Nav: Home

Repeatedly missing GP appointments may indicate greater risk of death from all causes

January 10, 2019

Repeatedly missing general practice (GP) appointments may be a risk marker for all-cause mortality, particularly in patients with mental health conditions, new research published in the open access journal BMC Medicine suggests. Although further research is needed to better understand the relationship between missed appointments and mortality, the authors suggest that general practices and other services within the UK National Health Service (NHS) may need to consider how to best engage with patients who repeatedly miss appointments.

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. Of the 824,374 patients whose data were examined in this study, 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 the 439, 592 patients who did not miss any GP appointments over a three-year period 51.5% had no LTCs, whereas 41.6% had one to three LTCs and 7% had four 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.

Mental-health-based LTCs were found to be associated with a higher risk of missing appointments than physical 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.

Dr Ross McQueenie, the corresponding 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."

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

The observational nature of this study does not allow for conclusions about cause and effect. The authors note that it is unlikely that the relationship between missed appointments and mortality is directly causal; one possible mechanism mediating that relationship involves conditions associated with cognitive impairment, such as dementia or problem alcohol and drug use. These conditions are also associated with an increased risk of missing appointments, as well as with increased mortality.
-end-
Media Contact

Anne Korn
Communications Manager
BMC
T: +44 (0)20 3192 2744
E: anne.korn@biomedcentral.com

Notes to editor:

1. Research article:
Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study
BMC Medicine 2018
DOI: 10.1186/s12916-018-1234-0

For an embargoed copy of the research article, please contact Anne Korn at BMC.

After the embargo lifts, the article will be available here: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1234-0

Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BMC's open access policy.

2. BMC Medicine is the flagship medical journal of the BMC series. An open access, open peer-reviewed general medical journal, BMC Medicine publishes outstanding and influential research in all areas of clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. We also publish stimulating debates and reviews as well as unique forum articles and concise tutorials.

3. A pioneer of open access publishing, BMC has an evolving portfolio of high quality peer-reviewed journals including broad interest titles such as BMC Biology and BMC Medicine, specialist journals such as Malaria Journal and Microbiome, and the BMC series. At BMC, research is always in progress. We are committed to continual innovation to better support the needs of our communities, ensuring the integrity of the research we publish, and championing the benefits of open research. BMC is part of Springer Nature, giving us greater opportunities to help authors connect and advance discoveries across the world.

BioMed Central

Related Mortality Articles:

How to attack Africa's neonatal mortality problem
Giving birth at home is the most significant risk factor for neonatal deaths in major sections of Africa -- a continent that continues to be plagued by the highest neonatal mortality rates in the world, indicates a new study by Michigan State University scholars.
DNA labels predict mortality
Methyl labels in the DNA regulate the activity of our genes and, thus, have a great influence on health and disease.
Hormone replacement therapy associated with lower mortality
Women using hormone replacement therapy to relieve the symptoms of menopause faced a lower risk of death and showed lower levels of atherosclerosis, or plaque buildup in the heart's arteries, compared to women not using hormone therapy, according to a single-center study scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session.
Cervical cancer mortality rates may be underestimated
A new analysis reveals that for most women, the risk of dying from cervical cancer is higher than previously thought.
Preventing mortality after myocardial infarction
How much blood to give to anemic patients after a heart attack?
Breast cancer mortality rates decline in many countries
Breast cancer mortality rates continue to decline in many nations, but a review of mortality trends in 47 countries around the world indicates some significant disparities, particularly in South Korea and some Latin American nations, according to results presented at the 2016 San Antonio Breast Cancer Symposium, held Dec.
Study examines trends in infectious disease mortality in US
In a study appearing in the Nov. 22/29 issue of JAMA, Heidi E.
Study links athletic performance to mortality
New University of Arizona research suggests that athletes perform better when reminded of something a bit grim: their impending death.
Statins may be associated with reduced mortality in 4 common cancers
A diagnosis of high cholesterol is associated with reduced mortality and improved survival in the four most common cancers, according to research presented today at Frontiers in CardioVascular Biology 2016.
Gene mutation causes juvenile mortality in calves
Based on genome data, breeders and scientists are able to determine which hereditary factors and which genetic diseases cattle pass on to their offspring.

Related Mortality Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Don't Fear Math
Why do many of us hate, even fear math? Why are we convinced we're bad at it? This hour, TED speakers explore the myths we tell ourselves and how changing our approach can unlock the beauty of math. Guests include budgeting specialist Phylecia Jones, mathematician and educator Dan Finkel, math teacher Eddie Woo, educator Masha Gershman, and radio personality and eternal math nerd Adam Spencer.
Now Playing: Science for the People

#517 Life in Plastic, Not Fantastic
Our modern lives run on plastic. It's in the computers and phones we use. It's in our clothing, it wraps our food. It surrounds us every day, and when we throw it out, it's devastating for the environment. This week we air a live show we recorded at the 2019 Advancement of Science meeting in Washington, D.C., where Bethany Brookshire sat down with three plastics researchers - Christina Simkanin, Chelsea Rochman, and Jennifer Provencher - and a live audience to discuss plastics in our oceans. Where they are, where they are going, and what they carry with them. Related links:...