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January 2019

Missing appointments increases risk of death

Patients with long term conditions, particularly those with mental health issues, face a higher risk of death if they miss appointments in general practices, according to a new study in the online medical journal, BMC Medicine.

Patients with long-term mental health conditions who missed more than two appointments per year had a greater than eight-fold increase in risk of death from any cause compared with those who missed no appointments. Among patients with physical health-related LTCs alone, those missing two or more appointments per year had a three-fold increase in all-cause mortality compared to those who missed no appointments.

And patients with the greatest number of long-term conditions had the highest risk of missing appointments, the researchers found. Even after taking account of the number of appointments made, these patients were at significantly greater risk of all-cause mortality, and the more appointments they missed, the greater their risk.

‘For these patients, existing primary healthcare appointment systems are ineffective,’ the authors say. Future interventions should be developed with a particular focus on increasing attendance, such as offering ‘on-the-day’ appointments for some patients.

RCGP chair Professor Helen Stokes-Lampard explained: ‘Patients with long-term conditions need regular monitoring and treatment and advice tailored to their unique health needs, so missing appointments and not being able to access that support has the potential to have a devastating impact on their wellbeing.

‘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 – for some, life gets in the way and they forget, but others might not turn up precisely because of their health issue.

‘As this research has demonstrated, this particularly applies to patients with mental health conditions.’

Professor Stokes-Lampard said: ‘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.

‘Ultimately, we need substantially more investment in general practice across the board. The NHS Long Term Plan announced this month guarantees that our profession will receive a significant share of the funding outlined for primary and community care. We need these pledges turned into a reality as a matter of urgency so that we have sufficient numbers of GPs and the wider practice team to give all our patients the care they need and deserve.’

It is estimated that more than 15 million appointments in general practice are missed each year, the equivalent of having an additional 375 practices.

McQueenie R, et al. BMC Medicine 2019;17:2.