Multiple sclerosis patients who were "no shows" at doctor appointments had lower annual incomes, weaker relationships with their health care provider, and greater cognitive difficulties, especially with short-term memory, according to a study by Trinity College researchers.
“One of the things that we found for certain is that people who don't show up for their appointments score more poorly on a test of prospective memory,” said Sarah Raskin, co-author, and professor of psychology and neuroscience at Trinity College. “And that's a test that says, 'in 15 minutes, please remember to do this.'”
That’s a big deal, Raskin said.
Missing doctor appointments can make it harder for patients to manage a complex disease like MS, which affects the brain, spinal cord, and optic nerves. In addition to having a potentially harmful impact on people living with MS, missed appointments overall mean financial losses for clinics.
One study estimated that 67,000 no-shows can cost the healthcare system approximately $7 million. A previous study by other researchers found that no-show rates at a Philadelphia health system was as high as 24% at neurology clinics, comprising MS patients.
“It's hard on the health care provider to have a no show in their schedule,” Raskin said. “If it happens more than once, they might say, ‘you know, we just really can't provide that treatment for you here any longer.’”
Their research was published in the journal Multiple Sclerosis and Related Disorders.
Elizabeth Gromisch, the study's lead author, is conducting a clinical trial to improve prospective memory – or what’s called “remembering to remember.”
“The next steps will be to test out different interventional approaches to see if they help improve attendance,” said Gromisch, a research neuropsychologist affiliated with the Mandell Center for Comprehensive Multiple Sclerosis Care at Trinity Health of New England.
A previous study by Gromisch found that the odds for poor medication adherence were 3.78 times higher in individuals who miss more than 20% of their appointments over a two-year period.
The new study also looked at how factors other than memory, such as clinic structure, the weather, and patient mood are related to appointment attendance, which could be potential targets for reducing the number of missed appointments.
“One of the other things that we found is that people who are worriers and have low resilience also tend to miss appointments,” Raskin said. “And I think community health workers can really help sort of bolster people’s confidence, if they know there’s somebody that they know personally that they can turn to.”
A trustful relationship between the doctor and patient was also found to improve adherence to appointments.
Alejandro Cortazar, 31, is a Hartford-based immigrant from Colombia living with MS. After his diagnosis, he became depressed. Cortazar’s car-detailing business took a hit financially after he was unable to focus as a result of the depression.
He called his Spanish-speaking neurologist at UConn Health, who is also from Colombia, “a miracle.” He said he was able to get a doctor to offer him “not only the expertise, but also understanding,” and free medication.
“I'm very grateful,” said Cortazar, who does not have health insurance.
