1112-P: Sustaining Show Rates in the Diabetes Clinic

The Parkland Diabetes Clinic provides specialty diabetes care to the indigent people of Dallas County with diabetes. Previously, we showed that using an internally scheduling patients, rather than a third-party call center, and personally calling scheduled patients to remind them of their appointments improved our clinic no-show rates in 2021, compared to 2019, from 32% to 22%. We have continued these interventions but questioned whether these results have been sustained. Three years later, we reviewed 1014 charts from a typical month at the clinic to determine how many patients completed their appointments compared to whether they received a reminder phone call, specifically focusing on demographic and glycemic data as mitigating factors. The average no-show rate has risen to ~26% even though the previous solutions were still in place. Approximately 66% of patients received reminder phone calls with 57% of these calls resulting in a direct conversation with the patient confirming the appointment. 30% of patients who directly spoke to a staff member confirmed attendance but did not show for their appointment. There were no statistically significant differences in demographics or visit type for patients who completed an appointment, but there was a difference in their last Hba1c prior to the scheduled appointment (9.3% in patients who completed their appointment vs. 10.0% in patient who did not attend the appointment, p = 0.003). Contrary to published data that calling patients to confirm their appointments improves show rates, the benefit of this is limited in our population. With 30% of patients confirming attendance to an appointment 1-3 days prior but not attending shows that there are other factors which can influence no-show rates. Furthermore, patient with poorer glycemic control at the prior visit tended to show less. In the indigent population, there are more complicating factors than reminder phone calls that prevent patients from attending their clinic appointment which should be researched further to address barriers to care.