Patient age, ethnicity and waiting times determine the likelihood of non-attendance at a first specialist rheumatology assessment.
OBJECTIVE
To identify demographic and geographic factors associated with non-attendance for first specialist assessment (FSA) at a publicly funded rheumatology clinic and identify changes in service provision that might improve attendance rates.


METHODS
Administrative data for 1953 new referrals over a 2-year period was collected from a New Zealand public rheumatology unit. Patient characteristics and location variables were tested for significance and odds ratios were generated to determine the relationship between non-attendance and referrals data.


RESULTS
Patients in the 20-29 years age-group were least likely to attend appointments (P ≤ 0.001, OR 2.81, 95%CI 1.59-4.98). Māori and Pacific Peoples were each almost twice as likely to miss a FSA (P = 0.02, OR 1.87, 95%CI 1.11-3.15 and OR 1.89, 95%CI 1.11-3.22) as New Zealand Europeans. Non-attendance was independently associated with longer waiting times to FSA; with residential location and the uneven provision of services being strong predictors of longer waiting times (P ≤ 0.001).


CONCLUSIONS
Non-attendance is associated with ethnicity, age and waiting times. It is likely that high deprivation influences ethnic variations in attendance but reasons for young people's non-attendance were difficult to identify. Patients domiciled further from the main rheumatology clinic were also less likely to attend. The influence of ethnicity and deprivation may be underestimated in this study as high Maori and Pacific ethnic populations live closer to well-resourced clinics. Focusing administrative resources on at-risk groups and restructuring the clinical service to improve uneven waiting times would be expected to improve attendance rates across the region.
Department of Medicine, Wellington School of Medicine, University of Otago, Wellington, New Zealand.
Valerie
V
Milne
Robin
R
Kearns
Andrew
A
Harrison
D000328:Adult; D000367:Age Factors; D000368:Aged; D001071:Appointments and Schedules; D005006:Ethnicity / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D016017:Odds Ratio; D010349:Patient Compliance / Q000208:ethnology* / Q000523:psychology; D010361:Patients / Q000523:psychology; D017150:Public Sector; D012017:Referral and Consultation; D012111:Residence Characteristics; D012189:Retrospective Studies; D012219:Rheumatology; D012307:Risk Factors; D013997:Time Factors; D014850:Waiting Lists; D044465:White People / Q000523:psychology; D055815:Young Adult
New Zealand; age; ethnicity; non-attendance; waiting time