Socioeconomic Deprivation Influences Failure to Attend Arranged Orthopaedic Outpatient Appointments as Well as Access to and Engagement With Health Care: A Cohort Study.

Background: We undertook this study to examine the "did-not-attend" (DNA) rate for the orthopaedic outpatient clinic at a large tertiary center, to understand the influencing factors and reasons from the patient perspective and to determine the impact of socioeconomic deprivation.

Methods: We reviewed all scheduled outpatient attendances to our trauma and orthopaedic surgery service over a 12-month period and demographic information for each patient, including the Index of Multiple Deprivation. We studied the rate and predictors for nonattendance in the outpatient clinic and the influence of socioeconomic deprivation. We undertook a secondary study to evaluate the reasons patients gave for nonattendance, their perception of the accessibility, usefulness, and format of the outpatient model and any relationship with socioeconomic deprivation.

Results: Eighteen thousand thirty-three patients attended 58,396 outpatient appointments over the 12-month study period. 2060 patients "did not attend" at least one arranged orthopaedic outpatient appointment over the 12 months of the study period. Men and more socioeconomically deprived patients were more likely to not attend. The most common reasons given for not attending were that patients did not feel that the appointment was useful for them. Patients from socioeconomically deprived groups were more likely to reference transport difficulties as a reason for not attending (p < 0.001). Socioeconomically deprived and disadvantaged patients reported poorer satisfaction scores regarding how able they felt to access orthopaedic help and services when they needed to and how able they felt to access orthopaedic help and services in a way that suits them.

Conclusions: Socioeconomic deprivation affects health and access to health care. Patients who are more socioeconomically deprived are more likely to not attend, and they report poorer satisfaction with access to orthopaedic outpatient care. DNA rates may reflect underlying health disparities.

Level of evidence: Level II. See Instructions for Authors for a complete description of levels of evidence.