Absenteeism in Specialized Pediatric Appointments in the Brazilian Health System: A Retrospective Cohort Study
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Background: Absenteeism in specialized healthcare appointments constitutes a barrier to healthcare performance, generating delays in diagnosis and treatment, inefficiencies in resources allocation, and inequities in health access. This study aims to analyze the determinants of absenteeism in specialized pediatric outpatient appointments. Methods: : A retrospective cohort study was conducted using data from 35,610 medical appointments scheduled at the Instituto de Puericultura e Pediatria Martagão Gesteira (UFRJ). Appointment outcomes were classified as attendance or no-show. Independent variables included waiting time from referral to appointment, referenced clinical area, month of the appointment, weekday of the appointment, programmatic area of the referring unit, and Human Development Index (HDI) of the patient’s area of residence. Descriptive analyses, bivariate tests, and multivariate logistic regression were applied. Results: : The overall absenteeism rate was 58%. Longer waiting times significantly increased the odds of non-attendance. Psychology and Ophthalmology appointments had the highest rates, while Infectious Diseases had the lowest. Marked territorial disparities were identified, with some areas facing over three times the absenteeism risk. Socioeconomic inequalities were evident: patients from intermediate HDI quartiles presented the highest absenteeism risks. Monthly and weekly patterns were also found, with December and Tuesdays/Thursdays showing the highest absenteeism rates, and Wednesdays the lowest. Conclusion: Absenteeism is a phenomenon influenced by structural, socioeconomic, temporal, and territorial factors, with major implications for resources allocation, continuity of care, and the design of evidence-based management strategies. The results provide a foundation for predictive modeling to support more efficient scheduling policies in pediatric tertiary care.
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Abstract
Background: Absenteeism in specialized healthcare appointments constitutes a barrier to healthcare performance, generating delays in diagnosis and treatment, inefficiencies in resources allocation, and inequities in health access. This study aims to analyze the determinants of absenteeism in specialized pediatric outpatient appointments. Methods : A retrospective cohort study was conducted using data from 35,610 medical appointments scheduled at the Instituto de Puericultura e Pediatria Martagão Gesteira (UFRJ). Appointment outcomes were classified as attendance or no-show. Independent variables included waiting time from referral to appointment, referenced clinical area, month of the appointment, weekday of the appointment, programmatic area of the referring unit, and Human Development Index (HDI) of the patient’s area of residence. Descriptive analyses, bivariate tests, and multivariate logistic regression were applied. Results: The overall absenteeism rate was 58%. Longer waiting times significantly increased the odds of non-attendance. Psychology and Ophthalmology appointments had the highest rates, while Infectious Diseases had the lowest. Marked territorial disparities were identified, with some areas facing over three times the absenteeism risk. Socioeconomic inequalities were evident: patients from intermediate HDI quartiles presented the highest absenteeism risks. Monthly and weekly patterns were also found, with December and Tuesdays/Thursdays showing the highest absenteeism rates, and Wednesdays the lowest. Conclusion: Absenteeism is a phenomenon influenced by structural, socioeconomic, temporal, and territorial factors, with major implications for resources allocation, continuity of care, and the design of evidence-based management strategies. The results provide a foundation for predictive modeling to support more efficient scheduling policies in pediatric tertiary care.
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Anderson Gonçalves Panisset, Bárbara Sarni Sanches, Marcelo Gerardin Poirot Land.
Absenteeism in Specialized Pediatric Appointments in the Brazilian Health System: A Retrospective Cohort Study. Authorea. 31 October 2025.
DOI: https://doi.org/10.22541/au.176193736.66272333/v1
DOI: https://doi.org/10.22541/au.176193736.66272333/v1
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