Characteristics of patients who leave without being seen: comparing with those who do not leave

The percent of patients leaving without been seen by a doctor (LWBS) is often seen as a quality indicator of care. In this longitudinal study, we compare the behaviour over time of two groups of patients: the LWBS group composed by patients who did at least one LWBS visit, with the no-LWBS group containing the remaining individuals. We analysed their low acuity visits over a period of 3.5 years and search for the most frequent sequences of use of the Emergency departments in the city of Sherbrooke, Quebec.  The LWBS visits represent a high percent of low acuity visits (14%) but they are generated by a low percent of the population (10.7%). The LWBS group generated 6.68 visits per person versus 3.13 visits in the no-LWBS group. The LWBS patients are young, 36 years old on average, and live in city areas either materially or socially deprived. Analysis of temporal sequences for all users revealed that patients’ conditions are being treated in the ED, instead of being followed up with a GP or a family doctor. Temporal sequences also revealed that a member of the LWBS group will likely repeat an LWBS visit within a week.  Mental disorders, respiratory and digestive system problems are more frequent in the LWBS group than in the no-LWBS group and this may indicate chronic situations poorly managed.  As there is no monetary incentive for the hospitals in Quebec to reduce the LWBS rate, we propose to establish a recall system that will direct chronic patients to external clinics already in service in the hospitals.