Primary Care Appointment Systems: Causes and Implications of Timely Arrivals
The primary goal of this study was to identify potential factors that might contribute to patient punctuality issues, while also assessing the satisfaction of a proposed intervention. In addition, we aimed to learn more about the psychosocial and behavioral implications that patients face with regards to arriving on time for their primary care visits. A mixed-method research study was used to identify and quantify potential factors that might contribute to patient punctuality issues, while also assessing the satisfaction of a proposed intervention. In addition to possible factors that contribute to punctuality, we aimed to learn more about how patients are affected when they arrive late for appointments. Through qualitative assessment, we explored the psychosocial and behavioral implications that patients face with regards to arriving on time for their primary care appointments. A total of 524 individuals out of 1050 patients (50%) responded to the paper-based survey. Of the 524 adult respondents, we excluded 103 (19.7%) participants due to the missing data on either of their historical behavior patterns, future intentions for arrival, or their definition of appointment time. We analyzed the data for the remaining 421 eligible survey participants. In addition, seven of the eight patient interviews were transcribed and analyzed in order to identify themes using the patient’s own words to better understand the psychosocial and behavioral implications patients face on arriving to their appointment on time. Three primary themes emerge in the interviews related to the perception of arriving late to appointments at the FMC. The findings of this study indicate that regardless of patients’ interpretation of appointment time, they typically arrive 10-15 minutes before the appointment time. In addition, there is a significant connection between patients’ perceptions of historically arriving late to appointments and the intent to arrive very early to their future appointments. Combined with the qualitative results, this study suggests that most patients are motivated to be on time, in some cases seeing the idea of lateness as a contradiction of their own self-identity. The behavioral causes and implications of the findings are explained using the concept of Fear Appeals and the Protection Motivation Theory (PMT).
Shaw, M. K., Davis, S. A., Fleischer, A. B., & Feldman, S. R. (2014). The duration of office visits in the United States, 1993 to 2010. The American journal of managed care, 20(10), 820-826.
Farber, J., Siu, A., & Bloom, P. (2007). How much time do physicians spend providing care outside of office visits?. Annals of internal medicine, 147(10), 693-698.
Doerr, E., Galpin, K., Jones-Taylor, C., Anander, S., Demosthenes, C., Platt, S., & Ponkshe, S. (2010). Between-visit workload in primary care. Journal of general internal medicine, 25(12), 1289-1292.
Keirns, C. C., & Bosk, C. L. (2008). Perspective: the unintended consequences of training residents in dysfunctional outpatient settings. Academic Medicine, 83(5), 498-502.
Shanafelt, T. D., Hasan, O., Dyrbye, L. N., Sinsky, C., Satele, D., Sloan, J., & West, C. P. (2015, December). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. In Mayo Clinic Proceedings (Vol. 90, No. 12, pp. 1600-1613). Elsevier.
Dyrbye, L. N., West, C. P., Burriss, T. C., & Shanafelt, T. D. (2012). Providing primary care in the United States: the work no one sees. Archives of internal medicine, 172(18), 1420-1421.
Reid, R. J., Coleman, K., Johnson, E. A., Fishman, P. A., Hsu, C., Soman, M. P., & Larson, E. B. (2010). The group health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health affairs, 29(5), 835-843.
Fetter, R. B., & Thompson, J. D. (1966). Patients' waiting time and doctors' idle time in the outpatient setting. Health services research, 1(1), 66.
Chambers, C. G., Dada, M., Elnahal, S., Terezakis, S., DeWeese, T., Herman, J., & Williams, K. A. (2016). Changes to physician processing times in response to clinic congestion and patient punctuality: a retrospective study. BMJ open, 6(10), e011730.
Christl, H. L. (1973). Some methods of operations research applied to patient scheduling problems. Medical progress through technology, 2(1), 19-27.
Fontanesi, J., Alexopoulos, C., Goldsman, D., Sawyer, M. H., De Guire, M., Kopald, D., & Holcomb, K. (2002). Non-punctual patients: planning for variability in appointment arrival times. J Med Pract Manage, 18(1), 14-8.
Gorodeski, E. Z., Joyce, E., Gandesbery, B. T., Blackstone, E. H., Taylor, D. O., Tang, W. W., ... & Hachamovitch, R. (2017). Discordance between'actual'and'scheduled'check-in times at a heart failure clinic. PloS one, 12(11), e0187849.
Perros, P., & Frier, B. M. (1996). An audit of waiting times in the diabetic outpatient clinic: role of patients' punctuality and level of medical staffing. Diabetic medicine, 13(7), 669-673.
Xakellis, G., & Bennett, A. (2001). Improving clinic efficiency of a family medicine teaching clinic. FAMILY MEDICINE-KANSAS CITY-, 33(7), 533-538.
Antle, D. W., & Reid, R. A. (1988). Managing service capacity in an ambulatory care clinic. Journal of Healthcare Management, 33(2), 201.
Medway, A. M., de Riese, W. T., de Riese, C. S., & Cordero, J. (2016, September). Why patients should arrive late: The impact of arrival time on patient satisfaction in an academic clinic. In Healthcare (Vol. 4, No. 3, pp. 188-191). Elsevier.
Shipman, S. A., & Sinsky, C. A. (2013). Expanding primary care capacity by reducing waste and improving the efficiency of care. Health Affairs, 32(11), 1990-1997.
Williams, K. A., Chambers, C. G., Dada, M., McLeod, J. C., & Ulatowski, J. A. (2014). Patient punctuality and clinic performance: observations from an academic-based private practice pain centre: a prospective quality improvement study. BMJ open, 4(5), e004679.
Milne, S., Sheeran, P., & Orbell, S. (2000). Prediction and intervention in health‐related behavior: A meta‐analytic review of protection motivation theory. Journal of Applied Social Psychology, 30(1), 106-143.
Tannenbaum, M. B., Hepler, J., Zimmerman, R. S., Saul, L., Jacobs, S., Wilson, K., & Albarracín, D. (2015). Appealing to fear: A meta-analysis of fear appeal effectiveness and theories. Psychological bulletin, 141(6), 1178.
Moyle, W. (2002). Unstructured interviews: challenges when participants have a major depressive illness. Journal of advanced nursing, 39(3), 266-273.
DiCicco‐Bloom, B., & Crabtree, B. F. (2006). The qualitative research interview. Medical education, 40(4), 314-321.
Cohen, D., & Crabtree, B. (2006). Qualitative research guidelines project.
Norman, P., Boer, H., & Seydel, E. R. (2005). Protection motivation theory. Predicting health behaviour, 81, 126.
Spickard Jr, A., Gabbe, S. G., & Christensen, J. F. (2002). Mid-career burnout in generalist and specialist physicians. Jama, 288(12), 1447-1450.