title: Missing scheduled visits in the outpatient clinic as a marker of short-term admissions and death.
abstract: BACKGROUND
  It is not uncommon for patients with HIV infection to miss scheduled visits in outpatient clinics without justifying the failure to appear or reschedule the appointment. Few studies have assessed the impact of inconsistent follow-ups on resource use and disease outcomes in this patient population.
  
  
  OBJECTIVE
  To assess the effect of missing scheduled visits to the outpatient clinic on the health outcomes of HIV-infected patients.
  
  
  METHODS
  Between January and June 2006, we conducted a prospective observational study monitoring assistance at an outpatient HIV/AIDS clinic of a tertiary hospital within a public health care system in a developed country. The short-term subsequent events (deaths and admissions) of the population were observed from January to December 2006.
  
  
  RESULTS
  Of the 1,733 HIV patients who were scheduled in the outpatient clinic, 103 met the criteria of missing scheduled visit (5.9%). Hospital admissions and mortality rates were significantly higher in the missing scheduled visit group compared to non-missing scheduled visits (27.2% vs 8.9%; P < .001 and 5.8% vs 0.7%; P < .001, respectively). Patients with missing scheduled visits had a higher risk of hospital admissions (odds ratio [OR] 2.4; 95% CI, 1.4-4) and mortality (OR 6.7; 95% CI, 2.2-18.5) adjusted by age, CD4 cell count, HIV stage, and category of transmission.
  
  
  CONCLUSIONS
  Missing scheduled visits was an independent predicting factor for hospital admission and mortality. It is warranted to monitor and implement resources to reduce missed appointments.
authors.affiliation: Infectious Diseases Department, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: María Martínez
authors.initials: MM
authors.lastname: Colubi
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Pérez-Elías
authors.forename: Laura
authors.initials: L
authors.lastname: Elías
authors.forename: María
authors.initials: M
authors.lastname: Pumares
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.forename: Ana Moreno
authors.initials: AM
authors.lastname: Zamora
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Casado
authors.forename: Fernando
authors.initials: F
authors.lastname: Dronda
authors.forename: Dolores
authors.initials: D
authors.lastname: López
authors.forename: Santiago
authors.initials: S
authors.lastname: Moreno
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001071:Appointments and Schedules; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D015438:Health Behavior; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data*; D010349:Patient Compliance; D012307:Risk Factors; D013997:Time Factors