Reasons for and consequences of missed appointments in general practice in the UK: questionnaire survey and prospective review of medical records.

BACKGROUND: Missed appointments are a common occurrence in primary care in the UK, yet little is known about the reasons for them, or the consequences of missing an appointment. This paper aims to determine the reasons for missed appointments and whether patients who miss an appointment subsequently consult their general practitioner (GP). Secondary aims are to compare psychological morbidity, and the previous appointments with GPs between subjects and a comparison group. METHODS: Postal questionnaire survey and prospective medical notes review of adult patients missing an appointment and the comparison group who attended appointments over a three week period in seven general practices in West Yorkshire. RESULTS: Of the 386 who missed appointments 122 (32%) responded. Of the 386 in the comparison group 223 (58%) responded, resulting in 23 case-control matched pairs with complete data collection. Over 40% of individuals who missed an appointment and participated said that they forgot the appointment and a quarter said that they tried very hard to cancel the appointment or that it was at an inconvenient time. A fifth reported family commitments or being too ill to attend. Over 90% of the patients who missed an appointment subsequently consulted within three months and of these nearly 60% consulted for the stated problem that was going to be presented in the missed consultation. The odds of missing an appointment decreased with increasing age and were greater among those who had missed at least one appointment in the previous 12 months. However, estimates for comparisons between those who missed appointments and the comparison group were imprecise due to the low response rate. CONCLUSION: Patients who miss appointments tend to cite practice factors and their own forgetfulness as the main reasons for doing so, and most attend within three months of a missed appointment. This study highlights a number of implications for future research. More work needs to be done to engage people who miss appointments into research in a meaningful way.

Why ethnic minority groups are under-represented in clinical trials: a review of the literature.

Randomised controlled trials (RCTs) are considered to be the gold standard in evaluating medical interventions; however, people from ethnic minorities are frequently under-represented in such studies. The present paper addresses a previously neglected debate about the tensions which inform clinical trial participation amongst people from ethnic minorities, in particular, South Asians, the largest ethnic minority group in the UK. In a narrative review of the available literature, based mainly on US studies, the present authors aim to make sense of the issues around under-representation by providing a theoretical reconciliation. In addition, they identify a number of potential barriers to ethnic minority participation in clinical trials. In so doing, the authors recognise that the recent history of eugenic racism, and more general views on clinical trials as a form of experimentation, means that clinical trial participation among people from ethnic minorities becomes more problematic. Lack of participation and the importance of representational sampling are also considered, and the authors argue that health professionals need to be better informed about the issues. The paper concludes by offering a number of strategies for improving ethnic minority accrual rates in clinical trials, together with priorities for future research.

Ethnic minority under-representation in clinical trials. Whose responsibility is it anyway?

Ethnic minority people are frequently under-represented in clinical trials. This potentially affects the generalisability/external validity of the trial findings. This not only has important repercussions regarding the safety and the efficacy of new drug use in ethnic minority groups, but also reduces opportunities for subgroup analysis. There can be no scientific basis for excluding this group of people from clinical trials. Aims to provide a mix of theoretical and empirical debates, in order to make sense of ethnic minority exclusion from clinical trials, and suggest possibility of change. Recommends that educational programmes should be directed at clinical trial investigators and funding bodies, to increase their awareness of under-representation of ethnic minority people in clinical trials. Ethics committees could also redress this inequality by providing guidance for investigators, and by being more rigorous about reviewing clinical trial protocols. Provides a set of guidelines to "enlighten" and aid health professionals in working with ethnic, linguistic and culturally diverse populations. The guidelines require additional work and have cost implications. Argues that cost should not be allowed as an acceptable excuse for excluding ethnic minority people from clinical trials.