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Original papers: Marek Marzanski, Padmapriya Musunuri, and Tim Coupe Copying letters to patients: a study of patients’ views Psychiatr Bull 2005; 29: 56-58 [Abstract] [Full text] [PDF]

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Non-attendance at learning disability out-patient clinics

C Feroz-Nainar, Meera Roy, Consultant in Learning Disability Psychiatry, South Birmingham PCT   (8 February 2005)

Non-attendance at learning disability out-patient clinics 8 February 2005
C Feroz-Nainar, SpR in Learning Disability Psychiatry South Birmingham PCT, Meera Roy, Consultant in Learning Disability Psychiatry, South Birmingham PCT Send letter to journal: Re: Non-attendance at learning disability out-patient clinics doctorferoz{at}yahoo.co.uk C Feroz-Nainar, et al.	We conducted an audit at the learning disability clinics in South Birmingham in an attempt to reduce the did not attend (DNA) rate. The DNA rate was 21%. The likelihood of a patient missing an appointment was independently associated with being a younger adult (p=0.036), a new referral (p<0.001), absence of a mental illness (p=0.043), absence of challenging behaviour (p=0.041), and a past history of non-attendance (p<0.001). As the DNA-rate for new referrals was very high compared to that of follow-ups (61% vs 17%, p<0.001), we sent reminder letters 3 days prior to the appointment for new referrals and this substantially decreased their DNA-rate to 10% (p<0.001). A 2-yr follow-up showed a DNA-rate of 37% among the new referrals. The presence of a psychiatric diagnosis and the severity of the mental disorder have been associated with missing appointments (Glyngdal et al 2002, Killaspy et al 2000). However in this study, the presence of a psychiatric diagnosis was associated with better clinic attendance. It maybe that as most of the people with learning disability live with carers it is possible that the carers recognise the change in behaviour associated with psychiatric diagnosis and bring them to medical attention. Inappropriate referral, social stigma and misconceptions about psychiatric consultations (Grunebaum et al 1996) may have been the reasons for the high DNA rate among the new referrals. Future interventions to reduce the DNA rate may be targeted at the other factors, which we have found to be significant. References 1. GLYNGDAL P, SORENSEN P, KISTRUP K (2002), ‘Non-compliance in community psychiatry: failed appointments in the referral system to psychiatric out-patient treatment’, Nordic Journal of Psychiatry, 56(2), 151-6 2. GRUNEBAUM M, LUBER P, CALLAHAN M ET AL(1996) ‘Predictors of missed appointments for psychiatric consultations in a primary care clinic’ Psychiatric Services, 47(8), 848-852 3. KILLASPY H, BANERJEE S, KING M & LLOYD M (2000), ‘Prospective controlled study of psychiatric out-patient non-attendance’, British Journal of Psychiatry, 176: 160-5