Missed Appointments: Factors Contributing to Patient No-Show in Outpatient Hospital Clinics in Tehran, Iran

Background and Objectives: Patient no-show in scheduled appointments is a major challenge for outpatient clinics. It negatively affects the efficiency, accessibility, and delivery of healthcare. This study was conducted to investigate the prevalence and potential predictors of patient no-show in outpatient clinics of a general and teaching hospital in Tehran, Iran. Methods: In this cross-sectional study, all outpatients who had scheduled appointments from March 20, 2016 to March 20, 2017 were included in the study (N = 148,077). Independent two-sample t-test and the Chi-square test were used for comparing the variables in the two groups-attending and no-show patients. Logistic regression was used to analyze predictors of no-show. Results: The no-show rate was 50.1%. General practice (80.3 %) and nephrology (40.1%) clinics had the highest and the lowest no-show rates, respectively. The mean lead time of appointments was 10.2 (± 14.7) days, while the average lead times for no-show and attending patients were 11.7 (± 15.6) and 8.8 (± 13.7) days respectively (P < 0.001). Lead-time of more than two weeks (OR = 1.80), web-based appointment system (OR = 1.71), interactive voice response appointment system (OR = 1.69), month of appointment (OR = 1.03), and clinic working shift (OR = 0.94) were the predictive variables of patient no-show. Conclusions: Findings indicate that appointment lead time is the main predictor of no show. Therefore, deploying strategies to reduce lead time, such as increasing the number of physicians, increasing working hours, or improving clinic efficiency can improve patient attendance. Other findings suggest that appointment reminders via text message, cancellation policy, and nurse-led telephone triage can be expected to decrease patients no-show.