Four million patients who failed to attend, Correspondence, British Medical Journal

Four million patients who failed to attend Dr MARY E CAWLEY (Department of Geography) and Dr FIONA M STEVENS (Department of Medicine, University College, Galway) write: The computerisation of appointments systems recommended as a solution to the failure of outpatients to keep their appointments (14 July, p 107) may not fulfil all the expectations of Dr Brian Mawhinney MP (23 June, p 1928). Factors other than death, recovery, and a lack of moral responsibility may impinge on a patients ability to attend a hospital clinic. Time and cost have idely differing effects depending on the social and economic circumstances of patients, and assume further importance in the case of hospitals serving a rural or widely dispersed population where patients often travel great distances to attend. Of a random sample of 325 patients attending general and specialist medical and surgical clinics at the Regional Hospital, Galway, in March 1983, 51%1 travelled more than 20 miles to the hospital; for 42%0 attendance required being away from home for more than six hours; and 25% spent IR10 or more on transport. Postal inquiries to patients who failed to attend the same clinics showed that the main reasons for non-attendance were related to transport, including difficulties of access to public transport and excessive costs. Patients attending the oncology outpatient clinic indicated that rapidly escalating transport costs were imposing a severe financial burden on some families. Thus, it is perhaps necessary to go beyond the mere figures for attendance and non-attendance to recognising that the latter may be due not just to a lack of awareness of the importance of keeping hospital appointments, but to the adverse social and economic circumstances of certain patients.