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*199. Patient Characteristics Associated with Failure to Keep Mental Health Primary Care Appointments

PM Dubbert, Jackson VA Medical Center & Univ Mississippi Medical Center; G Tkachuk, Jackson VA Medical Center & Univ Mississippi Medical Center; T Layer, Jackson VA Medical Center; MO Robbins, Jackson VA Medical Center

Objectives: To identify patient characteristics associated with failure to keep appointments in a primary care clinic for mental health patients.

Methods: All patients who kept at least one appointment in the mental health primary care clinic from October 1, 1999 to July 31, 2000 were identified. Characteristics hypothesized to be associated with appointment keeping and number of no-shows for primary care appointments during the observation period were extracted from the VA Decision Support System. Patientsí mental health subspecialty team assignments were obtained from the current list of case manager assignments. We compared patients who kept all scheduled appointments (APPT KEEPERS) with those who failed to show for at least one scheduled appointment (NO SHOWS).

Results: 2,555 patients kept at least one appointment in the mental health primary care clinic during the observation period. Of these, 1453 (57%) failed to show for an appointment on at least one occasion. In any month, more than 40% of scheduled appointments were not kept and patients did not call to reschedule. Data on patient characteristics was available in DSS for more than 1500 of the patients. Patients were of average age 52 years, with eras of military service as follows: 12.6% WWII , 8.6% Korean, 5.7%, post-Korean, 52% Vietnam, 13.9% post-Vietnam, and 5.5% Persian Gulf. 48.5% were married and 50% lived within a 50 mile radius of the medical center. 29.7% were assigned to the Chemical Dependence team, 34.5% to the General Psychiatry team, 14.3% to the PTSD team, and 21.6% were not currently assigned to a team. Average GAF score was 57. As expected, there were differences in age, era, and GAFs for patients assigned to different teams. NO SHOW patients were significantly younger than APPT KEEPERS, p=.01. Marital status, era of military service, and mental health subspecialty team assignment (pís<.001) were significantly associated with appointment keeping status. Only 24% of married patients failed to keep an appointment. Only 17% of WWII era veterans failed to keep an appointment, while 49% of post Vietnam and 40% of Persian Gulf veterans failed to show for at least one appointment. 76% of patients assigned to the Chemical Dependence team failed to show for an appointment. GAF scores were not different between APPT KEEPERS and NO SHOWS. Distance from the VAMC and means test results also were not associated with appointment keeping.

Conclusions: Several patient characteristics were significantly associated with having failed to show for a mental health primary care appointment. Younger patients from more recent eras of military service, nonmarried patients, and those assigned to substance abuse program case managers were more likely to miss their appointments. Distance from VAMC, means test, and GAF scores were not associated with appointment keeping in this sample.

Impact: Missed appointments in primary care reduce efficiency and may be associated with reduced continuity of medical care. Mental health patients may have more difficulty accessing medical care or may need extra encouragement to keep appointments with primary care providers. Successful identification of characteristics associated with mental health patients who fail to keep primary care appointments can make it possible to direct scarce resources for intervention efforts to those most likely to miss appointments.