Missed Appointments: Transport and Attendance Support

Every podiatry practice has its DNA list, and most of them know what it is, the most important thing is the patients who use it the least.

This caseload of high-risk feet is a group with the most difficult transportation, older, no longer driving, mobility limited, cognitively burdened, and the missed review isn't an administrative nuisance. It is a broken surveillance interval on a foot, which degrades silently, and the recall system of the practice can't fix what is essentially a logistical problem at the patient level. If the patient has a support arrangement, the logistics problem has an owner: transport and accompaniment is core work of the support arrangement, and constructing an attendance of podiatry into a support arrangement is one of the highest return lowest effort referral conversations in this campaign.

Attendance as a support task, specified

It is short and it is worth stating; attendance support that is not done in a precise manner results in late arrivals and confusion in the waiting room. The worker's role: the appointment in their calendar as a standing appointment, the reminder the day before, the preparation that the patient's mobility demands, transport to and from the appointment, the accompaniment to where the patient wants to go, and, importantly for the podiatrist, the two-way information exchange, the ability to report what happened during the fortnight, as described in the first article of this campaign, and carry out the new routine at home. For patients with cognitive load, the accompaniment does one quieter task: the instructions are delivered twice, with the patient and with the person who will prompt them for the next day.

The referral conversation

That's a sentence the podiatrist moves on at the moment of pattern recognition: this patient's misses are a transport issue; if they do have support, attendance goes into that arrangement, if they don't, a small arrangement, even at fortnightly intervals, can be arranged directly and the practice can point the family at the mechanism, platforms such as Support Network, which search for transport-capable workers by suburb and availability. The hours typically apply to plan-funded patients and the interim and private doors to older patients, as described in the library map. Practice-level habit that operationalises it: the DNA list reviewed monthly with one question per name, is this a clinical disengagement or a failed logistics, and the failed-logistics names receive the sentence at the next contact.

How this plays out in practice

Imagine a woman in her late 80s, with high risk feet, four missed appointments to be booked during the year, with each booked at a later date, each gap leaving her feet unsurveilled, which they cannot afford. The care instructions are currently being provided by the worker, who will also be there for transport six times a week, and her new version includes the addition of the podiatrist. Once attendance reaches full, the worker arrives with her fortnightly reports and the rhythm of the file shifts from crisis/rebook to routine surveillance, the entirety of her clinical goal with this foot type. This practice contributed one sentence and a suburb search.

Next steps

Perform the monthly DNA review with one question, and be prepared with the sentence for the failed-logistics names. The mechanism is a pointer, not a project.