Researcher Seeks Answers to Socially Relevant Questions, But Finds it Difficult to Get Respondents to Speak
Anthropologist Charlotte Nørholm, on behalf of Central Denmark Region, is investigating why 70,000 patients fail to attend their appointments in the healthcare system every year in Central Denmark Region alone. The challenge is that the researchers are unable to reach patients who don't show up.
Every year, up to 70,000 patients stay away from their appointments in the Central Denmark Region. That corresponds to just under three percent of all outpatient appointments at the region's hospitals. And although the Central Denmark Region has a wide range of health data on the absences, they don’t know much about why patients stay away.
Central Denmark Region has therefore asked anthropologist Charlotte Nørholm to provide answers to this. She is affiliated with the Interacting Minds Centre at the Department of Culture and Society and is employed by Central Denmark Region at Hammel Neurorehabilitation Centre.
As it is, the region only records that the patient stays away, but not the reason for the absence, says Charlotte Nørholm, who has worked on the project for six months with two other employees.
“We don't call the patient up and ask, »Why didn't you show up?« We lack the knowledge that allows us to start acting on it.”
But that has turned out to be easier said than done. The biggest challenge has undoubtedly been to establish contact with the absent patients.
“It’s very difficult to get hold of those who are absent — and without them, we don’t know what it’s about,” Charlotte Nørholm says, stressing that there are also rules that mean that they cannot simply look up the absent patients and contact them.
Guilt block the way for insight
It’s not that Charlotte Nørholm and her colleagues haven’t tried to reach those who are absent. She has created a Facebook post, been featured on a radio feature on DR, published an article, set up a telephone line, and addressed patients directly in the waiting rooms in Region Midtjylland. And although it’s anonymous to participate, there has been no real gap in reaching the missing patients.
Charlotte Nørholm's analysis is that there’s a very strong narrative that it’s the patient's own fault that they don’t show up to the appointment. It discourages many from speaking out.
“A discourse quickly arises that you have a moral obligation to show up so you don't waste our common resources. This, I think, may mean that it becomes really difficult to say out loud that you have difficulty showing up,” Charlotte Nørholm explains.
They have so far spoken to 10 patients, not all of whom have missed appointments, and another 10 employees from different departments in the Central Denmark Region.
MISSED THE BUS, LACK OF LANGUAGE SKILLS AND ANXIETY
From these conversations, they have found that there are many reasons for the absences. However, according to Charlotte Nørholm, absences can be broadly divided into two categories, particularly: acute and more complex ones.
“There are some very simple reasons, such as having missed the bus, forgotten it or having fallen ill on the day,” she says, pointing out that these absences are difficult to solve because they occur acutely.
“But there are also some slightly more complex absences. It may be, for example, that you have difficulty reading the letter you receive because you are dyslexic or that you are not very good at Danish,” Charlotte Nørholm points out and elaborates that this may mean that the patient has not, for example, been fasting or has stopped taking a certain type of medication, which is a condition for conducting the study.
“It can also be anxiety or nervousness about the conversation with the doctor, where you are afraid of getting an answer because you are unsure how it’s going to affect your life,” Charlotte Nørholm explains. It’s especially the more complex absences that they focus on in the project.
FEWER ABSENCES COULD REDUCE WAITING TIMES IN HEALTH CARE
According to Charlotte Nørholm, the reasons for the absences are a crucial piece of knowledge, because it has both human and socio-economic costs.
“Every time there is an absence, there’s also a patient who doesn’t get help in time – or at least as quickly as they could have received it,” she stresses, highlighting another aspect of the absences:
“From a slightly larger societal perspective, it's also about the fact that we already have some long waiting times in health care. Whenever someone is absent, we naturally face the problem that the queue certainly doesn’t get any shorter. The patient still needs to be seen by a doctor,” Charlotte Nørholm says. Therefore, she hopes that fewer absences can help make the queue a little shorter.
ADD TO MY CALENDAR
In connection with the project, they’ve also asked patients and staff for advice on possible solutions on how to reduce the number of absences. Here, they’ve received many good ideas, but there are two ideas in particular that Charlotte Nørholm has adhered to.
“There’s a patient who says, 'If you could do something like when I go to a restaurant, where I get an email with a confirmation - and I can press ‘add to the calendar’ in my own phone'. It would be smart if we could do this with our appointment notices to patients,” says Charlotte Nørholm.
The second idea is immediately more resource-intensive, but in all its simplicity, it’s that patients who need it can be called the day before their appointment, she says.
“But it’s also about the individual department and what can be done,” Charlotte Nørholm concludes.
This text is machine translated and post-edited by Lisa Enevoldsen.