How missing appointments increases the risk of death

Missing GP appointments is associated with early death, and those with long-term mental health conditions are at particular risk.

Dr Ross McQueenie led the study from the University of Glasgow along with colleagues from Lancaster University and the University of Aberdeen.

In the largest study of its kind, the team examined over 500,000 patients’ appointment histories in Scotland, tracked for 3 years between 2013 and 2016.

All data were provided on condition of patient and practice anonymity. Appointment information was then linked to patient medical histories and death records.

The researchers found that:

• Patients with a greater number of long-term health conditions had an increased risk of missing general practice appointments. These same patients were also at substantially greater risk of death within the following year.
• Patients with long term physical conditions who missed two or more appointments per year had a threefold increase in all-cause mortality compared with those who missed no appointments.
• Patients with mental-health conditions only who missed more than two appointments per year had an eight times greater risk of death during the follow-up period compared with those who missed no appointments.

These results emerged even after researchers controlled for a variety of other factors already known to affect attendance.
Dr McQueenie said “Patients diagnosed with long-term mental health problems, who did die during the follow-up period, died prematurely, often from non-natural external factors such as suicide.

Dr Ellis added “These results align with clinicians own observations. Specifically, patients with long-term mental health conditions are more likely to miss multiple appointments.”

The researchers are now exploring how new interventions might improve attendance however, their research raises important questions when it comes to ensuring that mental health services remain easy to access and are readily available across the UK.

Professor Wilson concluded “These findings are crucially important for GPs wishing to identify patients at high risk of premature death. For people with physical conditions missed appointments are a strong independent risk factor for dying in the near future. Among those without long-term physical conditions, the absolute risk is lower, but missing appointments is an even stronger risk marker for premature death from non-natural causes.”

###