Factors Involved in Failure to Keep Initial Appointments With Mental Health Professionals

As this overview has attempted to demonstrate, patients' failure to keep an initial appointment is an important problem that has not been investigated with consistent aims or consistent methods. Research has failed to identify with any certainty patient characteristics that could be used to screen out those who are not likely to keep the appointment. Nonetheless, research does indicate that patients in this population will likely seek help again. Therefore, the use of strategies to increase the number of patients who keep their initial appointment is strongly recommended to both reduce cost and the time before initiation of treatment.

Although research indicates that shorter waiting lists would decrease the rate of missed initial appointments, it is not feasible simply to ask clinicians to shorten waiting lists. Prompts, orientation letters, or pneappointment questionnaires have been found to increase attendance and are relatively easy and cost-efficient to employ. The reasons for their efficacy, however, are not always clear.

Given the current level of knowledge about missed initial appointments, the importance of the issue, and the simplicity and low cost of such research, it is now appropriate to focus on what strategy works best in what type of center. For example, does a specialty clinic for treatment of a disorder such as agoraphobia derive more benefit from telephone prompts than a general outpatient psychiatric clinic? Does the length of the wait for an appointment diffenentially affect the efficacy of an orientation letter? Although such issues are easy to examine, these types of cogent questions have yet to be addressed in research studies.