No-shows to primary care appointments: Subsequent acute care utilization among diabetic patients

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 6months (182days) following the patients 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. © 2012 Nuti et al.; licensee BioMed Central Ltd.