How do clinicians respond to patients who miss appointments?
BACKGROUND
Although patients miss up to 60% of scheduled outpatient appointments, little is known about how clinicians respond to "no-shows." In an effort to determine how clinicians customarily handle missed appointments, we surveyed mental health clinicians and internists at 2 academic hospitals: a private psychiatric hospital and an urban general hospital.


METHODS
An anonymous questionnaire survey was mailed to psychiatrists, psychologists, and social workers at both hospitals and to internists at the general hospital. Clinicians were surveyed about their usual response to psychotherapy, psychopharmacology, and internal medicine patients who miss appointments.


RESULTS
Among the 356 responses (39.5%) to 902 mailed questionnaires, there was substantial variability in clinicians' reported handling of "no-show" patients, although psychiatrists tended to be initially less active in pursuing patients than were nonphysician therapists and internists. A number of clinical variables were associated with clinicians' responses including the perceived risk of a bad outcome, hospital site, support staff availability, and billing practices.


CONCLUSIONS
The results suggest that clinicians' responses to missed appointments are determined by a complex mixture of influences rather than adherence to a readily definable "standard of care."
Department of Psychiatry, Massachusetts General Hospital, Boston 02114, USA. smoller@warren.med.harvard.edu
J W
JW
Smoller
R Y
RY
McLean
M W
MW
Otto
M H
MH
Pollack
D000328:Adult; D000553:Ambulatory Care; D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D010349:Patient Compliance; D010352:Patient Dropouts; D011364:Professional Practice / Q000458:organization & administration; D011369:Professional-Patient Relations; D011570:Psychiatry / Q000458:organization & administration*; D011586:Psychology, Clinical / Q000458:organization & administration; D011613:Psychotherapy / Q000458:organization & administration*; D012307:Risk Factors; D012947:Social Work / Q000458:organization & administration; D011795:Surveys and Questionnaires