Lindsay, C. , Baruffati, D. , Mackenzie, M. , Ellis, D. A., Major, M., O'Donnell, C. A., Simpson, S. A. , Williamson, A. E. and Wong, G. (2024) Understanding the causes of missingness in primary care: a realist review. BMC Medicine, 22(1), 235. (doi: 10.1186/s12916-024-03456-2) (PMID:38858690)
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Abstract
Background: Although missed appointments in healthcare have been an area of concern for policy, practice and research, the primary focus has been on reducing single ‘situational’ missed appointments to the benefit of services. Little attention has been paid to the causes and consequences of more ‘enduring’ multiple missed appointments in primary care and the role this has in producing health inequalities. Methods: We conducted a realist review of the literature on multiple missed appointments to identify the causes of ‘missingness.’ We searched multiple databases, carried out iterative citation-tracking on key papers on the topic of missed appointments and identified papers through searches of grey literature. We synthesised evidence from 197 papers, drawing on the theoretical frameworks of candidacy and fundamental causation. Results: Missingness is caused by an overlapping set of complex factors, including patients not identifying a need for an appointment or feeling it is ‘for them’; appointments as sites of poor communication, power imbalance and relational threat; patients being exposed to competing demands, priorities and urgencies; issues of travel and mobility; and an absence of choice or flexibility in when, where and with whom appointments take place. Conclusions: Interventions to address missingness at policy and practice levels should be theoretically informed, tailored to patients experiencing missingness and their identified needs and barriers; be cognisant of causal domains at multiple levels and address as many as practical; and be designed to increase safety for those seeking care.
Item Type: | Articles |
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Additional Information: | This was funded by a National Institute of Health Research UK research grant; NIHR study identification 135034. |
Keywords: | Multiple missed appointments, health service access, health service equity, candidacy, primary care, realist synthesis. |
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Lindsay, Dr Calum and Mackenzie, Professor Mhairi and Baruffati, Dr David and Williamson, Professor Andrea and Simpson, Professor Sharon |
Authors: | Lindsay, C., Baruffati, D., Mackenzie, M., Ellis, D. A., Major, M., O'Donnell, C. A., Simpson, S. A., Williamson, A. E., and Wong, G. |
College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU College of Social Sciences > School of Social and Political Sciences > Urban Studies |
Journal Name: | BMC Medicine |
Publisher: | BioMed Central |
ISSN: | 1741-7015 |
ISSN (Online): | 1741-7015 |
Copyright Holders: | Copyright © 2024 The Authors |
First Published: | First published in BMC Medicine 22(1):235 |
Publisher Policy: | Reproduced under a Creative Commons License |
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