Addressing DNKs through Transportation Assistance

When scanning through my host site’s daily patient schedule, I often notice that there is a high number of patients that do not keep their appointments (DNKs). This observation was one that I sometimes found challenging toward the beginning of my service year, as my position relies heavily upon meeting mothers during their babies’ well child appointments in order to provide interconception care. However, the high number of DNKs was also confusing to me, as I could see how much each mom prioritized their baby’s health and was genuinely making a tremendous effort to come to each appointment. 

While I previously knew that a lack of transportation could play a factor in a patient’s ability to see their physician, I did not truly understand how much of a barrier it could be. It was only through multiple conversations with different moms that I realized how challenging a visit to our Family Health Center can truly be. It often requires transferring buses, carrying their baby along with a stroller, corralling any other young children they may have, all in addition to paying for their bus tickets.

After recognizing that this was such a common challenge for patients, I began checking in with every mom I met with regarding transportation barriers and if they would be interested in any transportation assistance. Many moms immediately expressed interest, and I would be able to enroll them in Traveler’s Aid or a resident quality improvement initiative to be able to provide them with bus tickets during their visit.

While it initially felt like a simple resource to provide, I have had numerous patients tell me that knowing that they would receive free bus tickets was what allowed them to come to all of their babies’ scheduled appointments. For one particular high-risk pregnant mom, her concern about transferring her care to Maternal Fetal Medicine centered solely around not receiving bus tickets for those appointments.

So rather than penalizing or dismissing DNKs, healthcare providers can actively work to recognize and address the wide range of barriers that prevent patients from keeping their appointments. By being a part of these interventions during my service term, I have truly developed a greater understanding of how the social determinants of health not only impact patients’ ability to make it to their appointments, but ultimately all aspects of their health and wellbeing.