Abstract
Background
Patients who no-show to primary care appointments interrupt clinicians’ efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics.
Methods
A prospective cohort study was conducted using data from 8,787 adult diabetic patients attending outpatient clinics associated with a medical center in Indiana. The outcomes examined were hospital admissions or ED visits in the 6 months (182 days) following the patient’s last scheduled primary care appointment. The Andersen-Gill extension of the Cox proportional hazard model was used to assess risk separately for hospital admissions and ED visits. Adjustment was made for variables associated with no-show status and acute care utilization such as gender, age, race, insurance and co-morbid status. The interaction between utilization of the acute care service in the six months prior to the appointment and no-show was computed for each model.
Results
The six-month rate of hospital admissions following the last scheduled primary care appointment was 0.22 (s.d. = 0.83) for no-shows and 0.14 (s.d. = 0.63) for those who attended (p < 0.0001). No-show was associated with greater risk for hospitalization only among diabetics with a hospital admission in the prior six months. Among diabetic patients with a prior hospital admission, those who no-showed were at 60% greater risk for subsequent hospital admission (HR = 1.60, CI = 1.17–2.18) than those who attended their appointment. The six-month rate of ED visits following the last scheduled primary care appointment was 0.56 (s.d. = 1.48) for no-shows and 0.38 (s.d. = 1.05) for those who attended (p < 0.0001); after adjustment for covariates, no-show status was not significantly related to subsequent ED utilization.
Conclusions
No-show to a primary care appointment is associated with increased risk for hospital admission among diabetics recently hospitalized.
Keywords
No-show; Diabetes; Emergency department visits; Hospital admissions; Outcomes
Date of this Version
9-6-2012
DOI
10.1186/1472-6963-12-304
Recommended Citation
Nuti, Lynn A.; Lawley, Mark; Turkcan, Ayten; Tian, Zhiyi; Zhang, Lingsong; Chang, Karen; Willis, Deanna R.; and Sands, Laura P., "No-Shows to Primary Care Appointments: Subsequent Acute Care Utilization among Diabetic Patients" (2012). School of Nursing Faculty Publications. Paper 17.
http://dx.doi.org/10.1186/1472-6963-12-304
Comments
This is the publisher pdf of Nuti, Lynn A, Mark Lawley, Ayten Turkcan, Zhiyi Tian, Lingsong Zhang, Karen Chang, Deanna R Willis, and Laura P Sands. "No-shows to primary care appointments: subsequent acute care utilization among diabetic patients." BMC Health Services Research 12.1 (2012): 304. Print and is available at: 10.1186/1472-6963-12-304.