Skip to main content

Post-hospitalization followup appointment-keeping among the medically indigent


The purpose of this study was to measure followup appointment-keeping in patients discharged from a General Medicine Inpatient Service and to identify possible predictors of compliance. Patients were interviewed on hospital admission and all charts were reviewed on discharge. A subset of patients were interviewed by telephone an average of one month after first followup appointment date. The study was conducted in an urban public teaching hospital with hospital-based and community clinics. A convenience sample of 209 patients were selected from admissions to the General Medicine Inpatient Service over a three month period. Followup appointment-keeping was recorded on all 195 patients discharged alive. Seventy-five percent of patients had no medical insurance, public or private. A compliance rate of 60% (95% confidence interval: 53% to 67%) with first followup appointment was found. Variables associated with compliance and which retained independence on multiple logistic regression analysis, followed by adjusted odds ratios (95% confidence intervals) were: no copayment requirement, odds ratio 3.2 (1.6 to 6.3), single followup appointment 2.9 (1.4 to 5.9), apartment dwelling 3.2 (1.4 to 7.3) and non-primary care clinic appointment 2.3 (1.1 to 4.8). We conclude that health-care-delivery related factors such as no copayment requirements are strongly associated with appointment-keeping in a public hospital population.

This is a preview of subscription content, access via your institution.


  1. 1.

    Gage LS, Weslowski VB, Andrulis DP, Hintz E, Camper AB. America's safety net hospitals: the foundation of our nation's health system. Washington, DC: National Association of Public Hospitals, 1991. p. 31.

    Google Scholar 

  2. 2.

    Schwartz WB, Mendelson DN. Hospital cost containment in the 1980s. Hard lessons learned and prospects for the 1990s. N Engl J Med 324: 1037–1042, 1991.

    Google Scholar 

  3. 3.

    Eriksson EA. Continuity-of-care measures: random assignment of patients to providers and the impact of utilization level. Med Care 28:180–190, 1990.

    Google Scholar 

  4. 4.

    Steinwachs DM. Application of health status assessment measures in policy research. Med Care 27:12–26, 1989.

    Google Scholar 

  5. 5.

    Maronde RF, Chan LS, Larsen FJ, Strandberg LR, Laventurier MF, Sullivan SR. Underutilization of antihypertensive drugs and associated hospitalization. Med Care 27:1159–1166, 1989.

    Google Scholar 

  6. 6.

    Given CW, Branson M, Zemach R. Evaluation and application of continuity measures in primary care settings. J Community Health 10:22–41, 1985.

    Google Scholar 

  7. 7.

    McClellan WM, Hall WD, Brogan D, Miles C, Wilber JA. Continuity of care in hypertension—an important correlate of blood pressure control among aware hypertensives. Arch Intern Med 148:525–528, 1988.

    Google Scholar 

  8. 8.

    Beland F. A descriptive study of continuity of care as an element in the process of ambulatory medical care utilization. Can J Public Health 80:249–254, 1989.

    Google Scholar 

  9. 9.

    Bertakis KD, Robbins JA. Continuity of care for family practice patients in a university hospital based residency program. Family Practice Research Journal 8:100–106, 1989.

    Google Scholar 

  10. 10.

    Deyo RA, Inui TS. Dropouts and broken appointments—a literature review and agenda for future research. Med Care 18:1146–1157, 1980.

    Google Scholar 

  11. 11.

    Goldman L, Freidin R, Cook EF, Eigner J, Grich P. A multi-variate approach to the prediction of no-show behavior in a primary care center. Arch Intern Med 142:563–567, 1982.

    Google Scholar 

  12. 12.

    Gruzd DC, Shear C, Rodney W. Determinants of no-show appointment behavior: the utility of multivariate analysis. Fam Med 18:217–220, 1986.

    Google Scholar 

  13. 13.

    Lanska MJ, Sigmann P, Lanska DJ, Rimm AA. Effect of resident turnover on patients' appointment-keeping behavior in a primary care medical clinic. J Gen Intern Med 1:101–103, 1986.

    Google Scholar 

  14. 14.

    Frankel S, Farrow A, West R. Non-attendance or non-invitation? a case-control study of failed outpatient appointments. Br Med J 298:1343–1345, 1989.

    Google Scholar 

  15. 15.

    Smith PB, Weinman ML, Johnson TC, Wait RB. Incentives and their influence on appointment compliance in a teenage family-planning clinic. J Adolesc Health Care 11:445–448, 1990.

    Google Scholar 

  16. 16.

    Hermoni D, Mankuta D, Reis S. Failure to keep appointments at a community health centreanalysis of causes. Scand J Prim Health Care 8:151–155, 1990.

    Google Scholar 

  17. 17.

    Hamilton LC. Statistics with STATA. Pacific Grove, California: Brooks/Cole Publishing Company. 1989, Pp 137–145.

    Google Scholar 

  18. 18.

    Rosner B. Fundamentals of biostatistics. Third edition. Boston, Massachusetts: PWS-Kent Publishing Co., 1990. Pp. 432–36.

    Google Scholar 

  19. 19.

    Statistics/Graphics/Data Management. STATA Reference Manual. Fifth Edition. Los Angeles, California: Computing Resource Center, 1992.

    Google Scholar 

  20. 20.

    Cherkin DC, Grothaus L, Wagner EH. The effect of office visit copayments on utilization in a health maintenance organization. Med Care 27:1036–1045, 1989.

    Google Scholar 

  21. 21.

    Cherkin DC, Grothaus L, Wagner EH. The effect of office visit copayments on preventive care services in an HMO. Inquiry 27:24–38, 1990.

    Google Scholar 

  22. 22.

    Reeder CE, Nelson AA. The differential impact of copayment on drug use in a medicaid population. Inquiry 22:396–403, 1985.

    Google Scholar 

  23. 23.

    Greenwald HP. HMO membership, copayment, and initiation of care for cancer: a study of working adults. Am J Public Health 77:461–466, 1987.

    Google Scholar 

  24. 24.

    Bindman AB, Grumbach K, Deane D, Rauch L, Luce JM. Consequences of queuing for care at a public hospital emergency department. JAMA 266:1091–1096, 1991.

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Catarina I. Kiefe PhD, MD.

Additional information

Catarina I. Kiefe, is Associate Professor of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, and Prentiss L. Harrison, is Physician's Assistant, Department of Medicine, Ben Taub General Hospital and Baylor College of Medicine, Houston, Texas, USA

The authors thank David Hyman, M.D., M.P.H. for helpful suggestions and Ave Anderson for meticulous manuscript preparation.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kiefe, C.I., Harrison, P.L. Post-hospitalization followup appointment-keeping among the medically indigent. J Community Health 18, 271–282 (1993).

Download citation


  • Teaching Hospital
  • Adjusted Odds Ratio
  • Related Factor
  • Public Hospital
  • Public Teaching