Waiting time, doctor shopping, and nonattendance at specialist outpatient clinics: Case-control study of 6495 individuals in Hong Kong

Abstract

OBJECTIVE. Nonattendance is a major health services research and management issue that has received little attention or systematic study in Asia. We examined the independent associations between waiting time, doctor shopping, and nonattendance in specialist outpatient clinics of 4 large public hospitals in Hong Kong. RESEARCH DESIGN. Case-control study. SETTING AND PARTICIPANTS. A total of 6495 attenders and nonattenders enrolled from July 2000 through October 2001. MAIN OUTCOME MEASURES. Odds ratios (ORs) and associated 95% confidence intervals (CI) for nonattendance. RESULTS. Longer waiting times (adjusted OR 2nd quartile,/1-67; 95% CI, 1.38-2.03; adjusted OR 3rd quartile, 1-90; 95% CI, 1.56-2.30; adjusted OR 4th quartile, 2.30; 95% CI, 1.91-2.78) and doctor-shopping behavior (adjusted OR, 2.91; 95% CI, 2.51-3.38) were independent risk factors for nonattendance. These effects were robust after multivariate adjustment and testing for effect modification. They also appeared to persist uniformly across hospitals and specialties. There was no demonstrable relationship between waiting time and doctor shopping. CONCLUSIONS. This is the largest study of non-attendance at outpatient clinics and the first such study carried out in Asia. Targeted strategies should be implemented and evaluated using these results to reduce waiting time, doctor shopping, and ultimately nonattendance. © 2003 Lippincott Williams & Wilkins, Inc.