Missed appointments, also known as no-shows, have long been a concern for health care providers, particularly for psychiatric clinics. High no-show rates lead to financial losses, but they also impact patient care, provider workflow, and clinical capacity. For patients with mental health issues that are exacerbated by medication non-adherence, no-shows can lead to increased hospitalization.

Why do patients miss their appointments?

There are a number of factors that contribute to missed appointments, such as social determinants of health, which are the environmental and community conditions that affect a person’s life and wellbeing.

Because social determinants of health are not equally distributed, patients from historically marginalized communities face more barriers to accessing health care, and as a result, often have higher no-show rates. According to one study, Black patients were 68% more likely to miss appointments than white patients, and Asian patients were 32% more likely to be no-shows white patients. According to a study by The Center for American Progress, transgender patients were 10% less likely to get a routine check-up than cisgender patients. For trans patients, this can be largely attributed to a general distrust in medical providers due to past traumatic experiences.  

Missing appointments can be caused by logistical barriers, like not being able to take off from work, childcare/caregiver responsibilities, or a lack of reliable transportation. Patients from diverse backgrounds may also face cultural barriers that can discourage them from attending their appointments, like a lack of understanding and sensitivity towards their identities, not having a provider who speaks their language, or facing discrimination and biases throughout their interactions with the health care system.

How to reduce no-show rates.

There are a number of strategies that have been shown to reduce no-show rates, including:

• Scheduled reminders. Calling patients to remind them of their appointments is standard practice in many primary care offices. However, it can also be advantageous to contact patients in other ways, such as texting, email, and calendar invites.
• ‍Telehealth. Offering telemedicine appointments can be a big help for patients who need flexibility, and can reduce the logistical headaches of distance, transportation, or caregiving responsibilities.
• ‍Reducing wait times. Making patients wait weeks between scheduling a mental health appointment and seeing a provider contributes to higher rates of missed appointments. One study showed that reducing wait times in out-patient mental health settings from 13 days to 0 days reduced no-shows from 52% to 18%. This is, of course, easier said than done, as wait times are usually due to limited provider resources and a high patient demand. Adding more flexible appointment times, telehealth options, and streamlining the intake process whenever possible can help alleviate some of the burden. Another study by Violet showed that diverse patients got to care 9% faster after benchmarking clinicians’ cultural competence and matching them together.
  
  For in-office wait times, patients who are forced to wait extended periods for their appointments may be discouraged from attending in the future, but communication can be an effective tool. To reduce no-show rates, one Texas University clinic had a nurse routinely check which patients were waiting longer than 30 minutes, and inform the doctor.
• ‍Creating a welcoming environment.  Making patients feel comfortable when they visit the office is also important.  Aside from maintaining a clean and organized waiting area, check that all entrances are wheelchair accessible. Providers can also show their allyship with diverse communities through signage and seasonal celebrations (Black History Month, Pride, Transgender Day of Visibility, etc.).
• ‍Problem-solving with patients. If a patient is repeatedly missing their mental health appointments, the issue is most likely not apathy. That’s why it’s important to partner with patients to troubleshoot their lack of attendance. What kind of barriers are they facing? Are they logistical? Speak with your patients about any social determinants of health that may be affecting them—be sure to include racism and discrimination as possible factors.
  
  Patients also could be avoiding appointments for emotional reasons, like being anxious, fearing stigma, or feeling too depressed. In these cases, it can be useful to collaborate with patients using techniques like motivational interviewing and setting short-term goals.
• ‍Inclusive care matching. Patients are happiest when they feel seen, respected, and understood—which is possible when they have an inclusive health care provider. Violet Benchmarks help health care organizations improve patient engagement and retention by evaluating provider cultural competence and matching verified inclusive providers to diverse patients. One study showed that Violet Benchmarks increased first-match efficiency by 21%. To learn more, book a demo with Violet today.