Reasons for Missed Appointments at a Urogynecology Practice: A Qualitative Study

Objectives: This study aims to investigate patient no-shows— missed appointments or same-day cancellations— through qualitative interviews to understand patient-perceived barriers to appointment attendance in an academic Urogynecology clinic.

Methods: We conducted an IRB-approved prospective, qualitative study to identify reasons for no-shows at our institution’s outpatient Urogynecology clinics from April to September 2023. Patients >18 years of age who no-showed, and speak either English or Spanish, were invited to participate in semi-structured, one-on-one telephone interviews. Non-random, purposive sampling was used to ensure a sample reflecting our clinics’ patient population. The standardized interview guide was developed with a patient-centered focus and questions touched upon potential barriers to appointment attendance, specific reasons for the missed appointment, and accessibility of the clinic and how this impacted attendance (Figure 1). Interviews were audio-recorded, translated (if needed), and transcribed verbatim. New interviews were stopped once saturation was reached. Inductive codes were applied to interview text fragments using Atlas.ti software and a codebook was developed.

Results: Of the 230 patients eligible, 110 (48%) were contacted; of those, 26 (24%) consented to and completed interviews (Table 1). After examining codes, three major themes were established as barriers to attending appointments: (1) community and environmental barriers, (2) patient-related factors, and (3) clinic-related factors. Community and environmental barriers [20 (77%)] included unforeseen circumstances, such as inclement weather or car accidents, and transportation issues including heavy traffic or inadequate available transportation services. A majority (52%) of interviewed participants cited transportation difficulties. Patient-related factors [16 (62%)] were comprised of obligations to family members, personal illness, patient mental health, confusion with appointments, or competing job responsibilities. Finally, participants cited a few clinic-related factors [9 (35%)] such as scheduling/timing that made it harder to keep their appointments. Specifically, 12% reported not being offered different clinic locations and 20% reported long lead times before appointment date and consequently opted for first available appointments elsewhere.

In addition, patient-proposed themes emerged for possible changes our Urogynecology clinics could implement to facilitate appointment attendance. These included 1) offering assistance in arranging transportation to and from appointments, 2) providing more avenues for interpersonal support through patient support groups, 3) improving the patient care portal to make it easier for communicating with patients, scheduling appointments online, and appointment reminders.

Conclusions: Identifying the reasons why patients no-show is pivotal to providing better personalized care. Our findings offer a deeper understanding of the multiple issues underlying missed Urogynecology appointments at an academic center. Future research to develop an algorithm that identifies patients likely to no-show and provide interventions such as improved communication, via staffing deployment, user-friendly portals, intelligent technology use, and transportation support can be very beneficial.