Factors associated with adherence to follow-up care after burn injuries

Adult Burn Survivors and Burn Care Staff Perceptions Regarding Transitioning From the Burn Unit: A Cross-Country Qualitative Study in Ghana and China

Rehabilitative care for burn patients in developing countries is often wrought with several issues. Post-discharge support is equally challenging as there is often limited rehabilitative care as the burn survivors and their families transition. To inform practice, this study sought to explore the perspectives of adult burn survivors and burn care staff regarding transitioning from the burn unit and the development of a transitional rehabilitation programme. We employed interpretive description for this study. Semi-structured face-to-face interviews were conducted with adult burn survivors and burn care staff across two tertiary healthcare facilities in Lanzhou, Gansu Province of China, and Ghana. The thematic analytical approach was employed to analyse the data. Forty-six participants comprising 26 adult burn survivors and 20 burn care staff participated in this study. Two themes and five subthemes emerged from the data. Transitioning from the burn unit to the home was described as complex with varied biopsychosocial needs emerging. However, available support was not comprehensive to resolve these needs. Existing pre-discharge support is limited across both settings. Burn survivors expressed interest in taking on an active role in the rehabilitation process and being able to self-manage their post-burn symptoms following discharge. Transitional rehabilitative support should include an active follow-up system, ensure patient- and family-centred support, and offer a bundle of comprehensive rehabilitative services using locally available items which do not financially burden burn survivors and their families. In conclusion, transitioning from the burn unit is filled with varied health needs. Transitional rehabilitative care is required to bridge the pre-discharge and post-discharge periods.

Follow-up After Burn Injury Is Disturbingly Low and Linked With Social Factors

For medical and social reasons, it is important that burn patients attend follow-up appointments (FUAs). Our goal was to examine the factors leading to missed FUAs in burn patients. A retrospective chart review was conducted of adult patients admitted to the burn center from 2016 to 2018. Data collected included burn characteristics, social history, and zip code. Data analysis was conducted using chi-square, Wilcoxon Rank-Sum tests, and multivariate regression models. A total of 878 patients were analyzed, with 224 (25.5%) failing to attend any FUAs and 492 (56.0%) missing at least one appointment (MA). Patients who did not attend any FUAs had smaller burns (4.5 [8]% vs 6.5 [11]% median [inter quartile range]), traveled farther (70.2 [111.8] vs 52.5 [76.7] miles), and were more likely to be homeless (22.8% vs 6.9%) and have drug dependence (47.3% vs 27.2%). Patients who had at least one MA were younger (42 [26] vs 46 [28] years) and more likely to be homeless (17.5% vs 2.6%) and have drug dependence (42.5% vs 19.4%). On multivariate analysis, factors associated with never attending an FUA were distance from hospital (odds ratio [OR] 1.004), burn size (OR 0.96), and homelessness (OR 0.33). Factors associated with missing at least one FUA: age (OR 0.99), drug dependence (OR 0.46), homelessness (OR 0.22), and Emergency Department visits (OR 0.56). A high percentage of patients fail to make any appointment following their injury and/or have at least one MA. Both FUAs and MAs are influenced by social determinants of health.

Factors Associated with Pediatric Burn Clinic Follow-up after Emergency Department Discharge

Attrition between emergency department discharge and outpatient follow-up is well documented across a variety of pediatric ailments. Given the importance of outpatient medical care and the lack of related research in pediatric burn populations, we examined sociodemographic factors and burn characteristics associated with outpatient follow-up adherence among pediatric burn patients. A retrospective review of medical records was conducted on patient data extracted from a burn registry database at an urban academic children's hospital over a 2-year period (January 2018-December 2019). All patients were treated in the emergency department and discharged with instructions to follow-up in an outpatient burn clinic within one week. A total of 196 patients (Mage=5.5 years; 54% male) were included in analyses. Average percent total body surface area was 1.9 (SD=1.5%). One-third of pediatric burn patients (33%) did not attend outpatient follow-up as instructed. Older patients (OR=1.00; 95% CI: [.99-1.00], p=.045), patients with superficial burns (OR=9.37; 95% CI: [2.50-35.16], p=.001), patients with smaller percent total body surface area (OR=1.37; 95% CI: [1.07-1.76], p=.014), and patients with Medicaid insurance (OR=.22; 95% CI: [.09-.57], p=.002) or uninsured/unknown insurance (OR=.07; 95% CI: [.02-.26], p=.000) were less likely to follow up, respectively. Patient gender, race, ethnicity, and distance to clinic were not associated with follow-up. Follow-up attrition in our sample suggests a need for additional research identifying factors associated with adherence to follow-up care. Identifying factors associated with follow-up adherence is an essential step in developing targeted interventions to improve health outcomes in this at-risk population.