A realist review of the causes of, and current interventions to address 'missingness' in health care.

Background: This protocol describes a realist review exploring the problem of "missingness" in healthcare, defined as the repeated tendency not to take up offers of care that has a negative impact on the person and their life chances. More specifically, the review looks at the phenomenon of patients missing multiple appointments in primary care in the UK - at the causal factors that influence how patients come to be "missing" in this way, and what interventions might support uptake and "presence" in healthcare. Background research informing this project suggests that a high rate of missed appointments predicted high premature death rates, and patients were more likely to have multiple long-term health conditions and experience significant socioeconomic disadvantage.

Understanding the causes of missingness in primary care: a realist review.

Background: Although missed appointments in healthcare have been an area of concern for policy, practice and research, the primary focus has been on reducing single 'situational' missed appointments to the benefit of services. Little attention has been paid to the causes and consequences of more 'enduring' multiple missed appointments in primary care and the role this has in producing health inequalities.

Methods: We conducted a realist review of the literature on multiple missed appointments to identify the causes of 'missingness.