Adherence to attending appointments at Chris Hani Baragwanath Hospital outpatient physiotherapy department

Abstract

Eighty percent of South Africa‘s population utilizes public health care facilities. Chris Hani Baragwanath Hospital is such a facility and provides outpatient services to a population of approximately 3.5 million people with approximately 500 000 outpatients seen in the hospital annually. An audit conducted over a two month period (June 2009 and July 2009) in the general orthopaedic outpatient physiotherapy department brought to light that 38% of new patients that had appointments scheduled failed to arrive for their appointment. Non-attendance for an outpatient appointment results in a waste of resources, inefficiency, underutilization of facilities, potentially long waiting lists and potential complications for both attendees and non-attendees. Conducting research in the area of compliance to appointments would provide a better understanding of the nature of non-attendance, allow exploration of ways to reduce non-attendance, help to achieve set targets, improve efficiency in the services provided and thereby improve health service delivery. Statistics on non-attendance to initial outpatient physiotherapy appointments in South Africa is not readily available. Although non-attendance rates have been established internationally very little research has been done in developing countries on this area. The aim of this study was to identify the reasons for non-attendance at initial outpatient physiotherapy appointments. A retrospective audit and prospective descriptive series were utilized in the research project with face to face interviews conducted with attendees and telephonic interviews conducted with non-attendees. Questions used in the interview were based on areas that had been investigated previously in other studies and thought to have some impact on attendance as well as open ended question to obtain qualitative data. All data obtained in the interview were recorded on a 5 data collection sheet. Quantitative data was analysed using epi-info version 3.5.1 and qualitative data was analysed by formulating themes. Results revealed a non-attendance rate of 33% for initial scheduled outpatient physiotherapy appointments with the main reasons for non-attendance being transport problems (14%) followed by forgetting about the appointment (13%). Improved signage in the hospital, standardized information leaflets, SMS reminders, adjusting of appointment times, monitoring of waiting lists and disseminating of physiotherapy services into communities are some of the systems that can be put into place in an attempt to reduce the high non-attendance rate and thereby reduce inefficiencies, improve quality of services provided, better utilise human resources and improve productivity.