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Lindsay C, Baruffati D, Mackenzie M, Ellis DA, Major M, O'Donnell CA, Simpson SA, Williamson AE, Wong G. Understanding the causes of missingness in primary care: a realist review. BMC Med 2024; 22:235. [PMID: 38858690 PMCID: PMC11165900 DOI: 10.1186/s12916-024-03456-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/30/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Although missed appointments in healthcare have been an area of concern for policy, practice and research, the primary focus has been on reducing single 'situational' missed appointments to the benefit of services. Little attention has been paid to the causes and consequences of more 'enduring' multiple missed appointments in primary care and the role this has in producing health inequalities. METHODS We conducted a realist review of the literature on multiple missed appointments to identify the causes of 'missingness.' We searched multiple databases, carried out iterative citation-tracking on key papers on the topic of missed appointments and identified papers through searches of grey literature. We synthesised evidence from 197 papers, drawing on the theoretical frameworks of candidacy and fundamental causation. RESULTS Missingness is caused by an overlapping set of complex factors, including patients not identifying a need for an appointment or feeling it is 'for them'; appointments as sites of poor communication, power imbalance and relational threat; patients being exposed to competing demands, priorities and urgencies; issues of travel and mobility; and an absence of choice or flexibility in when, where and with whom appointments take place. CONCLUSIONS Interventions to address missingness at policy and practice levels should be theoretically informed, tailored to patients experiencing missingness and their identified needs and barriers; be cognisant of causal domains at multiple levels and address as many as practical; and be designed to increase safety for those seeking care.
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Affiliation(s)
- Calum Lindsay
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK.
| | - David Baruffati
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK
| | - Mhairi Mackenzie
- School of Social & Political Sciences, Urban Studies, University of Glasgow, 27 Bute Gardens, Glasgow, G12 8RS, UK
| | - David A Ellis
- Centre for Healthcare Innovation and Improvement Information, Decisions and Operations, Centre for Business Organisations and Society (CBOS), University of Bath, Bath, UK
| | - Michelle Major
- Homeless Network Scotland, 12 Commercial Rd, Adelphi Centre, Gorbals, Glasgow, G5 0PQ, UK
| | - Catherine A O'Donnell
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK
| | - Sharon A Simpson
- MRC/CSO Social & Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrea E Williamson
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Alturbag M. Factors and Reasons Associated With Appointment Non-attendance in Hospitals: A Narrative Review. Cureus 2024; 16:e58594. [PMID: 38765331 PMCID: PMC11102763 DOI: 10.7759/cureus.58594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Non-attendance at hospital appointments is an extremely prevalent issue impacting healthcare systems on a daily basis. This phenomenon adversely affects patient health and healthcare providers, leading to delays in diagnosis and treatment, inefficient resource utilization, and increased healthcare expenses. The detrimental impact of non-attendance is not limited to patients who miss appointments, the knock-on effects of extended waiting times and reduced appointment availability are felt throughout healthcare systems. The purpose of this narrative review is to explore the factors underlying appointment non-attendance in hospital settings, to improve healthcare delivery and patient adherence. An extensive review of the existing global literature was conducted. Quantitative studies that explored the relationship between appointment non-attendance and patient characteristics, such as age, gender, marital status, education level, distance from the hospital, and source of referral, were included. Younger patients, males, individuals with lower levels of education, and those living farther from hospitals were more likely to miss appointments. Marital status was significant, with married patients showing better attendance, as was referral source, with general practitioner referrals associated with higher non-attendance. Qualitative studies identifying both patient-centered and hospital-specific reasons, such as forgetfulness, appointment time, protracted waiting times, patient-physician relationship, and patients' knowledge and perception of their health condition, were also included in the review. Lack of appointment reminders, difficulties in managing appointments, and inadequate patient-physician communication were significant hospital-specific reasons given for non-attendance. Patients' lack of awareness regarding the importance of attending appointments and limited understanding of their health conditions were also identified as patient-centered contributors. Non-attendance at hospital appointments is a multifaceted issue influenced by a range of socioeconomic, personal, and systemic factors. Addressing these factors requires a holistic approach that includes patient education, improved communication, and tailored healthcare delivery strategies, especially for vulnerable populations in rural areas. Enhanced reminder systems and streamlined appointment management could serve as pivotal interventions to reduce non-attendance rates, ultimately improving healthcare outcomes and resource utilization.
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Affiliation(s)
- Majed Alturbag
- School of Nursing & Midwifery, University of Dublin, Trinity College, Dublin, IRL
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Adkins D, Rojas-Ramirez MV, Shanker A, Burruss CP, Mirsky B, Westgate P, Shinn JB, Bush ML. Factors Associated with No-Show Rates in a Pediatric Audiology Clinic. Otol Neurotol 2023; 44:e648-e652. [PMID: 37590879 PMCID: PMC10529984 DOI: 10.1097/mao.0000000000003997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To evaluate factors associated with no-show rates in a pediatric audiology clinic. STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PARTICIPANTS All pediatric patients younger than 18 years whose parents/guardians scheduled an appointment at a tertiary Audiology Clinic between June 1, 2015, and July 1, 2017. MAIN OUTCOME MEASURES Data included whether the patient came to their appointment, patient age, sex, race, insurance type, appointment type, location, season of appointment, and day of the week of the appointment. RESULTS Of the 7,784 pediatric appointments scheduled with audiology, the overall no-show rate was 24.3% (n = 1893). Lower age was significantly associated with no-shows ( p = 0.0003). Black/African American children were more likely to no-show compared with White/Caucasians ( p = 0.0001). Compared with self-pay/military/other insurance, those with Medicaid were more likely to no-show ( p = 0.0001). The highest rate of no-shows occurred during summer (27%). On multivariate analysis, younger age, Black/African American race, and Medicaid insurance were associated with increased no-show rates. CONCLUSION A variety of factors influence no-show rates in a pediatric audiology setting. No-shows can affect treatment quality and affect overall hearing outcomes. Further investigation is necessary to assess barriers to appointment adherence and to develop interventions to improve adherence and care.
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Affiliation(s)
- David Adkins
- University of Kentucky, Department of Otolaryngology – Head & Neck Surgery, Lexington, KY, USA
| | | | - Anita Shanker
- University of Kentucky, College of Medicine, Lexington KY, USA
| | | | - Becky Mirsky
- University of Kentucky, College of Medicine, Lexington KY, USA
| | - Philip Westgate
- University of Kentucky, University of Kentucky, College of Public Health, Department of Biostatistics, Lexington, KY, USA
| | - Jennifer B Shinn
- University of Kentucky, Department of Otolaryngology – Head & Neck Surgery, Lexington, KY, USA
| | - Matthew L. Bush
- University of Kentucky, Department of Otolaryngology – Head & Neck Surgery, Lexington, KY, USA
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4
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Forchuk C, Serrato J, Scott L, Rudnick A, Dickey C, Silverman M. "No Good Choice": What are the Issues of Having no Harm Reduction Strategies in Hospitals? Subst Abuse 2023; 17:11782218231186065. [PMID: 37476501 PMCID: PMC10354823 DOI: 10.1177/11782218231186065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023]
Abstract
Background Despite an increase in methamphetamine use and subsequent hospitalizations, the majority of Canadian hospitals currently lack harm reduction strategies for substance use. This can mean that people with lived experience of methamphetamine use are faced with a number of difficult decisions to make when admitted to hospital. Caring for people with lived experience of methamphetamine use can also be problematic with zero tolerance policies requiring abstinence to be maintained. This analysis set out to understand potential health care issues due to a lack of harm reduction strategies from the prospective of people with lived experience of methamphetamine use as well as health care/service professionals. Methods Based on a larger study, this secondary analysis explored issues discussed by people with lived experience of methamphetamine use and health care/service professionals regarding the challenges of providing harm reduction approaches in the hospital setting. A total of 108 individuals with lived experience of methamphetamine use completed a qualitative component of a mixed-method interview. In addition, 31 health care/service professionals participated in virtual focus groups and one-to-one interviews. Responses were analyzed using an ethnographic thematic approach. Results People with lived experience of methamphetamine use reported 3 choices upon admission: leave or avoid the hospital, stay but experience unsupported withdrawal, or stay but hide their substance usage from health care professionals. Health care/service professionals described 2 options: uphold zero tolerance that can lead to stigma and a lack of knowledge regarding addiction, or accept harm reduction but be unable to implement such strategies. This could lead to health being compromised due to policy and practice that requires abstinence. Neither group of participants described a good choice for them. Conclusion Current policy and education related to substance use needs to be revised.
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Affiliation(s)
- Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | | | - Leanne Scott
- Lawson Health Research Institute, London, ON, Canada
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Wilson R, Winnard Y. Causes, impacts and possible mitigation of non-attendance of appointments within the National Health Service: a literature review. J Health Organ Manag 2022; ahead-of-print. [PMID: 35918282 DOI: 10.1108/jhom-11-2021-0425] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Missed appointments within the National Health Service (NHS) are a drain on resources, associated with not only considerable time and cost implications, but also sub-optimal health outcomes. This literature review aims to explore non-attendance within the NHS in relation to causes, impacts and possible mitigation of negative effects of missed appointments. DESIGN/METHODOLOGY/APPROACH MEDLINE, CINAHL Plus and PubMed were searched with a date range of 2016-2021. Databases were searched for peer-reviewed articles published in English addressing non-attendance of adults within the NHS. Studies were excluded if they were theoretical papers, dissertations or research concerning patients aged under 18. A total of 21 articles met the inclusion criteria and were selected for analysis. FINDINGS The results indicate a significant association of non-attendance and poor health outcomes. Patients from a lower socioeconomic status, adults aged over 85 and those with multiple co-morbidities are more likely to miss appointments. The most commonly reported patient-centred reasons for failing to attend were forgetfulness, transportation difficulties, and family commitments. Practice-specific reasons were cited as inefficiencies of the appointment booking system, failure of traditional reminders and inconvenient timings. Interventions included text reminder services, the inclusion of costs within reminders and enhanced patient involvement with the booking process. ORIGINALITY/VALUE Non-attendance is complex, and to secure maximum attendance, targeted interventions are required by healthcare facilities to ensure patient needs are met. The adaption of scheduling systems and healthcare services can assist in reducing DNA rates.
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Affiliation(s)
| | - Yvette Winnard
- School of Allied Health, Anglia Ruskin University, Cambridge, UK
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6
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Asynchronous electronic consultation between primary care and specialized care proved effective for continuum of care for viraemic hepatitis C patients. GASTROENTEROLOGÍA Y HEPATOLOGÍA 2022; 46:266-273. [PMID: 35964811 DOI: 10.1016/j.gastrohep.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION It has been proposed that primary care diagnose and treat hepatitis C virus (HCV) infection. However, a care circuit between primary and specialized care based on electronic consultation (EC) can be just as efficient in the micro-elimination of HCV. It is proposed to study characteristics and predictive factors of continuity of care in a circuit between primary and specialized care. METHODS From February/2018 to December/2019, all EC between primary and specialized care were evaluated and those due to HCV were identified. Variables for regression analysis and to identify predictors of completing the care cascade were recorded. RESULTS From 8098 EC, 138 were performed by 89 (29%) general practitioners over 118 patients (median 50.8 years; 74.6% men) and were related to HCV (1.9%). Ninety-two patients (78%) were diagnosed>6 months ago, and 26.3% met criteria for late presentation. Overall, 105 patients required assessment by the hepatologist, 82% (n=86) presented for the appointment, of which 67.6% (n=71) were viraemic, 98.6% of known. Finally, 61.9% (n=65) started treatment. Late-presenting status was identified as an independent predictor to complete the care cascade (OR 1.93, CI 1.71-1.99, p<0.001). CONCLUSION Communication pathway between Primary and Specialized Care based on EC is effective in avoiding significant losses of viraemic patients. However, the referral rate is very low, high in late-stage diagnoses, heterogeneous, and low in new diagnoses. Therefore, early detection strategies for HCV infection in primary care are urgently needed.
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Busschots D, Kremer C, Bielen R, Koc ÖM, Heyens L, Dercon E, Verrando R, Windelinckx T, Maertens G, Bourgeois S, Hens N, Matheï C, Robaeys G. Identification and treatment of viral hepatitis C in persons who use drugs: a prospective, multicenter outreach study in Flanders, Belgium. Harm Reduct J 2021; 18:54. [PMID: 34001145 PMCID: PMC8130277 DOI: 10.1186/s12954-021-00502-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/09/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Targeted screening for hepatitis C viral (HCV) infection is not yet widely executed in Belgium. When performed in people who use drugs (PWUD), it is mainly focused on those receiving opiate agonist therapy (OAT). We wanted to reach out to a population of difficult to reach PWUD not on centralized OAT, using non-invasive screening as a bridge to re-integration in medical care supported by facilitated referral to a specialist. METHODS This was a prospective, multicenter cohort study in PWUD not enrolled in a centralized OAT program in a community-based facility in Limburg or OAT program in a community-based facility in Antwerp, Belgium, from October 2018 until October 2019. Two study teams recruited participants using an outreach method at 18 different locations. Participants were tested for HCV antibodies (Ab) by finger prick, and risk factors were assessed through a face-to-face questionnaire. Univariate analyses were used to assess the association between HCV Ab and each risk factor separately. A generalized linear mixed model was used to investigate the association between the different risk factors and HCV. RESULTS In total, 425 PWUD were reached with a mean age of 41.6 ± 10.8, and 78.8% (335/425) were men. HCV Ab prevalence was 14.8% (63/425). Fifty-six (88.9%) PWUD were referred, of whom 37 (66.1%) were linked to care and tested for HCV RNA. Twenty-nine (78.4%) had a chronic HCV infection. Treatment was initiated in 17 (58.6%) patients. The adjusted odds for HCV Ab were highest in those with unstable housing 6 months before inclusion (p < .001, AOR 8.2 CI 95% 3.2-23.3) and in those who had ever shared paraphernalia for intravenous drug use (p < .001, AOR 6.2 CI 95% 2.5-16.0). CONCLUSIONS An important part tested positive for HCV. Treatment could be started in more than half of the chronically infected referred and tested positive for HCV-RNA. Micro-elimination is necessary to achieve the World Health Organization goals by 2030. However, it remains crucial to screen and link a broader group of PWUD to care than to focus solely on those who inject drugs. TRIAL REGISTRATION clinicaltrials.gov NCT04363411, Registered 27 April 2020-Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04363411?term=NCT04363411&draw=2&rank=1.
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Affiliation(s)
- Dana Busschots
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium. .,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.
| | - Cécile Kremer
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-Biostat), Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | - Rob Bielen
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Özgür Muhammet Koc
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,School of NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Leen Heyens
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,School of NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Tessa Windelinckx
- Free Clinic Ngo, Antwerp, Belgium.,Harm Reduction, Coordinator GIG - Health promotion in Injecting Drug use Flanders, Flanders, Belgium
| | | | | | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-Biostat), Data Science Institute, Hasselt University, Diepenbeek, Belgium.,Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Catharina Matheï
- Free Clinic Ngo, Antwerp, Belgium.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Geert Robaeys
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
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8
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Briggs MS, Ulses C, VanEtten L, Mansfield C, Ganim A, Hand BN, Quatman-Yates CC. Predictive Factors for Patients' Failure to Show for Initial Outpatient Physical Therapist Evaluation. Phys Ther 2021; 101:6124132. [PMID: 33528021 DOI: 10.1093/ptj/pzab047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/19/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study was to examine primary factors that may predict patients' failure to show at initial physical therapist evaluation in an orthopedic and sports outpatient setting. METHODS A retrospective analysis of patients' demographic data for physical therapist evaluations between January 2013 and April 2015 was performed. A binary logistic regression model was used to evaluate the odds of a no-show at evaluation. Demographic variables of age, employment status, days waited for the appointment, payer source, and distance traveled to the clinic were analyzed. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0. RESULTS A total of 6971 patients were included in the final analysis, with 10% (n = 698) of the scheduled patients having a no-show event for their initial evaluation. The following factors increased the odds of patients having a no-show event: days to appointment (OR = 1.058; 95% CI = 1.042-1.074), unemployment status (OR = 1.96; 95% CI = 1.41-2.73), unknown employment status (OR = 3.22; 95% CI = 1.12-8.69), Medicaid insurance (OR = 4.87; 95% CI = 3.43-6.93), Medicare insurance (OR = 2.22; 95% CI = 1.10-4.49), unknown payer source (OR = 262.84; 95% CI = 188.72-366.08), and distance traveled 8 or more kilometers (OR = 1.31; 95% CI = 1.01-1.70). Female sex (OR = 0.73; 95% CI = 0.57-0.95) and age 40 years or older (OR = 0.44; 95% CI = 0.33-0.60) decreased the odds of a no-show event. CONCLUSIONS Results from this study indicate there may be some demographic factors that are predictive of patients failing to attend their first physical therapist visit. IMPACT Understanding the predictive factors and identifying potential opportunities for improvements in scheduling processes might help decrease the number of patients failing to show for their initial physical therapy appointment, with the ultimate goal of positively influencing patient outcomes.
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Affiliation(s)
- Matthew S Briggs
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christine Ulses
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lucas VanEtten
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cody Mansfield
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Anthony Ganim
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brittany N Hand
- School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Catherine C Quatman-Yates
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Sherbuk JE, Tabackman A, McManus KA, Kemp Knick T, Schexnayder J, Flickinger TE, Dillingham R. A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban US South. Harm Reduct J 2020; 17:64. [PMID: 32948189 PMCID: PMC7501689 DOI: 10.1186/s12954-020-00409-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Most people diagnosed with hepatitis C virus (HCV) have not linked to care, despite the availability of safe and effective treatment. We aimed to understand why people diagnosed with HCV have not pursued care in the non-urban Southern United States. METHODS We conducted a survey and semi-structured interview with participants referred to an HCV clinic who did not attend an appointment between 2014 and 2018. Our clinic is located in a non-urban region of Virginia at a university hospital. Qualitative data collection was guided by the Health Belief Model (HBM). Data was analyzed using qualitative content analysis to identify key factors influencing patient perceptions regarding HCV and pursuit of care. RESULTS Over half of previously referred patients (N = 200) could not be reached by phone. Eleven participants enrolled, including 7 men and 4 women. Based on survey responses, unreliable transportation, unstable housing, substance use, and lack of insurance were common. Participants demonstrated good knowledge of HCV disease, complications, and treatment. On qualitative analysis of semi-structured interviews, final themes emerged from within and between HBM constructs. Emerging themes influencing patient perceptions included (1) structural barriers, (2) stigma, (3) prior experiences of HCV disease and treatment, (4) discordance between the recognized severity of HCV and expected impacts on one's own health, and (5) patient-provider relationship. Substance use was not identified to be a barrier to care. CONCLUSIONS Participants perceived individual and structural barriers to linking to care. A strong HCV knowledge base was not sufficient to motivate pursuit of care. Efforts to improve linkage to care must address barriers at multiple levels, and system-level changes are needed. As the majority of previously referred patients could not be contacted by phone, current approaches to patient engagement are not effective for reaching these populations. Expansion of HCV care to primary care settings with an established patient-provider relationship or co-located treatment within substance use treatment programs may serve to increase access to HCV treatment.
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Affiliation(s)
- Jacqueline E Sherbuk
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Alexa Tabackman
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kathleen A McManus
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Terry Kemp Knick
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Julie Schexnayder
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Tabor E Flickinger
- Division of General, Geriatric, Palliative, and Hospital Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA
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Wolstenholme D. Innovating access to the nurse-led hepatitis C clinic using co-production. J Res Nurs 2020; 25:211-224. [PMID: 34394628 PMCID: PMC7932491 DOI: 10.1177/1744987120914353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many reasons for missed appointments are given by people who inject drugs and it is suggested that one solution cannot solve this complex issue (Poll et al., 2017). Increasingly, nurses and other health professionals are expected to actively involve patients and service users in developing innovative, effective and accessible services. This project used co-production as the approach to address this challenge. AIMS This paper describes how a co-production method was used to develop accessible nurse-led hepatitis C virus services for people who inject drugs. METHODS Using research evidence from a study conducted by the lead author as a starting point, a series of co-production workshops were run using creative co-design methods to identify the barriers to engagement with clinics. Potential solutions were then co-produced. RESULTS The solutions included myth-busting posters, peer-support, a mobile clinic van and the offer of incentives and enablers (travel costs or a reward for attendance). CONCLUSIONS The service-development project illustrates how, with the right methods, it is possible to successfully engage with hard-to-access groups to co-produce innovative solutions for an important clinical challenge.
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Affiliation(s)
- Daniel Wolstenholme
- Director, Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, United Kingdom
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11
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12
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Caldwell H. Preventing, identifying and treating hepatitis C. Nurs Stand 2019; 34:e11321. [PMID: 31468895 DOI: 10.7748/ns.2018.e11321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 06/10/2023]
Abstract
Hepatitis C is a blood-borne virus that, if left untreated, can result in significant liver damage and cancer. Most individuals are unaware that they have been infected with the hepatitis C virus and remain asymptomatic, which makes early diagnosis challenging. While the virus will spontaneously clear in some individuals, the majority will develop chronic hepatitis C. This article provides nurses with an overview of hepatitis C and how it is transmitted. It details the available treatments, and examines the challenges involved in early identification and access to treatment, as well as outlining the barriers to treatment and how these can be overcome. This article also discusses the role of the nurse in the management of people with hepatitis C and in addressing their complex needs.
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Affiliation(s)
- Helen Caldwell
- Nurse consultant in hepatology, Royal Liverpool University Hospital NHS Trust, Liverpool, England
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