Missing general practice (GP) healthcare appointments was found to be associated with increased risk of multimorbidity in patients with long-term physical and mental health-related conditions, according to a study published in BMC Medicine.

Researchers used a Scottish primary healthcare appointment dataset to analyze the association between the number of long-term conditions that contribute to morbidity and mortality rates and the risk of missing GP appointments. National Health Service data from 136 practices were extracted from September 5, 2013, to September 5, 2016; the extraction resulted in more than 11.4 million separate appointments from approximately 800,000 patients.

The primary outcome analysis assessed whether patients with more long-term conditions missed more GP appointments. A secondary outcome analysis was conducted to determine whether patients who missed multiple appointments were at greater risk for all-cause mortality.

Patients were classified into groups based on the number of missed appointments per year: zero missed appointments; a low number of missed appointments (<1/ y); a medium number of missed appointments (1-2/y); and a high number of missed appointments (>2/y). Overall, 59.0% of patients had 1 or more long-term condition, with 13.3% reporting 4 or more. Only 7.0% of patients with no missed appointments had 4 or more long-term conditions, whereas 40.1% of participants with a high number of missed appointments had 4 or more long-term conditions.

Compared with patients with no long-term conditions, patients with 1 to 3 long-term conditions were 30% more at risk of missing appointments (relative risk ratio [RRR] 1.29), and patients with 4 or more long-term conditions were 70% more at risk of missing appointments (RRR 1.70). Patients who had a high number of missed appointments had a lower number of appointments within 30 days of a missed appointment (5.7%) compared with patients with a low number of missed appointments (21.6%).

Long-term physical health conditions were associated with a slightly increased risk of missing appointments; patients with 1 to 3 physical conditions had a 16% increased risk of missing appointments (RRR 1.16) and those with 4 or more conditions had a 38% increased risk of missing appointments (RRR 1.38). Mental health-related long-term conditions were associated with a more significant risk of missing appointments; those with 1 to 3 long-term mental health conditions had a 30% increased risk of missing appointments (RRR 1.30) and those with 4 or more had a greater than 2-fold increased risk of missing appointments (RRR 2.05).

Of the long-term mental health conditions, groups who misused alcohol (22.2%) and psychoactive substances (27.4%) contained a larger number of patients who missed 2 or more appointments per year. Groups with other mental health conditions such as depression, anxiety, dementia, schizophrenia, anorexia, and bulimia had a smaller proportion of patients (14.1%) who missed 2 or more appointments per year. The proportion of patients with a high number of missed appointments was highest in those with both alcohol and psychoactive substance misuse (32.1%).

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A dose-related effect for any physical or mental long-term condition showed a stepwise increase in all-cause mortality for the “low” (hazard ratio [HR] 1.55), “medium” (HR 2.04), and “high” (HR 3.11) groupings. Patients with long-term physical health-related conditions showed similar patterns (low: HR 1.53; medium: HR 2.31; high: HR 3.36). These effects were more significant for long-term mental health-related conditions (low: HR 2.10; medium: HR 4.02; high: HR 8.37).

Reference

McQueenie R, Ellis DA, McConnachie A, Wilson P, Williamson AE. Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study. BMC Med. 2019;17(1):2.