Insights into Appointment-Related Factors on Attendance in Persons with Multiple Sclerosis

Background: Short-notice cancellations (cancelled <24 hours before the appointment) and no shows (non-attendance with no prior cancellation) are both issues in the multiple sclerosis (MS) population. While there is information about the influence of appointment-related factors, such as season, day of the week, time slot, and lead time, on attendance in other populations, this has yet to be explored in persons with MS (PwMS).

Objectives: To identify whether attendance behaviors in PwMS are related to the season, day of the week, time slot, or lead time of the appointment.

Methods: Participants (n=110) were PwMS who were seen as part of a cross-sectional study between June 2019 and early March 2020. Appointment attendance data were extracted from the electronic medical record and were limited to MS-related appointments (i.e., neurology, case management, infusions, and rehabilitation), for the year prior to their study evaluation. Appointments were characterized as “attended,” “short-notice cancellation,” or “no show.” Chi-squares and Kruskal-Wallis tests were used to examine differences between the three appointment behaviors, with Bonferroni post-hoc corrections.

Results: Half of participants had a least one short-notice cancellation, while 20% had at least one no show. During the winter, there was a lower number of attended appointments (80.8% versus 89.1%-90.6% in other seasons; χ²(1)=22.75, p<.001) and a higher number of short-notice cancellations (14.8% versus 7.0%-7.9% in other seasons; χ²(1)=20.61, p<.001). Lower attendance (79.8% versus 87.2%-91.6% on other days; χ²(1)=15.76, p<.001) and greater short-notice cancellations (14.6% versus 6.5%-9.8% on other days; χ²(1)=9.99, p=.002) were also noted on Thursdays. PwMS were more likely to attend (93.2% versus 82.8%-87.1% at other times; χ²(1)=16.56, p<.001) and less likely to have a short-notice cancellation (5.2% versus 9.7%-11.8% at other times; χ²(1)=10.76, p=.001) when appointments were scheduled between 7 am and 9 am. While there was an overall difference in lead time by appointment attendance behaviors (attended Mdn: 28 days, short-notice cancellation Mdn: 23 days; no show Mdn: 17 days; H(2)=6.36, p=.042), there were no significant differences between groups after the Bonferroni correction.

Conclusions: These findings provide insights into which types of appointments PwMS are more likely to attend. Certain strategies, such as scheduling patients on preferred days, providing reminders, or offering telehealth services, may help improve attendance behaviors.