The effect of fines on non-attendance in public hospital outpatient clinics
| ISRCTN | ISRCTN61925912 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN61925912 |
| Secondary identifying numbers | N/A |
- Submission date
- 22/06/2015
- Registration date
- 06/07/2015
- Last edited
- 19/02/2021
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Other
Plain English Summary
Background and study aims
Non-attendance at scheduled appointments in public hospitals is a challenge to the best use of healthcare resources, which could ultimately affect patient health due to longer waiting times. It has been estimated that 7% of all scheduled outpatient appointments in the United Kingdom are not kept by patients. Different reminder systems have been shown to have a moderate effect on reducing the number of patient no-shows whereas the effect of fining people who do not show up for their appointment has not yet been tested in a clinical trial. Such use of financial incentives could however impact access to care differently across different socioeconomic groups (horizontal inequality). The aim of this study is to assess the effect of fines on hospital outpatient non-attendance.
Who can participate?
Patients that have made an appointment at the participating outpatient clinic.
What does the study involve?
All appointments made at the outpatient clinic are randomly assigned to one of two groups; an intervention group and a control group. Appointments assigned to the intervention group includes an attachment to the appointment letter explaining that a fine will be issued in case of non-attendance without giving notice. Appointments assigned the control arm follow usual practice (same system but no letter attachment). The study then compares the number of appointments for which the patients did not show up in each group, along with other analysis.
What are the possible benefits and risks of participating?
Not provided at time of registration
Where is the study run from?
The Department of Orthopaedic Surgery at Viborg Regional Hospital (Denmark)
When is the study starting and how long is it expected to run for?
March 2014 to June 2017
Who is funding the study?
The Danish Regions, Central Denmark Region and the Ministry of Health and Prevention (Denmark)
Who is the main contact?
1. Ms Emely Ek Blæhr
emebla@rm.dk
2. Dr Ulla Væggemose
Ulla.Vaeggemose@stab.rm.dk
Contact information
Scientific
CFK Public Health and Quality
Region House Aarhus
Olof Palmes Allé 15
Aarhus N
8200
Denmark
| Phone | +45 7841 4370 |
|---|---|
| emebla@rm.dk |
Scientific
CFK Public Health and Quality
Region House Aarhus
Olof Palmes Allé 15
Aarhus N
8200
Denmark
| Phone | +45 7841 4360 |
|---|---|
| Ulla.Vaeggemose@stab.rm.dk |
Study information
| Study design | Single-centre randomised controlled trial |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Randomised controlled trial |
| Study setting(s) | Hospital |
| Study type | Other |
| Participant information sheet | Not available in web format, please use contact details to request a participant information sheet |
| Scientific title | The effect of fines on non-attendance in public hospital outpatient clinics: a pragmatic, randomised controlled trial |
| Study hypothesis | In Denmark, introduction of fines for non-attendance in hospital outpatient clinics have been debated over years. Already in 2005, a collaborative agreement between the Danish Regions and the Danish Medical Association opened the opportunity for privately practicing specialists to issue fines for non attendance of DKK 250 for consultations and DKK 500 for surgical procedures. The expected benefits were overall related to better use of resources whereas concerns were expressed about a detrimental effect on horizontal equity due to that fines could have the greatest impact on the most vulnerable individuals. Moreover, the use of fines was seen as a break with the fundamental value of free and equal access to health care as well as a potential threat to the patient-health professional relationship, which should ideally be independent of financial interests. Despite the fact that 10 years have passed since the regulatory context opened for use of fines in the Danish health care system for privately practicing specialists, no systematic evidence on the resulting practice, the efficacy or the effect appears to have been reported. It has therefore been decided by the Danish Regions that the effect of using fines to moderate non-attendance at somatic, hospital-based outpatient clinics in Denmark should be scientifically investigated. This trial is a result of that decision. In accordance, the objective is to investigate the effect of fines on hospital outpatient non-attendance with respect to attendance and efficiency as well as horizontal inequality. |
| Ethics approval(s) | The Ministry of Health and Prevention in Denmark, 28/11/2014, ref: 303/2014 |
| Condition | The effect of fines on hospital outpatient non-attendance with respect to attendance and efficiency as well as horizontal inequality. |
| Intervention | All appointments will be made in accordance with usual practice except for two facts. First, the appointment letter will inform the individual (both intervention and control arms) about the trial. It is explained that the investigation has been initiated by the Danish Regions and approved by the Ministry of Health and that their appointment has been randomly assigned to be subject to a fine, in case of non-attendance without notice, if the appointment letter is attached to letter about the fine system. Second, for appointments randomised to the intervention group only, the letter specifying the conditions is attached to the appointment letter. In this letter it is made clear that a fine will be issued in case of non-attendance without giving notice, at any time, before the time of the appointment. It is also informed that the fine amounts to DKK 250 and that it will be issued by a central office under the local government administration (Corporate Finance, Central Denmark Region), which is open for e-mails and telephone calls during normal office hours in case of questions or complaints. |
| Intervention type | Behavioural |
| Primary outcome measure | Proportion of appointments who are attended: All types of appointments are registered in the clinic by the secretariat on a daily basis. All parameters except for sociodemographics are automatically extracted from the electronic patient journal system into a trial registry administrative registered in electronic trial registries. Sociodemographics are extracted from various, individual-level national registries administered by Statistics Denmark. |
| Secondary outcome measures | 1. Proportions of appointments cancelled by the department 2. Proportion of appointments cancelled by the individual 3. Case-mix of individuals in terms of sociodemographics such as age, sex, income, education, distance to hospital, travel time and waiting times and in terms of health problem characteristics such as anatomy, type of appointment and treatment costs will be used as a secondary outcome All types of appointments are registered in the clinic by the secretariat on a daily basis. All parameters except for sociodemographics are automatically extracted from the electronic patient journal system into a trial registry administrative registered in electronic trial registries. Sociodemographics are extracted from various, individual-level national registries administered by Statistics Denmark. |
| Overall study start date | 18/03/2014 |
| Overall study end date | 30/06/2017 |
Eligibility
| Participant type(s) | All |
|---|---|
| Age group | All |
| Sex | Both |
| Target number of participants | Around 6,500 appointments (based on department statistics). |
| Total final enrolment | 6746 |
| Participant inclusion criteria | Inclusion criteria as of 28/06/2016: 1. Consecutive appointments for individuals scheduled for diagnostics, treatment or follow up in the outpatient clinic 2. Appointments for individuals who are booked via an appointment letter sent between 01/05/2015 and 01/12/2015 Original inclusion criteria: 1. Consecutive appointments for individuals scheduled for diagnostics, treatment or follow up in the outpatient clinic 2. Appointments for individuals who are booked via an appointment letter sent between 01/05/2015 and 30/04/2016 |
| Participant exclusion criteria | Exclusion criteria as of 28/06/2016: 1. As a user may have more than one appointment, only the first appointment during the period was considered 2. Appointments for individuals who are booked without an appointment letter, e.g. via telephone or face-to-face 3. Appointments for individuals receiving physiotherapy or occupational therapy in the outpatient clinic (typically in a group-based setup also without appointment letters) 4. Appointments for individuals with residence in Greenland (requiring an overseas flight) Original exclusion criteria: 1. Appointments for individuals who are booked without an appointment letter, e.g. via telephone or face-to-face 2. Appointments for individuals receiving physiotherapy or occupational therapy in the outpatient clinic (typically in a group-based setup also without appointment letters) 3. Appointments for individuals with residence in Greenland (requiring an overseas flight) |
| Recruitment start date | 01/05/2015 |
| Recruitment end date | 01/12/2015 |
Locations
Countries of recruitment
- Denmark
Study participating centre
Heibergs Allé 4
8800 Viborg
Viborg
8800
Denmark
Sponsor information
Research organisation
Olof Palmes Allé 15
Aarhus N
8200
Denmark
| Phone | +45 (0)7841 4360 |
|---|---|
| cfk@rm.dk | |
| Website | http://www.cfk.rm.dk/ |
Funders
Funder type
Government
No information available
No information available
No information available
Results and Publications
| Intention to publish date | 01/01/2017 |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Not expected to be made available |
| Publication and dissemination plan | All results from the trial will be published in the end of 2016 or beginning of 2017. |
| IPD sharing plan |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol article | protocol | 13/06/2016 | Yes | No | |
| Results article | results | 13/04/2018 | 19/02/2021 | Yes | No |
Editorial Notes
19/02/2021: Publication reference and total final enrolment added.
28/06/2016: The overall trial dates have been updated from 14/03/2014 - 31/12/2016 to 18/03/2014 - 30/06/2017 and the recruitment end date has been updated from 30/04/2016 to 01/12/2015. In addition, the inclusion and exclusion criteria have been updated and the target number of participants has been updated from 23,500 to 6,500. The sponsor has also changed it's name from CFK - Public Health and Quality Improvement to DEFACTUM – Public Health & Health Services Research. Finally, Mr Thomas Kristensen has been removed from the study contacts section as he is no longer associated with the trial, and Miss Emely Ek Blæhr has been added.
15/06/2016: Publication reference added.
