For patients with chronic conditions, regular medical appointments are integral to treatment. So, a research team including a Trinity College professor and an alumna is trying to pinpoint the reasons some patients with multiple sclerosis miss them.

Trinity College's Sarah Raskin, the Charles A. Dana Research Professor of Psychology and Neuroscience.
Trinity College’s Sarah A. Raskin, Charles A. Dana Professor of Psychology and Neuroscience.

How persons with multiple sclerosis missed a visit and why they missed it were linked in the new study led by Elizabeth S. Gromisch ’09, Trinity Health of New England’s Joyce D. and Andrew J. Mandell Center for Comprehensive Multiple Sclerosis Care and Neuroscience Research, and Sarah A. Raskin, Charles A. Dana Professor of Psychology and Neuroscience at Trinity College.

While last-minute cancellations were tied to appointment characteristics, the no-shows were associated with participant characteristics, according to their study in the February issue of Multiple Sclerosis and Related Disorders.

“These findings highlight potential targets for reducing the number of missed appointments in the clinic, providing opportunities for improved healthcare efficiency and most importantly, health,” noted the authors.

The study included 110 participants between the ages of 21 and 74 years with multiple sclerosis, a disease that impacts the brain, spinal cord, and optic nerves, which make up the central nervous system and control everything we do.

Researchers examined a total of 1,600 unique appointments booked at three Connecticut clinics. Overall, about 87 percent of the appointments were attended, while 9 percent were short-notice cancellations, and 3 percent were no-shows.

Short-notice cancellations were tied to appointment-related factors such as the season, day of the week, or time of day, researchers said. The highest number occurred during the winter, a season in which snowfall can impact travel in New England. About 23 percent were attributed to the weather. They were also more common on Thursdays and less likely early in the day.

However, no-shows were associated with different factors. Those included lower income levels, weaker healthcare provider relationships, and higher levels of neuroticism, depressive symptoms, and health distress overall, as well as greater cognitive difficulties, particularly with prospective memory–the ability to remember to complete planned intentions.

The importance of attending medical appointments has been documented. People with multiple sclerosis who miss more than 20 percent of appointments over a two-year period have less than optimal rates of sticking with their medications.

Several other medical conditions have benefited from strategies to address treatment adherence, the authors noted. Those include human immunodeficiency virus (HIV), for which case managers have been used to identify barriers and address them prior to the scheduled appointment. In other populations, text messages and phone call reminders, psychoeducation, and active commitments have been used.

This study is the latest collaboration between Raskin and Gromisch, who have teamed up on several investigations. They also worked with Lindsay O. Neto, Trinity Health of New England; and Jodie K. Haselkorn and Aaron P. Turner, Multiple Sclerosis Center of Excellence West, Veterans Affairs.

The work was supported by a pilot grant from the National Multiple Sclerosis Society, and preliminary results were presented at the Consortium of Multiple Sclerosis Centers 2021 and 2022 annual meetings.