Tackling No-Show Rates: Addressing Barriers in a Free Clinic's Attendance

Abstract

Problem Statement: Health disparities persist due to social determinants of health impacting appointment no-show rates at the Matthew 25 clinic. Rationale: Addressing health disparities has been at the forefront of challenges faced in the medical field. Social determinants of health (SDOH) have a significant impact on patient populations, often contributing to health disparities (1). SDOH refers to environmental factors that contribute to one’s overall health and longevity (2,3). It is estimated that SDOH account for 50% of the variation in health outcomes. Intervening on factors that contribute to poor SDOH could have a profound impact on many lives. Matthew 25, a free clinic in Fort Wayne, IN, serves a large immigrant population and natives who are of a low socioeconomic status. While the clinic helps to bridge the gap in healthcare by providing free healthcare services, it is hypothesized that SDOH are influencing the quality of care the clinic can provide. This study’s objective is to evaluate the effectiveness of the proposed survey model on increasing healthcare accessibility by observing its effects on rate of missed appointments. Methods: This was a single-center prospective questionnaire-based research project designed to determine the reasons for missed appointments and what resources can assist in reducing the no-show rate. This study was approved by the Indiana University Institutional Review Board. Participants included patients scheduled for appointments from November 2023 to the end of December 2023. Inclusion criteria were patients aged 18 and above who had at least one scheduled appointment during the study period. Any patient under the age of 18 years, who communicates exclusively in any language other than English or Spanish, or has substantial cognitive impairment was excluded. The data was stored on a Microsoft Excel Spreadsheet. The ultimate objective of this project was to implement interventions that would mitigate the no-show rate at Matthew 25. The survey was administered by clinic staff, including volunteers and nurses, at the conclusion of each patient's visit prior to discharge. A verbal explanation of the intention of the study was given to potential participants before they completed the questionnaire. To encourage participation, the questionnaire was designed to be anonymous. The instrument comprised of ten questions. Completed surveys were securely stored at the clinic in a designated folder until the data was digitized, after which the physical questionnaires were disposed of securely. Results: A total of 64 participants completed the survey, shedding light on the primary reasons for missing appointments at Matthew 25. The most common reason was work obligations (19 participants, 29.7%), followed by simply forgetting (17 participants, 26.6%). Lack of transportation affected 10 participants (15.6%), while 5 participants (7.8%) cited lack of childcare. Seven respondents (10.9%) identified the absence of a translator as a significant barrier, and 4 (6.3%) selected "Other" reasons. A smaller percentage (3.1%) reported fear or anxiety about attending the clinic. A second survey, with 149 responses, assessed preferred reminder times. Results showed 14% preferred reminders 1 day prior, 38% preferred 2 days prior, 43% opted for 1 week before, and 5% wanted a reminder 1 month in advance. No-show rates did not significantly change within the first three months after posting informational materials, possibly due to insufficient time for patients to schedule follow-up visits. A newer Spanish-language poster was recently added, but its effects are still being evaluated. These findings emphasize the importance of addressing social determinants of health on a community level, such as employment conflicts, transportation, and language barriers, to reduce no-show rates and improve healthcare access. Additionally, increasing patient awareness through multilingual outreach efforts, like the newly introduced Spanish-language poster, may further enhance attendance rates over time. Potential Impact: The survey highlighted common barriers that prevented patients from attending their appointments, allowing us to create English and Spanish posters with information about free services to help patients become more aware of the resources that, ideally, would make it simpler to attend appointments. References:

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