Waiting time, doctor shopping, and nonattendance at specialist outpatient clinics: case-control study of 6495 individuals in Hong Kong.
OBJECTIVE
Nonattendance is a major health services research and management issue that has received little attention or systematic study in Asia. We examined the independent associations between waiting time, doctor shopping, and nonattendance in specialist outpatient clinics of 4 large public hospitals in Hong Kong.


METHODS
Case-control study.


METHODS
A total of 6495 attenders and nonattenders enrolled from July 2000 through October 2001. PAIN OUTCOME MEASURES: Odds ratios (ORs) and associated 95% confidence intervals (CI) for nonattendance.


RESULTS
Longer waiting times (adjusted OR2nd quartile, 1.67; 95% CI, 1.38-2.03; adjusted OR3rd quartile, 1.90; 95% CI, 1.56-2.30; adjusted OR4th quartile, 2.30; 95% CI, 1.91-2.78) and doctor-shopping behavior (adjusted OR, 2.91; 95% CI, 2.51-3.38) were independent risk factors for nonattendance. These effects were robust after multivariate adjustment and testing for effect modification. They also appeared to persist uniformly across hospitals and specialties. There was no demonstrable relationship between waiting time and doctor shopping.


CONCLUSIONS
This is the largest study of nonattendance at outpatient clinics and the first such study carried out in Asia. Targeted strategies should be implemented and evaluated using these results to reduce waiting time, doctor shopping, and ultimately nonattendance.
Department of Community Medicine, The University of Hong Kong.
Gabriel M
GM
Leung
Susana
S
Castan-Cameo
Sarah M
SM
McGhee
Irene O L
IO
Wong
Janice M
JM
Johnston
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D016022:Case-Control Studies; D016001:Confidence Intervals; D003625:Data Collection; D005260:Female; D006304:Health Status; D006723:Hong Kong; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D010817:Physician-Patient Relations; D012959:Socioeconomic Factors; D013689:Telephone; D013997:Time Factors; D014850:Waiting Lists