Demographic and Clinical Factors Are Associated With Frequent Short-Notice Cancellations in Veterans With Multiple Sclerosis on Disease Modifying Therapies

Objectives: (1) To identify the rate of short-notice canceled appointments in a large national sample of persons with multiple sclerosis (MS) and (2) examine the demographic and clinical factors associated with frequent cancellations. Design: Retrospective cross-sectional cohort using electronic health records. Setting: Veterans Health Administration. Participants: Veterans with MS (N=3742) who were part of the Veterans Health Administraiton's MS Center of Excellence Data Repository and (1) had at least one outpatient appointment at the VA in 2013, (2) were alive in 2015, and (3) were prescribed a disease modifying therapy (DMT). Interventions: Not applicable. Main Outcome Measures: Frequent short-notice cancellations, defined as > 20% of scheduled appointments canceled with less than 24-hour notification over a 24-month period. This threshold was based on the definition of <= 80% for suboptimal treatment adherence. Several demographics and clinical variables were examined as potential explanatory factors. Results: Approximately 75% (n=2827) had at least 1 short-notice cancellation, with more than 3% (n=117) categorized as frequent cancelers. The odds of frequent cancellations were greater in women (odds ratio [OR], 1.81; P=.004) and among 18- to 44-year-olds (OR, 2.77; P=.004) and 45- to 64-year-olds (OR, 2.49; P=.003) compared to those over 65. The odds were lower among persons who lived < 25 miles away (OR, 0.58; P=.043) compared with persons who lived >= 75 miles away and those who had at least 1 emergency department visit (OR, 0.55; P=.012). Conclusions: Short-notice cancellations are common in persons with MS, although few have more than 20%. These findings highlight who is at greater risk for frequent cancellation and disruptions in their care. Although additional research is needed, the results provide insights into how clinics may approach handling frequent short-notice cancellations among persons with MS. Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine.