某醫學中心家庭醫學部門診複診預約病患未回診相關因子之研究

Factors Associated with Non-attendance in Patients with Follow-up Appointment at Family Practice Clinics of a Medical Center

目的：預約制度，可以提供就醫的方便性，提升醫師看病的效率、維持醫療品質。但若病患預約沒來可能影響其他病患就醫的權利以及醫院的營運。本研究的目的為先瞭解某醫學中心家庭醫學部門診複診預約病患失約率，並探討失約之可能影響因素。方法：本研究是以2003年3月1日至2003年3月31日，某醫學中心家庭醫學部門診所有複診預約病人為母群體，計算其失約率；並以所有未回診的病人為研究對象，再隨機抽取門診當天各診複診預約病患中有依約回診者2名為對照組，依結構式問卷進行資料收集，探討失約之可能影響因素。結果：主治醫師門診共預約有3,962人，未回診者212人(5.35%)；預約住院醫師門診者共有845人，未回診者86人(10.18%)。住院醫師門診預約病人的未回診率明顯高於主治醫師(p<0.001)。在未回診298人中資料完整者199人，而依約回診之對照組者完成問卷者396人。在主治醫師與住院醫師複診病人未回診可能影響因素的單變項分析方面，不管是主治醫師或住院醫師之未回診病患的平均年齡皆比有回診者年輕（50.9±18.4 vs. 58.0±13.6歲、44.6±20.2 vs. 51.8±18.6歲）。有無回診者間的慢性病／連續處方箋與預約掛號科別／自行預約的比率有明顯差異。而未回診者在未被跟診人員告知下次回診時間、不會自行取消預約、覺得看病過程麻煩、此次門診不需要的比率比依約回診者為高。此外在住院醫師預約未回診者有比較高的比率認為看病昂貴。複邏輯複迴歸分析顯示影響主治醫師複診病人未回診的獨立正相關因素為跟診人員未告知下次回診時間、無慢性病或有慢性病但未開立慢性病連續處方箋、病人或家屬不會自行取消預約、病患覺得此次門診不需要。影響住院醫師複診病患未回診的正相關因子為病人或家屬不會自行取消預約、跟診人員未告知下次回診時間、覺得看診費用昂貴；而年齡則是住院醫師病患未回診的負相關因子。結論：主治醫師對於慢性病況穩定者給予慢性病連續處方箋、跟診人員若能給予說明下次回診的時間、並告知若無法回診時如何取消預約或改掛其他時間可能可以減少複診病人的失約率。

Purposes: Outpatients Appointment system can provide better service, increase patients' accessibility to doctors and improve efficiency of medical care. The aim of this study was to investigate the non-attendance rate and its associated factors in patients with follow-up appointment at Family Practice Clinics of a medical center. Methods: The rate of non-attendance was calculated by the number of non-attendance divided by the number of total patients with follow-up appointment in the department of family medicine in a medical center from March 1 to 31, 2003. We further conducted a case-control study, including 199 non-attendances and 396 attendances, to determine the associated factors of non-attendance. Results: The overall non-attendance rate was 6.2% (298/4,807). The non-attendance rate in resident's clinics was 10.18% (86/845) which was higher than that of visiting staff's clinics (5.35%, 212/3,962). Of the 199 non-attendance, 147 and 52 were recruited from visiting staff's and resident's clinics, respectively. Of the 396 attendances, 269 and 127 came from visiting staff's and resident's clinics, respectively. Univariate analysis showed that the non-attendances were younger and had higher rates of not-receiving the next visit information from clinic assistant, were unaware of appointment cancelling procedure, and perceived of the follow-up visit was troublesome and unnecessary in subjects from both visiting staff's and resident's clinics. Furthermore, there were significant differences in the proportion of appointments scheduling with Family Practice or with others and subjects with or without chronic diseases having refill prescription. In addition, the proportion of perceiving expensive visiting cost was higher in nonattendance than attendance at resident's clinics. Based on multiple logistic regression analysis, not-receiving the next visit information from clinic assistant, absence of chronic diseases, presence of chronic diseases without refill prescription, unaware of appointment cancelling procedure, perception of the follow-up visit was unnecessary were positively related to nonattendance at visiting staff's clinics. At resident's clinics, the following were the positively associated factors of non-attendance: not-receiving the next visit information from clinic assistant, unaware of appointment cancelling method, perception of follow-up visit was expensive; but age was the negatively associated factors. Conclusions: Clinically, the following may decrease the non-attendance rate: 1) visiting staff may offer refill prescription, if patients' chronic diseases are stable and 2) clinic assistants provide the information of the next visit and the appointment cancelling method if necessary.