P280 Reducing Non-Attendance at a Difficult Asthma Clinic – Are Phone Calls Futile?

Abstract

Background Missed outpatient appointment cost NHS hospitals in the region of 600 million per year.1 There is some evidence that 'did-not-attend' (DNA) rates are particularly high for primary care asthma reviews2. Increasing demand for our weekly difficult asthma clinic means that routine appointments are at a premium. This led us to attempt to reduce the DNA rate. Our asthma specialist nurses began to interview patients that failed to attend over the telephone within a week of their scheduled appointment. Aim To ascertain whether telephoning patients that DNA clinic leads to an attendance at the next scheduled clinic appointment. Methods Review of database generated from contacting patients that DNA asthma clinic between April 2011 and March 2012. Results There were a total of 153 missed appointments. We attempted to contact the patient following their missed appointment in 101 cases. We were able to contact 51 patients, of these 20 (39%) attended their next appointment. We tried but failed to contact 50 patients of whom 5 (10%) attended their next appointment. We did not contact 52 patients for various reasons, 10 (19%)attended their next appointment. Conclusions Telephoning patients that DNA asthma clinic led to a two fold increase in attendance at subsequent clinics. Each phone call lasted approximately ten minutes and there were often several attempts required before contact was made. The patient's asthma control was assessed during the call and the outcome was recorded in the case notes. Despite that fact that telephoning patients led to a reduction in subsequent missed appointments, this is a time consuming and therefore costly exercise and 24/51 (47%) of patients missed their subsequent appointment despite having been contacted. Non-attendance may be a reflection of poor concordance which in itself may be contributing to the patients' difficult asthma.