Poster Presentation 29th Australian and New Zealand Bone and Mineral Society Annual Scientific Meeting 2019

Predicting failure to attend: lessons learnt from the first year in a fracture liaison service (FLS) (#190)

Allison Sigmund 1 2 , Navneeta Reddy 3 , Sue Lynn Lau 1 2 4
  1. Endocrinology, Blacktown Hospital, Blacktown, NSW, Australia
  2. School of Medicine, Western Sydney University, Blacktown, NSW, Australia
  3. The Children’s Hospital at Westmead, Westmead, NSW, Australia
  4. School of Medicine, University of Sydney, Sydney, NSW, Australia

Introduction/aims: The FLS provides early identification, assessment, treatment and long-term support of patients at risk of refracture. In the first year of our service, high rates of first visit non-attendance occurred, despite early identification in the outpatient fracture clinic and inpatient ward. All patients were mailed an appointment date and information explaining the visit’s purpose and had SMS reminder. Some received face-to-face contact with an FLS coordinator at time of referral, and/or telephone contact just prior to the appointment. For logistical reasons, several received no contact beyond the appointment letter. We audited patient characteristics and service-related issues associated with failure to attend (FTA).
Results: 192 patients were scheduled for 204 new FLS appointments between 1/6/18 and 31/5/19; 94(49%) attended the first appointment, 10(5%) attended a rescheduled appointment, 48(25%) cancelled, 36(19%) had FTA and 4 await rescheduling. This compares with an 84% first appointment attendance in non-FLS metabolic bone appointments (n=49) over the same period.
Comparing 104 attendees with 84 non-attendees, mean age was similar (70.5 vs 72.5 yrs, p=0.3). There was a trend to lower attendance rates in females (53% vs 66%, p=0.1) The proportion of patients with primary language other than English did not differ between attendees and non-attendees (22%  vs 18%), nor was there any difference in fracture distribution - hip/pelvis fracture (35% vs 39%); peripheral fracture (57% vs 48%). The proportion who received face-to-face FLC contact prior to booking did not differ (25% vs 27%), however significantly more attendees received a pre-clinic phone-call than non-attendees (27% vs 7%, p<0.01). 82% of phone-contactable patients attended.
Conclusion: Cancellation and FTA rates were high across the spectrum of age, fracture location and language, no specific target group was identified. Patients contactable by phone generally attended, but many were uncontactable. Designing and testing interventions to improve attendance is the next challenge.