Why patients miss follow-up appointments: a prospective control-matched study.

OBJECTIVES To investigate missed appointments in a South African tertiary hospital. STUDY DESIGN Prospective, descriptive series with controls. SETTING The ENT/Oncology clinic at Tygerberg Academic Hospital, South Africa. SUBJECT 305 patients with a head and neck malignancy who had follow-up appointments over 4 consecutive months between June and September 2006. A control group of 31 patients who attended the clinic was recruited in September 2006. METHOD Analysis of the clinic attendance statistics to identify patients who missed follow-up appointments followed by a file review and interview of these patients. The results were compared with a control group. OUTCOME MEASURES 1) Incidence rate of failure to attend follow-up. 2) Causative factors. RESULTS 51 (17%) booked patients missed their appointments. Non-attenders were most likely to miss their follow-up between 6 and 12 months (17/31) after treatment. No correlations were found between diagnosis, disease stage and missed appointments. Reasons include: transport (19 responses), ill-health (6) and financial constraints (5). State transport was unavailable to almost two-thirds of the responders who cited transport as a problem. CONCLUSIONS The 17% missed appointment rate is largely due to transport constraints. The commonest time for patients to miss appointments is the 6-12 month follow-up period. The authors seek to identify patients at risk of missed appointments and suggest interventions to decrease this incidence.