume":"22","author":"Herrick, J.; Gilhooly, M.L.; Geddes, D.A.","year":"1994","unstructured":"Herrick J, Gilhooly ML, Geddes DA. Non-attendance at periodontal clinics: forgetting and administrative failure. J Dent 1994; 22(5):307-309.","journal-title":"J Dent"},{"issue":"10","key":"ref_4","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1177\/014107689408701007","article-title":"Non-attendance at ophthalmology outpatient clinics","volume":"87","author":"Potamitis, T.; Chell, P.B.; Jones, H.S.; Murray, P.I.","year":"1994","unstructured":"Potamitis T, Chell PB, Jones HS, Murray PI. Non-attendance at ophthalmology outpatient clinics. J R Soc Med. 1994; 87(10):591-593.","journal-title":"J R Soc Med"},{"issue":"6","key":"ref_5","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1177\/014107680209500605","article-title":"Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic","volume":"95","author":"Murdock, A.; Rodgers, C.; Lindsay, H.; Tham, T.C.","year":"2002","unstructured":"Murdock A, Rodgers C, Lindsay H, Tham TC. Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic. J R Soc Med 2002; 95(6):284-286.","journal-title":"J R Soc Med"},{"issue":"6","key":"ref_6","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/j.1742-1241.1998.tb08898.x","article-title":"Why do outpatients fail to keep their clinic appointments? Results from a survey and recommended remedial actions","volume":"52","author":"Pal, B.; Taberner, D.; Readman, L.; Jones, P.","year":"1998","unstructured":"Pal B, Taberner, D, Readman, L and Jones, P. Why do outpatients fail to keep their clinic appointments? Results from a survey and recommended remedial actions. Int J Clin Pract 1998; 52(6):436-437.","journal-title":"Int J Clin Pract"},{"issue":"1","key":"ref_7","first-page":"70","article-title":"Failure of patients to attend a medical outpatient clinic","volume":"31","author":"Simmons, A.V.; Atkinson, K.; Atkinson, P.; Crosse, B.","year":"1997","unstructured":"Simmons AV, Atkinson K, Atkinson P, Crosse B. Failure of patients to attend a medical outpatient clinic. Journal of the Royal College of Physicians London 1997; 31(1):70-73.","journal-title":"Journal of the Royal College of Physicians London"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1111\/j.1365-2230.1994.tb02691.x","article-title":"An audit of the factors involved in new patient non-attendance in a dermatology out-patient department","volume":"19","author":"Bottomley, W.W.; Cotterill, J.A.","year":"1994","unstructured":"Bottomley WW, Cotterill JA. An audit of the factors involved in new patient non-attendance in a dermatology out-patient department. Clin Exp Derm 1994; 19:399-400.","journal-title":"Clin Exp Derm"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1370\/afm.123","article-title":"Why We Don\u2019t Come: Patient Perceptions on No-Shows","volume":"2","author":"Lacy, N.L.; Paulman, A.; Reuter, M.D.; Lovejoy, B.","year":"2004","unstructured":"Lacy NL, Paulman A, Reuter MD, Lovejoy B. Why We Don\u2019t Come: Patient Perceptions on No-Shows. Annals Family Med 2004; 2:541-545.","journal-title":"Annals Family Med"},{"issue":"1","key":"ref_10","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1093\/milmed\/163.1.58","article-title":"Missed and canceled appointments at a military psychiatry clinic","volume":"163","author":"Dotter, J.F.; Labbate, L.A.","year":"1998","unstructured":"Dotter JF, Labbate LA. Missed and canceled appointments at a military psychiatry clinic. Mil Med. 1998; 163(1):58-60.","journal-title":"Mil Med"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1080\/08870449608400270","article-title":"The illness perception questionnaire: a new method for assessing the cognitive representation of illness","volume":"11","author":"Weinman, J.; Petrie, K.J.; Moss-Morris, R.; Horne, R.","year":"1996","unstructured":"Weinman J, Petrie, KJ, Moss-Morris R, Horne R. The illness perception questionnaire: a new method for assessing the cognitive representation of illness. Psychology and Health 1996; 11:431-435.","journal-title":"Psychology and Health"},{"issue":"1","key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/08870440290001494","article-title":"The Revised Illness Perception Questionnaire (IPQ-R)","volume":"17","author":"Moss-Morris, R.; Weinman, J.; Petrie, K.J.; Horne, R.; Cameron, L.D.; Buick, D.","year":"2002","unstructured":"Moss-Morris R, Weinman J, Petrie, KJ, Horne R, Cameron LD, Buick, D. The Revised Illness Perception Questionnaire (IPQ-R). Psychology and Health 2002; 17(1):1-16.","journal-title":"Psychology and Health"},{"issue":"13","key":"ref_13","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1001\/jama.1992.03480130129038","article-title":"An overview of interventions to improve compliance with appointment keeping for medical services","volume":"267","author":"Macharia, W.M.; Leon, G.; Rowe, B.H.; Stephenson, B.J.; Haynes, R.B.","year":"1992","unstructured":"Macharia WM, Leon G, Rowe BH, Stephenson BJ, Haynes RB. An overview of interventions to improve compliance with appointment keeping for medical services. JAMA 1992; 267(13):1813-1817.","journal-title":"JAMA"},{"issue":"7","key":"ref_14","doi-asserted-by":"crossref","first-page":"366","DOI":"10.5694\/j.1326-5377.2005.tb07085.x","article-title":"Use of SMS text messaging to improve outpatient attendance","volume":"183","author":"Downer, SR, Meara; JG, Da Costa; A.C.","year":"2005","unstructured":"Downer SR, Meara JG, Da Costa AC. Use of SMS text messaging to improve outpatient attendance. Med J Aust 2005; 183(7):366-8.","journal-title":"Med J Aust"},{"issue":"477","key":"ref_15","first-page":"317","article-title":"and general practitioner characteristics associated with non-attendance: a cohort study","volume":"52","author":"Hamilton, W.; Round, A.; Patient, Sharp D.; hospital","year":"2002","unstructured":"Hamilton W, Round A, Sharp D. Patient, hospital, and general practitioner characteristics associated with non-attendance: a cohort study. Br J Gen Pract 2002; 52(477):317-9.","journal-title":"Br J Gen Pract"},{"key":"ref_16","first-page":"407","article-title":"Failed appointments in residency practices: who misses them and what providers are most affected","volume":"106","author":"Weingarten, N.; Meyer, D.L.; Schneid, J.A.","year":"1997","unstructured":"Weingarten N, Meyer DL, Schneid JA. Failed appointments in residency practices: who misses them and what providers are most affected. J American Board Fam Pract 1997; 106:407-411.","journal-title":"J American Board Fam Pract"},{"issue":"11","key":"ref_17","first-page":"147","article-title":"Outpatient clinic nonarrivals and cancellations","volume":"15","author":"Dockerty, J.","year":"1992","unstructured":"Dockerty J. Outpatient clinic nonarrivals and cancellations. New Zealand Med J 1992; 15(11):147-149.","journal-title":"New Zealand Med J"},{"issue":"11","key":"ref_18","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/0277-9536(87)90365-0","article-title":"Non-attendance at outpatient clinics at the regional hospital Galway Ireland","volume":"25","author":"Cawley, M.A.; Stevens, F.M.","year":"1987","unstructured":"Cawley MA, Stevens FM. Non-attendance at outpatient clinics at the regional hospital Galway Ireland. Soc Sci Med 1987; 25(11):1189-1196.","journal-title":"Soc Sci Med"},{"issue":"471","key":"ref_19","first-page":"830","article-title":"Missed appointments in general practice: retrospective data analysis from four practices","volume":"51","author":"Neal, R.D.","year":"2001","unstructured":"Neal RD et al. Missed appointments in general practice: retrospective data analysis from four practices. Br J Gen Pract 2001; 51(471):830-832.","journal-title":"Br J Gen Pract"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/S0190-9622(99)70152-0","article-title":"The incidence of cancellation and non-attendance at a dermatology clinic","volume":"405","author":"Penneys, N.S.; Glaser, D.A.","year":"1999","unstructured":"Penneys NS, Glaser DA. The incidence of cancellation and non-attendance at a dermatology clinic. J American Ac Derm 1999; 405:714-718.","journal-title":"J American Ac Derm"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1002\/(SICI)1096-9136(199804)15:4<339::AID-DIA577>3.0.CO;2-E","article-title":"Factors associated with clinical nonattendance in adults with type 1 diabetes mellitus","volume":"15","author":"Dyer, P.H.; Lloyd, C.E.; Lancashire, R.J.","year":"1998","unstructured":"Dyer PH, Lloyd CE, Lancashire RJ, et al. Factors associated with clinical nonattendance in adults with type 1 diabetes mellitus. Diabetic med 1998; 15:339-343.","journal-title":"Diabetic med"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.2105\/AJPH.67.11.1033","article-title":"Appointment keeping behaviour evaluated","volume":"67","author":"Hertz, P.; Stamps, P.L.","year":"1997","unstructured":"Hertz P, Stamps PL. Appointment keeping behaviour evaluated. American J Pub Hlth 1997; 67:1033-1036.","journal-title":"American J Pub Hlth"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1093\/fampra\/10.2.111","article-title":"Non-attendance at outpatient clinics: is it related to the referral process?","volume":"102","author":"Lloyd, M.; Bradford, C.; Webb, S.","year":"1993","unstructured":"Lloyd M, Bradford C, Webb S. Non-attendance at outpatient clinics: is it related to the referral process? Fam Pract 1993; 102:111-117.","journal-title":"Fam Pract"},{"issue":"5","key":"ref_24","first-page":"402","article-title":"Nonattendance at outpatient endoscopy. Endoscopy","volume":"36","author":"Adams, L.A.; Pawlik, J.; Forbes, G.M.","year":"2004","unstructured":"Adams LA, Pawlik J, Forbes GM. Nonattendance at outpatient endoscopy. Endoscopy. 2004; 36(5):402-404."},{"issue":"1","key":"ref_25","first-page":"25","article-title":"Factors associated with appointment keeping in a family practice residency clinic","volume":"38","author":"Smith, C.M.; Yawn, B.P.","year":"1994","unstructured":"Smith CM, Yawn BP. Factors associated with appointment keeping in a family practice residency clinic. J Fam Pract 1994; 38(1):25-9.","journal-title":"J Fam Pract"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1136\/bmj.298.6684.1343","article-title":"Non-attendance or non-invitation? A casecontrol study of failed outpatient appointments","volume":"298","author":"Frankel, S.; Farrow, A.; West, R.","year":"1989","unstructured":"Frankel S, Farrow A, West R. Non-attendance or non-invitation? A casecontrol study of failed outpatient appointments. BMJ 1989; 298:1343-1345.","journal-title":"BMJ"},{"issue":"1","key":"ref_27","first-page":"62","article-title":"A waste of time: nonattendance at out-patient clinics in a Scottish NHS Trust","volume":"60","author":"Hull, A.M.; Alexander, D.A.; Morrison, F.; McKinnon, J.S.","year":"2002","unstructured":"Hull AM, Alexander DA, Morrison F, McKinnon JS. A waste of time: nonattendance at out-patient clinics in a Scottish NHS Trust. Health Bull (Edinb) 2002; 60(1):62-9.","journal-title":"Health Bull (Edinb)"},{"issue":"5","key":"ref_28","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1111\/j.1365-2648.1992.tb02832.x","article-title":"Non-attendance at out-patient clinics: a case study","volume":"17","author":"Mason, C.","year":"1992","unstructured":"Mason C. Non-attendance at out-patient clinics: a case study. J Adv Nurs 1992; 17(5):554-560.","journal-title":"J Adv Nurs"},{"issue":"4","key":"ref_29","first-page":"563","article-title":"Failed appointments. Who misses them, why they are missed, and what can be done. Prim Care","volume":"7","author":"Barron, W.M.","year":"1980","unstructured":"Barron WM Failed appointments. Who misses them, why they are missed, and what can be done. Prim Care. 1980; 7(4):563-74."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1001\/archinte.1982.00340160143026","article-title":"A multivariate approach to the prediction of no-show behaviour in a primary care centre","volume":"142","author":"R, Goldman Freidin; EF, Cook; J, Eigner; P, Grich","year":"1982","unstructured":"Goldman Freidin R, Cook EF, Eigner J, Grich P. A multivariate approach to the prediction of no-show behaviour in a primary care centre. Arch Intl Med 1982; 142:563-567.","journal-title":"Arch Intl Med"},{"key":"ref_31","first-page":"180","article-title":"Reasons for non-attendance for the treatment of venous ulcers in an inner city clinic","volume":"25","author":"Pieper, B.; DiNardo, E.","year":"1998","unstructured":"Pieper B, DiNardo E. Reasons for non-attendance for the treatment of venous ulcers in an inner city clinic. J Wound Ostomy and Continence Nurses 1998; 25:180-186.","journal-title":"J Wound Ostomy and Continence Nurses"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1136\/qshc.1.4.236","article-title":"Factors influencing default at a hospital colposcopy clinic","volume":"1","author":"Samanta, G.; Craddock, C.; Wagstaff, I.","year":"1992","unstructured":"Samanta G, Craddock C, Wagstaff I. Factors influencing default at a hospital colposcopy clinic. Qual Hlth Care 1992; 1:236-240.","journal-title":"Qual Hlth Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1136\/hrt.82.2.234","article-title":"Why patients do not attend cardiac rehabilitation: role of intentions and illness beliefs","volume":"82","author":"Cooper, A.; Lloyd, G.; Weinman, J.; Jackson, G.","year":"1999","unstructured":"Cooper A, G Lloyd, J Weinman, G Jackson. Why patients do not attend cardiac rehabilitation: role of intentions and illness beliefs. Heart 1999; 82:234-236.","journal-title":"Heart"},{"key":"ref_34","article-title":"Director General Army Medical Services. Annual Report on the Health of the Army 2005. 2007; Ministry of Defence","unstructured":"Director General Army Medical Services. Annual Report on the Health of the Army 2005. 2007; Ministry of Defence."}],"container-title":["Journal of the Royal Army Medical Corps"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-154-01-08","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T05:20:56Z","timestamp":1716182456000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-154-01-08"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,3]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2008,3,1]]},"published-print":{"date-parts":[[2008,3]]}},"alternative-id":["10.1136\/jramc-154-01-08"],"URL":"https:\/\/doi.org\/10.1136\/jramc-154-01-08","relation":{},"ISSN":["0035-8665","2052-0468"],"issn-type":[{"value":"0035-8665","type":"print"},{"value":"2052-0468","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,3]]}}}