Abstracts

Rationale: The Health Sciences Centre of Winnipeg is the only tertiary hospital in the province of Manitoba that offers adult seizure clinic appointments with board certified epileptologists on a referral basis. However, the no-show rates have been worrisome as the seizure clinic has very limited resources and a patient may need to wait for more than one year to be seen. A no-show spot could have been offered to another patient. In this study, we examine the characteristics of the no-show patients and compare with those who showed for their appointments, to develop insights for data-driven decision making, and improve patient care.


Methods: This is a retrospective observational study for the period of January 2 to April 30, 2023. Ethics review and approval have been granted by the University of Manitoba Research Ethics Board. Data include demographics such as sex, age, postal code, a new or follow up visit; relevant clinical history such as brain imaging, EEG, a prior diagnosis of epilepsy and/or seizure, antiseizure medication, seizures being recurrent, presence of a family physician. An equal number of showed patients were matched to the no-shows. We use Chi squared tests and logit regression models to compare the two groups. We use a binary variable for whether the patient resides in the north of the Assiniboine River as a proxy of socioeconomic status, as the population to the north are generally poorer according to the Canadian census.

Results: During the 4-month study period, 115 no-showed. Among these, 53 were female; average age was 37 (range 17-79); 64 lived in Winnipeg, 34 lived within 500 km of Winnipeg, 3 lived between 500 and 1000 km from Winnipeg, and 14 lived further than 1000 km, with the farthest being Naujaat (Nunavut) at 1960km. A patient who lives in Winnipeg was assigned 0 km. 38 were without a family physician. Among the control group of 115 patients who showed, 57 were female; average age was 40 (range 17-84); 70 lived in Winnipeg, 39 lived within 500 km, 3 lived between 500 and 1000 km, and 3 lived further than 1000 km, with the farthest being Rankin Inlet (Nunavut) at 1467km. Only 10 were without a family physician. Chi squared test was not statistically significantly for sex (p=0.308), age (p=0.459), or distance (p=0.017), but was statistically significant for whether the patient has a family physician (p< 0.001). The logit regression model reveals only the binary data on family physician (p< 0.001) was statistically significant. A patient is much more likely to show if they have a family physician, or female (p=0.604), or older (p=0.333).


Conclusions: This study demonstrates that while factors such as sex, age, and travel distance to a clinic can influence the decision to no-show, having a family physician significantly improves the chance for a patient to show. From an upstream social determinant perspective, this confirms the vital importance of obtaining a family physician because they are the gatekeepers to healthcare in the universal Canadian health care system. Following these measures may potentially save healthcare resources that have been lost due to high numbers of no-show appointments.


Funding: No funding source.