No-shows
for scheduled appointments are a are a frequent occurrence creating unused
appointment slots reducing patient quality of care and access to services while
increasing loss to follow-up and medical costs.(Rodriguez et al., n.d.). We undertook
the task to determine factors responsible for patients
missing their dental appointments in Eastern Province Military Hospitals,
Kingdom of Saudi Arabia who were military personals and their families attending
dental clinics of Armed
Forces hospital Jubail, King Fahd Military Medical Complex Dhahran and Airbase
Hospital Dhahran. In our study the percentage of missed appointments
was found to be 58.1%, which is higher than 24.8% reported in Dr. Salwa’s study in Riyadh Saudi Arabia (Alsadhan, 2013) and 36.8% in Dr.
Sandeep Tendon’s research in India (Govt, 2016). Our study calculated 54.4%
of the participants who cancelled dental appointment in the past, which is
higher than 40.5% in Dr. Salwa’s study (Alsadhan, 2013). Out of our study
population, 36% preferred
morning appointment and 56% an afternoon one who were likely to miss a morning
appointment if given one.

The
most common reasons for missing an appointment were forgetting about it (24.3%)
and the inability to get time off either from work or school (15.4%), which is
consistent with the ?ndings of most of the previous studies (Skaret,
Raadal, Kvale, & Berg, 2000) (Bos,
Hoogstraten, & Prahl-Andersen, 2005) (Alsadhan,
2013) (Storrs, Ramov, & Lalloo, 2016),. In our research we found only 3.7 % patents had a bad
dental experience and feared dental treatment while unavailability of transport
was only 9.5%. For cancelling an appointment, inability to get time off from
workschool was the most common reason (22.1%), whereas, dislike of treatment
was the least common (0.7%). The association between cancelling and missing an
appointment (table 4) was found to be statistically
signi?cant (p=0.00), which might indicate that people who missed an appointment
were more likely to cancel an appointment. 60.3%
of participants in our research still relied on their personal diary to
remember appointments, which could be a reason for high rate of missed appointments
as 24.3% stated they forgot their appointment. It would be reasonable to assume
that missed appointment rates could be reduced if patients were advised to use their
mobile phones/computers (reminder systems) to record and remember their appointments.

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Females
were found to cancel and miss dental appointments more than males (table 6) although
the differences were insignificant (p=0.64 and p=0.21 respectively). This might
indicate that males were more concerned about maintaining a good record with the
dental clinic. This finding is in disagreement with
the ?ndings of previous studies (Skaret E., et al 1998).

59%
respondents felt that missing an appointment was important
to them while 72% stated that it could affect the work of the clinic but still believed
that automatic appointments should be given to patients
who missed their appointments and a charge be made for such missed appointments (table 7).

In
dental practice, missing appointments can disrupt the patients’ treatment to a large
extent for example; orthodontic treatment relies on regular adjustment of the
appliances and monitoring the progress of occlusal changes, where as early
detection and treatment of carious lesions, gingival and periodontal disease demand
regular dental visits missing which can seriously limit the treatment
efficiency. Therefore, to control missed and cancelled appointments, the dental
team must educate the patient on their first visit and cautiously communicate
the importance of maintaining appointment schedule and its effect on treatment outcomes.
The patient should also be told how and when they can inform the clinic incase
they were unable to make it to their appointment (Reekie D., Devlin H., 1998),(Christensen
A., et al 2001).

The
use of some reminder system such as telephone reminders (calls or text
messages) can also be used to improve the attendance rate as it has proven to
be successful in previous studies.

Future studies should focus on the
methods that can reduce or eliminate missed and cancelled appointments and
encourage patients’ attendance, to enhance the treatment outcome in addition to
improving the economics and quality of dental practice.

 

 

 

Recommendations:

 

In the present study, the
sample was small in relation to other studies that have been done on similar
topic in other parts of the world, so we recommended enlarging the sample size
in future. New studies should be conducted to find radical solutions to this
problem. Some recommended solutions based on our findings are given below.

1.     An
efficient reminder system.

2.     Give
appointment according to patient preference.

3.     Reduce
the time between subsequent appointments.

4.     Reduce
the duration of each appointment.

5.     Facilitate
transportation for the patient.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Conclusion:

 

A high
percentage of patients miss their dental appointments in the eastern province
military hospitals, Saudi Arabia causing not only detrimental effects for the
patient community but also wastage of resources at the military hospitals.
Since major reasons found were lack of reminder message and appointments
scheduled at inconvenient timing, sending reminder message to patient and
giving preference to their schedule for appointment and giving them shorter
appointment, reducing interval between subsequent appointments, educating the
patient regarding treatment plan to reduce anxiety are some steps which can
help reduce the frequency of missed appointments.

 

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