Improving follow-up: How to manage no-shows in veteran care

The challenge of managing no-shows in veteran care goes far beyond missed appointments.

In VA clinics, providers often navigate complex patient needs, systemic barriers, and fluctuating engagement levels. Below, a practitioner reflects on a veteran who repeatedly misses outpatient visits but engages well during hospital stays—raising important questions about continuity of care, trust-building, and how to maintain meaningful follow-up.

If you have experience working in VA clinics, how did you manage no-shows to ensure veterans still received care? Log in or sign up to share it with our community and see the consensus.

Questions for consult 

 Consults

Key takeaways about managing no-shows in veteran care:

• Ask with empathy and curiosity
  Open, respectful conversations can uncover barriers like transportation, sleep patterns, or caregiving responsibilities—often the real reasons behind missed appointments.
  
• Tailor support to individual needs
  Solutions like later appointment times, telehealth options, or care coordination can make follow-up more accessible and realistic for veterans.
  
• Engage the broader care team
  Involving social workers, case managers, and even family members helps address logistical and emotional challenges that impact continuity of care.
  

Family Practice

"I had a similar situation in my practice a few years ago. I had an honest and respectful conversation, asking the question directly.

'You and I have good communication here at Mercy Hospital. May I ask why you have difficulty keeping follow-up appointments at the clinic?' (pursuing transportation, financial, or other hardships that hinder appointment follow-up).

My patient had transportation hindrances as well as a habit of daytime sleeping/irregular sleep schedule. It took a care coordinator to help with transportation as well as scheduling later-day appointments to help him keep follow-ups. Summary: good communication on hindrances and reassurance that we would do our best to accommodate his needs."

Nurse Practitioner

"There could be many reasons why they don't show up to appointments. It could be a transportation, mental health, or caregiver issue. It's important to ask questions about home life, other factors involved in their day-to-day lives, because it's usually not as simple as they 'no show'. Maybe they have someone else to care for, or they don't have a reliable way to get to the appointment. Maybe telehealth options would be better if available."

Internal Medicine

"I would be worried about the patient’s mental status and transportation availability. If possible, I would contact a family member to help with transportation. If not, I would reach out to social services to see if there is any transportation available."

Internal Medicine

"Maintain a stance of curiosity and partnership. Say something like,

'It’s clear that when you’re in the hospital, you really connect with your care team and get a lot done together. I noticed it’s been harder for us to link up in the clinic. Can you help me understand what makes coming in for outpatient visits tough for you? I want to make sure we’re offering support in a way that works best for you.'"

Hospitalist

"Involve social worker and case management to assist with assessing the patient’s social situation and see if there is anything we can do to help with ensuring follow ups ie, transportation, financial support, work letter, etc. Also discuss with the patient regarding the rationale for no-shows in the clinic when he is hospitalized, or be proactive in reaching out on no-show days."

Do you have a suggestion on how to manage no-shows in veteran care? Review the full case on Healthcasts and share your experience.