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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.123224v1 AJPH.2007.123224v2 98/12/2207    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Siminoff, L. A. Articles by Ibrahim, S. Search for Related Content PubMed PubMed Citation Articles by Siminoff, L. A. Articles by Ibrahim, S. Related Collections Health Care Facilities/Services Access to Care Other Health Service Delivery Cardiovascular Disease

Laura A. Siminoff, PhD, Leslie R. M. Hausmann, PhD and Said Ibrahim, MD

Laura A. Siminoff is with the Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond. Leslie R. M. Hausmann is with the Veterans Admnistration Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA. Said Ibrahim is with the Veterans Administration Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, and the School of Medicine, University of Pittsburgh, Pittsburgh.

Correspondence: Requests for reprints should be sent to Laura A. Siminoff, PhD, Department of Social and Behavioral Health, Virginia Commonwealth University, PO Box 980149, 1112 E Clay St, Richmond, VA 23298 (e-mail: lasiminoff{at}vcu.edu).

Objectives. We sought to identify factors associated with appointment nonattendance for diagnostic testing of coronary artery disease among veterans. For patients with possible heart disease, appointment nonattendance may seriously compromise short- and long-term outcomes. Understanding factors associated with nonattendance may help improve care while reducing inefficiency in service delivery.

Methods. We surveyed patients who attended (n = 240) or did not attend (n = 139) a scheduled cardiac appointment at a midwestern Veterans Administration medical center. Multivariable regression models were used to assess factors associated with nonattendance.

Results. Younger age, lower income, unemployment, and longer wait times for appointments were predictive of nonattendance. Nonattenders reported fewer cardiac symptoms and were more likely to attribute their symptoms to something other than heart disease. Nonattendance was also associated with a coping style characterized by avoidance of aversive information. Logistical issues, fear of diagnostic procedures, disbelief that one had heart disease, and medical mistrust were some of the reasons given for missed appointments.

Conclusions. Appointment nonattendance among veterans scheduled for cardiology evaluation was associated with several important cognitive factors. These factors should be considered when one is designing clinical systems to reduce patient nonattendance.