Clinic 'no-show' costs West Coast DHB $400k a year

2:54 pm on 17 June 2020

Patients who do not show up for medical appointments are costing the West Coast District Health Board more than $400,000 a year.

The man's GP believed he was getting counselling for his depression.

Photo: 123RF

And it is worried that a disproportionate number of those patients are Māori.

DHB chair Rick Barker has vowed to make a difference to the health of tangata whenua on the Coast.

At its Health Advisory Committee meeting last week, members heard Māori non-attendance rates at outpatient clinics across the country were typically twice that of non-Māori.

Last year the monthly figures showed between 8 percent and 19 percent of West Coast Māori patients failed to show up for appointments.

But last month, Māori 'did-not-attends' (DNAs) surged to a high of 34 percent of all patients.

Committee member Edie Moke said that was likely to be related to fear of Covid but the increase was concerning.

Barker agreed.

"If people don't attend, it's not because they have found a miracle cure. Is there anything we can do?"

The consequence for Māori was compromised health, and the consequence for the DHB was that scarce resources, such as specialist and nursing time were wasted, Māori health manager Gary Coghlan said in his report.

"The estimated cost of each DNA is between $262 to $412, and based on total DNAs reported in 2019, (Māori and non-Māori) the cost to the West Coast DHB was in excess of $400,000."

The Hauora Māori team was now looking at a 'whole of system' approach to the problem, Coghlan said.

"We had a valuable kōrero with the central booking unit management and staff and heard the challenges they face and ways they have tried to improve DNA rates for vulnerable populations."

Speaking after the meeting, Coghlan told the Greymouth Star the 34 percent increase on DNAs last month looked alarming but the actual figures involved were small, with so many clinics reduced by Covid restrictions.

"But it is a problem and one that all DHBs are trying to deal with," he said.

There were many reasons Māori on the Coast were not showing up for outpatient appointments, Coghlan said.

"The barriers in a rural area for everyone are transport and phone and internet connections, and sometimes it's fear of what you might hear. But the consequences for Māori were often more serious because they tended to present late with symptoms.

"If you are staring down the barrel of something serious, and Māori generally don't fare as well health-wise, sometimes you just don't want to hear any more bad news."

One option might be to offer Māori patients a support person to go with them to appointments, as a guide or navigator, he said.

On a positive note, more West Coast Māori women were taking the opportunity of breast screening, Coghlan reported.

The Breastscreening Mobile Unit was up and running again operating at about 50 percent capacity for safety reasons, as soon as Covid restrictions allowed.

In Westport, 18 of the 80 tests were for Māori and one for Pasifika, and in Greymouth, eight of the 16 screens were for Māori, which was a great result, he said.

The clinics had been targeting Māori and Pasifika women, and the Poutini Ngāi Tahu-owned Māori health provider Poutini Waiora provided support and worked in collaboration with the team from Breastscreen South.

The equity plan in place was producing consistent improvement in screening uptake by Māori women, Coghlan said.

Māori make up an estimated 14 percent of the population in the West Coast region.

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