Using volunteers to reduce Did Not Attend rate amongst the most deprived

As part of our population health and equity framework, innovative work is underway to design and deliver ways to improve our patient’s access, experience and outcomes and to reduce inequalities. Here, Arissa James, FY3 doctor, shines a light on a volunteer-led project to tackle Did-Not-Attend (DNA) rates in Gastroenterology first outpatient appointments.

In a collaborative project with the Gastroenterology department, the health equity team trialled a volunteer-based pilot to tackle the higher Did-Not-Attend (DNA) rates in Gastroenterology first outpatient appointments (OPAs) amongst patients of ethnic minority and/or deprived backgrounds.

In January 2023, we called patients who fell into the (a) most deprived quintile and/or (b) black, mixed and other ethnic minorities who had DNA’d their first Gastroenterology OPA at Imperial College Healthcare Trust. Patients identified multiple factors that contributed towards their DNA’d OPAs, including poor transport options, accessibility, lack of knowledge of the appointment and personal reasons.

Given this data, we worked together with volunteers from Imperial Health Charity to make telephone calls to patients in Indices of Multiple Deprivation (IMD) deciles 1-3. IMD is a single score of deprivation with weighted components that measures how deprived an area is. In England, this score is based on seven domains including income, employment, education, health, crime, barriers to housing and services, and living environment.

One week prior to their first Gastroenterology OPA, volunteers called patients to remind them of their OPA and provide any additional details that might improve their experience of attending the appointment.

318 patients were contacted between 15 May and 19 July 2023 by a team of two volunteers. Our volunteer-led intervention showed that 84.3% of patients who were successfully spoken to by volunteers attended their appointment, compared to 70.2 % of patients who did not respond to the volunteer calls. We also found that patients who were spoken to by volunteers were 13.5% less likely to DNA their appointment compared to patients who did not respond to the calls.

Given the positive outcomes from the pilot so far, we will continue this volunteer-led intervention for a total of six months, gathering further data to enable us to understand DNA rates and what we can do to further reduce them at our Trust as part of our commitment to reducing inequalities in our patient care.