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Missed GP appointments raises risk for patients

Eight times higher risk of death for LTC patients missing appointments

Adrian O'Dowd

Friday, 11 January 2019

GPs should monitor patients with long-term conditions who repeatedly miss appointments because this appears to raise their risk of death significantly, claims a study* published today in the journal BMC Medicine.

Researchers at the universities of Glasgow, Aberdeen and Lancaster found that the more long-term conditions (LTC) a person had, the more likely they were to miss appointments.

Although further research is needed to understand the relationship between missed appointments and mortality, the authors suggested that general practices and other NHS services should consider how to best engage with patients who repeatedly fail to turn up for their appointments.

Previous studies have examined the underlying patient and practice factors for missed appointments, but less is known about the impact on patient health.

Therefore, the authors set out to examine the effect of missed primary healthcare appointments on all-cause mortality in those with long-term mental and physical health conditions.

They used a large Scottish primary healthcare appointment dataset collected from 136 general practices from 11 Scottish health boards between 2013 and 2016, resulting in a cohort of 11.5 million appointments from 824,374 patients.

They linked that data to the Scottish death registry to examine the association between missed appointments and mortality.

Analysis showed that of the 824,374 patients whose data were examined, 59% had one or more LTC, while 13.3% had four or more. Patients with no LTCs were less likely to miss GP appointments than patients with LTCs.

Out of 59,340 patients who missed three or more appointments per year over the same three-year period, 40.1% had four or more LTCs, 50.1% had one to three LTCs, and 9.8% had no LTCs.

One to three mental health comorbidities were associated with a 30% higher risk of missing appointments compared to those who had no LTCs, and patients with four or more mental health LTCs were twice as likely to miss appointments.

Patients with one to three physical morbidities were 16% more likely to miss appointments than those with no LTCs, whereas those with four or more physical LTCs were at 38% higher risk of missing appointments.

The observational nature of this study does not allow for conclusions about cause and effect and the authors noted that it was unlikely that the relationship between missed appointments and mortality was directly causal.

Dr Ross McQueenie, lead author of the study, said: “Patients with a higher number of missed appointments were also at greater risk of death within the following year.

“Those with long-term physical conditions who missed two or more appointments per year had a threefold increase in all-cause mortality compared with those who missed no appointments.

“Patients with only mental health conditions who missed more than two appointments per year had an eightfold increase in all-cause mortality compared with those who missed no appointments.

“Patients diagnosed with long-term mental health problems, who died during the follow-up period, were more likely to die prematurely, often as a result of external factors such as suicide, rather than of natural causes.”

Royal College of General Practitioners chair Professor Helen Stokes-Lampard, said: “People miss appointments for a range of reasons, but this study highlights why it’s more important to show compassion to people who fail to attend, rather than punishing them.

“We need systems in place to better accommodate for these situations and the starting point is having more mental health therapists based in primary care, where the majority of mental health issues are identified and managed.”


*McQueenie R, Ellis D A, McConnachie A, et al. Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study. BMC Medicine. DOI: 10.1186/s12916-018-1234-0

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