Understanding the impact and causes of ‘failure to attend’ on continuity of care for patients with chronic conditions
Open Access
- 2 March 2021
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 16 (3), e0247914
- https://doi.org/10.1371/journal.pone.0247914
Abstract
Aim: To understand the impact and causes of ‘Failure to Attend’ (FTA) labelling, of patients with chronic conditions. Background: Nurse navigators are registered nurses employed by public hospitals in Queensland, Australia, to coordinate the care of patients with multiple chronic conditions, who frequently miss hospital appointments. The role of the nurse navigator is to improve care management of these patients. Evidence for this is measured through improvement in patient self-management of their conditions, a reduction in preventable hospital admissions and compliance with attendance at outpatient clinics. Failure to attend (FTA) is one measure of hospital utilisation, identifying outpatient appointments that are cancelled or not attended. Method: The cohort for this study was patients with multiple chronic conditions, and nurse navigators coordinating their care. Data describing the concept of FTA were thematically analysed twelve months into this three year evaluation. Results: Although the patient is blamed for failing to attend appointments, the reasons appear to be a mixture of systems error/miscommunication between the patient and the health services or social reasons impacting on patient’s capacity to attend. Themes emerging from the data were: access barriers; failure to recognise personal stigma of FTA; and bridging the gap. Conclusion: The nurse navigators demonstrate their pivotal role in engaging with outpatient services to reduce FTAs whilst helping patients to become confident in dealing with multiple appointments. There are many reasons why a patient is unable to attend a scheduled appointment. The phrase ‘Failure to Attend’ has distinctly negative connotations and can lead to a sense of blame and shame for those with complex chronic needs. We propose the use of the neutral phrase “appointment did not proceed” to replace FTA. Implications for Nursing management: This article advocates for further consideration of collaborative models that engage the patient in their care journey and for consideration of the language used within the outpatient acute hospital setting, proposing the term ‘appointment did not proceed.’Funding Information
- Department of Health, Queensland
This publication has 16 references indexed in Scilit:
- How Decision Support Systems Can Benefit from a Theory of Change ApproachEnvironmental Management, 2017
- Assumptions, conjectures, and other miracles: The application of evaluative thinking to theory of change models in community developmentEvaluation and Program Planning, 2016
- What's in a name? Concordance is better than adherence for promoting partnership and self-management of chronic diseaseAustralian Journal of Primary Health, 2016
- Living with chronicity and complexity: Lessons for redesigning case management from patients' life stories – A qualitative studyJournal of Evaluation in Clinical Practice, 2014
- Sustaining Universal Health Coverage: The Interaction of Social, Political, and Economic SustainabilityValue in Health, 2013
- Patients’ engagement in primary care: powerlessness and compounding jeopardy. A qualitative studyHealth Expectations, 2012
- Failure to attend out‐patient clinics: is it in our DNA?International Journal of Health Care Quality Assurance, 2011
- The power of language: a secondary analysis of a qualitative study exploring English midwives’ support of mother's baby-feeding practiceMidwifery, 2010
- Why outpatients fail to attend their scheduled appointments: a prospective comparison of differences between attenders and non-attendersAustralian Health Review, 2003
- The Quality of Life Scale (QOLS): Reliability, Validity, and UtilizationHealth and Quality of Life Outcomes, 2003