Irish Journal of Medical Science (1971 -)

, Volume 187, Issue 2, pp 525–528 | Cite as

Non-attendance of vulnerable populations within epilepsy outpatient services in Ireland

Original Article



Outpatient non-attendance is a prevalent issue that contributes to significant wasted clinical resources and can be influenced by a number of complex factors.


The aim of this study is to characterize “did not attend” (DNA) rates in three identified subpopulations of epilepsy patients to determine if current care provision models suffice.


In this study, we identified all patients residing in social housing, in residential care, and those incarcerated who have been offered appointments by our service. We calculated the total number of appointments issued to each group over their entire interaction with our service and their subsequent non-attendance rate as a group. Additionally, we calculated the baseline DNA rate for our epilepsy clinic as a whole for comparison.


We found that the baseline DNA rate for the clinic as a whole was 18.9%. Those in social housing, in residential care, and incarcerated had significantly higher DNA rates of 24, 20.2, and 54.3%, respectively.


This study provided evidence that in certain groups of patients, clinicians may need to explore other care delivery models due to high DNA rates.


DNA rates Epilepsy Outpatients Vulnerable patient populations 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Executive HS (2015) Community healthcare data report: April 2015: Health Service Executive (HSE). Accessed 16 July 2016
  2. 2.
    Scotland NH. Who is least likely to attend? An analysis of outpatient appointment “Did Not Attend” (DNA) data in Scotland. Accessed 16 July 2016
  3. 3.
    Sharp DJ, Hamilton W (2001) Non-attendance at general practices and outpatient clinics. Local systems are needed to address local problems British Medical Journal 323:1081–1082. Google Scholar
  4. 4.
    Ellis DA, Jenkins R (2012) Weekday affects attendance rate for medical appointments: large-scale data analysis and implications. PLoS One 7:e51365. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hasvold PE, Wootton R (2011) Use of telephone and SMS reminders to improve attendance at hospital appointments: a systematic review. J Telemed Telecare 17:358–364. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Hallsworth M, Berry D, Sanders M et al (2015) Stating appointment costs in SMS reminders reduces missed hospital appointments: findings from two randomised controlled trials. PLoS One 10:e0137306. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Baron R, Mannien J, te Velde SJ et al (2015) Socio-demographic inequalities across a range of health status indicators and health behaviours among pregnant women in prenatal primary care: a cross-sectional study. BMC Pregnancy Childbirth 15:261. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Trohel G, Bertaud-Gounot V, Soler M et al (2016) Socio-economic determinants of the need for dental care in adults. PLoS One 11:e0158842. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Glader EL, Jonsson B, Norrving B et al (2016) Socioeconomic factors’ effect on return to work after first stroke. Acta Neurol Scand 135(6):608–613. CrossRefPubMedGoogle Scholar
  10. 10.
    Nielsen KM, Faergeman O, Foldspang A et al (2008) Cardiac rehabilitation: health characteristics and socio-economic status among those who do not attend. Eur J Public Health 2008;18:479–483.
  11. 11.
    Bonevski B, Randell M, Paul C et al (2014) Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Med Res Methodol 14:42–42. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kaiboriboon K, Bakaki PM, Lhatoo SD et al (2013) Incidence and prevalence of treated epilepsy among poor health and low-income Americans. Neurology 80:1942–1949. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Thompson AW, Miller JW, Katon W et al (2009) Sociodemographic and clinical factors associated with depression in epilepsy. Epilepsy & behavior : E&B 14:655–660. CrossRefGoogle Scholar
  14. 14.
    Richard L, Furler J, Densley K et al (2016) Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations. Int J Equity Health 15:64. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Dahrouge S, Hogg W, Ward N et al (2013) Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter? BMC Health Serv Res 13:517–517. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Varley J, Delanty N, Normand C et al (2010) Epilepsy in Ireland: towards the primary-tertiary care continuum. Seizure : the journal of the British Epilepsy Association 19:47–52. CrossRefGoogle Scholar
  17. 17.
    Jayaram M, Rattehalli RD, Kader I (2008) Prompt letters to reduce non-attendance: applying evidence based practice. BMC Psychiatry 8:90. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Roberts K, Callanan I, Tubridy N (2011) Failure to attend out-patient clinics: is it in our DNA? Int J Health Care Qual Assur 24:406–412. CrossRefPubMedGoogle Scholar
  19. 19.
    White M, Fitzsimons M, Banguiran J et al (2015) Changing the way epilepsy care is delivered- audit of a multidisciplinary epilepsy outreach clinic in an intellectual disability facility supported by the electronic patient record. In: Poster presentation at the international epilepsy congress TurkeyGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2017

Authors and Affiliations

  1. 1.Department of NeuroscienceBrandeis UniversityWalthamUSA
  2. 2.Department of NeurologySt.James’s HospitalDublinIreland
  3. 3.Academic Center for Neurology, Trinity Biomedical Science InstituteTrinity CollegeDublinIreland

Personalised recommendations