An investigation into the default rate at the Fife colposcopy clinic: implications for target setting

Abstract

Background: High default rates have been reported from the Fife colposcopy clinic in recent years. However, it was felt that this rate was misleading, as many patients who defaulted initially attended subsequent appointments. It was therefore decided to determine the default rate of a cohort of new patients given appointments at the clinic. The objective of the study was to determine the attendance rates for these new patients, between the dates they were first invited to their various appointments and the dates that their notes were subsequently examined as part of this study in September 1992.

Methods: A retrospective cohort study of new patients invited to the Fife colposcopy clinic was undertaken. The notes of 200 new patients who had been invited during the eight-month period January-August 1991 were selected by systematic sampling. The dates that they had attended for their new patient assessment/treatment, first follow-up and second follow-up appointments were recorded. Attendance rates were then calculated using an incomplete life-table method. Patients were censored if they failed to attend their assessment/treatment or review appointments by 1 October 1992.

Results: The study demonstrated that 96 per cent of patients attended their first treatment appointment within six months of their appointment date, 91 per cent of first review patients attended within six months, and 88 per cent of second review patients attended within four months.

Conclusions: These findings suggest that there are two distinct groups of defaulters: those who default initially but subsequently re-attend, and those who default completely. We have named these type A and type B defaulters, respectively. This means that attendance within a certain period of time should also be used to monitor clinic attendance in addition to simple mean attendance rates. As patients who default completely may be more likely to have a severe histological lesion, further work is required to identify factors associated with this type of patient.