112,534/824,374 (14%) patients in the GP data set had school attendance and exclusions data and a smaller subset, 66,967 (8%) also had school-leaving attainment data available. Figure 1 is a flow diagram of participants included in the study.
The demographic characteristics of this sample in relation to GP missed appointment classification are described in Table 1.
After processing , the final dataset included information from 109,073 patients in total. A 3-year appointment history for each patient was uploaded to the NHS national secure safe haven (1,137,610 appointments). The mean age of included patients was 18.2 years (SD 4.44), 51,566 (47%) were male and 57,507 (53%) were female (Table 1). Seventy-five percent of the patients who had linked school attendance records were aged 15–34 years old, and measures of SIMD were evenly distributed across the school attendance sample. Thirty-eight percent of patients had 1–3 long-term health conditions, with 0.6% having four or more.
We note that only 6% of the sample who had attainment data were aged 11–15 years, likely due to small numbers leaving school before age 16. Of the attainment data sample, 55% were female and socio-economic deprivation measures were evenly distributed. We observed that 41% of these patients had 1–3 long-term health conditions and 0.8% had four or more.
School attendance, exclusions and missed appointments
After offsetting for number of GP appointments scheduled and adjusting for age, sex, SIMD and number of long-term health conditions, a single percentage of increased attendance (over the entire study period) reduces the chance of missing a GP appointment by 1% (95% CI 0.98–0.99).
Given the skewed distribution, quartiles of attendance were used to illustrate the differences over a longer period of time in an educational setting. When analysed in this way, patients with the lowest level of school attendance were 49% more likely (RR 1.49, 95% CI 1.18–1.88) to miss GP appointments compared with those in highest attendance quartile after adjusting for age, sex, SIMD, number of long-term conditions and number of GP appointments scheduled. This remained stable at RR 1.45 and 95% CI 1.40–1.50 and RR 1.47 and 95% CI 1.35–1.60 when comparing the highest attendance quartile with the third and second lowest quartiles respectively (Fig. 2).
Patients who had ever been excluded from school were also at increased risk of missing general practice appointments (RR 1.47, 95% CI 1.43–1.52) after adjusting for age, sex, SIMD and number of long-term conditions.
Educational attainment and missed appointments
Compared to achieving SCQF 6, patients achieving SCQF3 when leaving school had 44% (RR 1.44, 95% CI 1.41–1.47) increased risk of missing GP appointments after adjusting for age, sex, SIMD, number of long-term conditions and number of GP appointments scheduled.
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