Educational associations with missed GP appointments for patients under 35 years old: administrative data linkage study

Ross McQueenie; David Ellis; Michael Fleming; Philip Wilson; Andrea Williamson

doi:10.1186/s12916-021-02100-7

Educational associations with missed GP appointments for patients under 35 years old: administrative data linkage study

Ross McQueenie
, David Ellis
, Michael Fleming
, Philip Wilson
, Andrea Williamson

Public Health Scotland
University of Glasgow
University of Aberdeen

Research output: Contribution to journal › Article › peer-review

9 Citations (SciVal)

Abstract

Background There is an evidence gap about whether levels of engagement with public services such as schools and health care affect people across the lifespan. Data on missed patient appointments from a nationally representative sample of Scottish general practices (GP) (2013-2016) were probabilistically linked to secondary school pupil data. We tested whether school attendance, exclusions (2007-2011) or lower educational attainment (2007-2016) was associated with an increased risk of missing general practice appointments. Methods School attendance data were classified into quartiles of possible days attended for years we had data. School exclusions were derived as a categorical variable of ‘ever excluded’. Attainment data were categorised via the Scottish Credit and Qualifications Framework (SCQF) level 3 or 6; a cumulative measure of attainment on leaving school. The associations between school attendance, exclusions and attainment and risk of missing medical appointments were investigated using negative binomial models, offset by number of GP appointments made and controlling for potential confounders. Results 112,534 patients (all aged under 35) had GP appointment and retrospective school attendance and exclusion data, and a subset of 66,967 also had attainment data available. Patients who had lower attendance, had been excluded from school or had lower educational attainment had an increased risk of missing GP appointments (all rate ratios >1.40). Conclusions This study provides the first evidence from a population-representative sample in a high-income country that increased numbers of missed appointments in health care are associated with reduced school attendance, higher levels of school exclusion and lower educational attainment. Insights into the epidemiology of missingness across public services can support future research, policy, and practice that aims to improve healthcare, health outcomes and engagement in services.

Original language	English
Article number	219
Pages (from-to)	19
Journal	BMC medicine
Volume	19
DOIs	https://doi.org/10.1186/s12916-021-02100-7
Publication status	Published - 27 Sept 2021

Funding

Thank you to all the GP practices who participated in this study and for strategic support from Ellen Lynch (Health and Social Care Analytical Services, Scottish Government). The general practice data expertise of Dave Kelly (Albasoft) was invaluable. Thanks also to the eDRIS team who facilitated the safe use of our data in the Safehaven, especially Dionysis Vragkos and colleagues at ScotXed for the education data. This study was funded by a grant from Chief Scientist Office, Scottish Government (reference CZH/4/1118), with Safe Haven and data linkage costs supported in lieu by the DSLS at Scottish Government. The funding sources for this analysis had no influence over study design, data collection, data analysis, data interpretation, the writing of the report or the decision to submit for publication. All authors confirm they had full access to all the data in the study if required, and the corresponding author had final responsibility for the decision to submit for publication.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 4 Quality Education

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10.1186/s12916-021-02100-7Licence: CC BY

Cite this

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title = "Educational associations with missed GP appointments for patients under 35 years old: administrative data linkage study",

abstract = "Background There is an evidence gap about whether levels of engagement with public services such as schools and health care affect people across the lifespan. Data on missed patient appointments from a nationally representative sample of Scottish general practices (GP) (2013-2016) were probabilistically linked to secondary school pupil data. We tested whether school attendance, exclusions (2007-2011) or lower educational attainment (2007-2016) was associated with an increased risk of missing general practice appointments. Methods School attendance data were classified into quartiles of possible days attended for years we had data. School exclusions were derived as a categorical variable of {\textquoteleft}ever excluded{\textquoteright}. Attainment data were categorised via the Scottish Credit and Qualifications Framework (SCQF) level 3 or 6; a cumulative measure of attainment on leaving school. The associations between school attendance, exclusions and attainment and risk of missing medical appointments were investigated using negative binomial models, offset by number of GP appointments made and controlling for potential confounders. Results 112,534 patients (all aged under 35) had GP appointment and retrospective school attendance and exclusion data, and a subset of 66,967 also had attainment data available. Patients who had lower attendance, had been excluded from school or had lower educational attainment had an increased risk of missing GP appointments (all rate ratios >1.40). Conclusions This study provides the first evidence from a population-representative sample in a high-income country that increased numbers of missed appointments in health care are associated with reduced school attendance, higher levels of school exclusion and lower educational attainment. Insights into the epidemiology of missingness across public services can support future research, policy, and practice that aims to improve healthcare, health outcomes and engagement in services.",

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N2 - Background There is an evidence gap about whether levels of engagement with public services such as schools and health care affect people across the lifespan. Data on missed patient appointments from a nationally representative sample of Scottish general practices (GP) (2013-2016) were probabilistically linked to secondary school pupil data. We tested whether school attendance, exclusions (2007-2011) or lower educational attainment (2007-2016) was associated with an increased risk of missing general practice appointments. Methods School attendance data were classified into quartiles of possible days attended for years we had data. School exclusions were derived as a categorical variable of ‘ever excluded’. Attainment data were categorised via the Scottish Credit and Qualifications Framework (SCQF) level 3 or 6; a cumulative measure of attainment on leaving school. The associations between school attendance, exclusions and attainment and risk of missing medical appointments were investigated using negative binomial models, offset by number of GP appointments made and controlling for potential confounders. Results 112,534 patients (all aged under 35) had GP appointment and retrospective school attendance and exclusion data, and a subset of 66,967 also had attainment data available. Patients who had lower attendance, had been excluded from school or had lower educational attainment had an increased risk of missing GP appointments (all rate ratios >1.40). Conclusions This study provides the first evidence from a population-representative sample in a high-income country that increased numbers of missed appointments in health care are associated with reduced school attendance, higher levels of school exclusion and lower educational attainment. Insights into the epidemiology of missingness across public services can support future research, policy, and practice that aims to improve healthcare, health outcomes and engagement in services.

AB - Background There is an evidence gap about whether levels of engagement with public services such as schools and health care affect people across the lifespan. Data on missed patient appointments from a nationally representative sample of Scottish general practices (GP) (2013-2016) were probabilistically linked to secondary school pupil data. We tested whether school attendance, exclusions (2007-2011) or lower educational attainment (2007-2016) was associated with an increased risk of missing general practice appointments. Methods School attendance data were classified into quartiles of possible days attended for years we had data. School exclusions were derived as a categorical variable of ‘ever excluded’. Attainment data were categorised via the Scottish Credit and Qualifications Framework (SCQF) level 3 or 6; a cumulative measure of attainment on leaving school. The associations between school attendance, exclusions and attainment and risk of missing medical appointments were investigated using negative binomial models, offset by number of GP appointments made and controlling for potential confounders. Results 112,534 patients (all aged under 35) had GP appointment and retrospective school attendance and exclusion data, and a subset of 66,967 also had attainment data available. Patients who had lower attendance, had been excluded from school or had lower educational attainment had an increased risk of missing GP appointments (all rate ratios >1.40). Conclusions This study provides the first evidence from a population-representative sample in a high-income country that increased numbers of missed appointments in health care are associated with reduced school attendance, higher levels of school exclusion and lower educational attainment. Insights into the epidemiology of missingness across public services can support future research, policy, and practice that aims to improve healthcare, health outcomes and engagement in services.

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Educational associations with missed GP appointments for patients under 35 years old: administrative data linkage study

Abstract

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UN SDGs

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