title: Understanding repeated non-attendance in health services: a pilot analysis of administrative data and full study protocol for a national retrospective cohort.
abstract: Understanding the causes of low engagement in healthcare is a pre-requisite for improving health services' contribution to tackling health inequalities. Low engagement includes missing healthcare appointments. Serially (having a pattern of) missing general practice (GP) appointments may provide a risk marker for vulnerability and poorer health outcomes.
  
  
  
  A proof of concept pilot using GP appointment data and a focus group with GPs informed the development of missed appointment categories: patients can be classified based on the number of appointments missed each year. The full study, using a retrospective cohort design, will link routine health service and education data to determine the relationship between GP appointment attendance, health outcomes, healthcare usage, preventive health activity and social circumstances taking a life course approach and using data from the whole journey in the National Health Service (NHS) healthcare. 172 practices will be recruited (∼900 000 patients) across Scotland. The statistical analysis will focus on 2 key areas: factors that predict patients who serially miss appointments, and serial missed appointments as a predictor of future patient outcomes. Regression models will help understand how missed appointment patterns are associated with patient and practice characteristics. We shall identify key factors associated with serial missed appointments and potential interactions that might predict them.
  
  
  
  The results of the project will inform debates concerning how best to reduce non-attendance and increase patient engagement within healthcare systems. Significant non-academic beneficiaries include governments, policymakers and medical practitioners. Results will be disseminated via a combination of academic outputs (papers, conferences), social media and through collaborative public health/policy fora.
authors.affiliation: General Practice and Primary Care, School of Medicine, Dentistry and Nursing, MVLS, University of Glasgow, Glasgow, UK.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Williamson
authors.affiliation: Department of Psychology, University of Lancaster, Lancaster, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Ellis
authors.affiliation: Centre for Rural Health, Institute of Applied Health Sciences University of Aberdeen, Aberdeen, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Wilson
authors.affiliation: General Practice and Primary Care, School of Medicine, Dentistry and Nursing, MVLS, University of Glasgow, Glasgow, UK.
authors.forename: Ross
authors.initials: R
authors.lastname: McQueenie
authors.affiliation: Robertson Centre for Biostatistics, Institute of Health and Wellbeing, MVLS University of Glasgow, Glasgow, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
mesh_terms: D001071:Appointments and Schedules; D017144:Focus Groups; D058006:General Practice / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008498:Medical Record Linkage; D000067455:No-Show Patients / Q000523:psychology / Q000706:statistics & numerical data*; D010865:Pilot Projects; D000075082:Proof of Concept Study; D012107:Research Design; D012189:Retrospective Studies; D012606:Scotland; D035862:Vulnerable Populations / Q000706:statistics & numerical data
keywords: administrative data; data linkage; health inequalities; health utilisation; missed appointments; social vulnerability