Prescribing is, in many cases, straightforward once you have done a full clinical review on a patient. One of the most challenging things in primary care, however, can be getting hold of the person in the first place. Patients frequently do not attend arranged appointments, which can be a headache for prescribers and can increase waiting times.
For many people, going to see their GP is a reactive step rather than a proactive one. They are happy to arrange a visit when they feel unwell or when they think there might be a problem. So attending a proactive secondary prevention clinic (like the one I run in primary care for heart failure) is a concept that can seem alien to some patients. During periods of good health or when their symptoms appear to be under control, patients often fail to see the benefit in turning up when invited for a review.
Barriers to patient engagement are complex and multifaceted. Factors can include: literacy (not being able to read letters), language (not being able to speak to healthcare professionals in their preferred tongue), education (poor understanding of their condition, medicines or need for monitoring), time restraints (being at work during the usual appointment times), age, social issues, cultural beliefs and religion.
Traditionally patients are invited to clinics via a letter. However, attendance rates can vary when using this method and much time is often wasted waiting for patients who do not attend. To boost attendance at my clinics, I have had to try a number of other approaches. I attempt to contact patients by telephone in the first instance, rather than writing to them. I also make use of text messaging and email if we have details of these in the patient records.
I now only use letters as a second or third tactic. Thereafter, other methods such as seeking an interpreter who speaks the patient’s preferred language and making outreach visits (where someone goes to the patient’s home to arrange a review) can be used. Offering different types of appointment (eg, at home or after hours) greatly improves the likelihood that patients will attend.
With the use of these techniques, over 90% of my target patients are now attending their appointments — compared with approximately 70% when I only contacted patients by letter. And so my time is far better spent and I am less frustrated when patients do not show up. I have certainly given them every chance to do so.
