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Does implementing an appointment no-show fee decrease the amount of noshows within a one- year period?

By: Jason Kinnin, Zach Turcotte, Ryan Toews, Tara Lee, & Adam Clay

Introduction: The Associate Family Physician’s Clinic in Swift Current implemented a no-show fee policy on January 1st, 2019 in an effort to reduce missed patient appointments and improve clinic flow.

Research question: Does the implementation of no-show fee decrease the number of patient no-shows over a one-year period in a family medicine clinic?

Methodology: This study was a pre/post implementation cohort analysis. The clinic’s EMR was used to extract the age, gender and attendance status for each appointment booked in the year before and after the policy implementation. Statistical tests were used to compare no-show rates before and after the implementation of the no-show policy, as appropriate. Statistical tests were performed to ascertain the effect of age and sex on the likelihood of patients missing an appointment in 2019.

Results: There was no significant reduction in the proportion of patient who no-showed after the fee policy was implemented (9.5% vs 10.1%). There was also no significant reduction in the proportion of patients who no-showed more than once (1.5% vs 1.4%). There was no difference among the sexes in terms of no-show rates in 2019, but the median patient age who no-showed (41 years) was significantly lower than those who showed for all appointments in the same year (50 years).

Discussion: The no-show fee did not have any significant reduction on the number of patients who no- showed over a one-year period. Nor was there a decrease in the number of patients who no-showed more than once. Possible reasons for this include patients not knowing about the no-show fee, the no- show fee only being applied after missing two visits, or patients not finding this enough incentive to change their usual behavior.

Conclusions: Overall, this no-show fee did not reduce the number of missed appointments in the year after it was implemented.

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