1
|
Presume M, Almazor CP, Altmann M. Implementation of a patient reminder system in Haiti in a socio-political crisis context: evaluation of outcomes. BMC Health Serv Res 2024; 24:958. [PMID: 39164639 PMCID: PMC11337644 DOI: 10.1186/s12913-024-11395-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/02/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND In Haiti, patient's adherence to treatment and compliance with medical appointments are very challenging due to different local factors. We aimed to assess the effectiveness of a reminder system implemented in health facilities in Haiti in a context of socio-political crisis. METHODS We used appointment data from patients aged 15 years and older between January 2021 and November 2023 from four healthcare centers in the Port-au-Prince metropolitan area. We performed descriptive analysis, crossing covariates with appointment attendance. We performed Pearson's Chi-squared test, and multivariate regression analysis using a mixed-effect logistic regression model in order to explore the association between sending reminders and appointment attendance, with and without adjustment for other patient-level covariates. RESULTS A total of 14 108 appointments were registered on the reminder systems, with 2 479 (17.6%) attendances. Among those to whom reminders were sent, the number of attendances was 167 (17.4%) for email recipients only, 199 (36.7%) for SMS recipients only, and 19 (42.2%) for both SMS and email recipients - versus 2 094 (16.7%) for non-reminders. After adjusting on all other covariates, we found that patients to whom a reminder was sent via email (aOR: 1.45; CI: 1.08, 1.94), SMS (aOR: 2.95; CI: 2.41, 3.60), and both SMS and email (aOR: 2.86, CI: 1.37, 5.96) were more likely to show up on their appointment day compared to those who did not receive any reminder. Other socio-demographic factors such as being 50 years and older (aOR: 1.31; CI: 1.10, 1.56) compared to under 30 years, living as couple (aOR: 1.23; CI: 1.10, 1.37), and not having children (aOR: 1.21; CI: 1.07, 1.37) were significantly associated with appointment attendance. CONCLUSIONS Our study suggests that patient reminder systems may be used to reduce non-attendance in Haiti, even in a context of socio-political crisis.
Collapse
Affiliation(s)
- Marcmy Presume
- Association de Technologistes Médicaux Licenciés d'Haiti (ATMLH), Port-au-Prince, Haiti.
| | | | - Mathias Altmann
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| |
Collapse
|
2
|
Profit DD. Describing and Predicting Preprocedural Anxiety in Patients Scheduled for Advanced Gastrointestinal Endoscopy During the COVID-19 Pandemic. Gastroenterol Nurs 2023; 46:475-488. [PMID: 37639614 DOI: 10.1097/sga.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/26/2023] [Indexed: 08/31/2023] Open
Abstract
Advanced gastrointestinal endoscopy includes a group of specialized procedures and interventions that are being performed more frequently, with little attention given to a patient's preprocedural anxiety issues. Compounding this concern, in 2020 the COVID-19 pandemic resulted in the delay of many endoscopy cases. It is unknown how this affected the anxiety of patients preparing for advanced endoscopy procedures. Patients with higher anxiety require higher doses of anesthetic medications, and experience increased pain and decreased satisfaction. The purpose of this study was to describe the biological, psychological, and social attributes of patients and identify whether social support, COVID-19-related anxiety, delay of procedure, patient's physical status, and procedural indication category were predictors of state anxiety levels in patients undergoing advanced gastrointestinal endoscopy during the COVID-19 pandemic. The research study was a cross-sectional descriptive design with 90 patients. Patients were classified into low state and high state anxiety groups. Fifty-eight percent of patients had high state anxiety scores. Using logistic regression, social support was identified as a predictor of preprocedural anxiety (odds ratio [OR] = 0.318 [95% confidence interval, CI = 0.170, 0.597, p < .001]) as less social support was associated with higher anxiety. It is imperative that strategies to maximize social support are reinforced.
Collapse
Affiliation(s)
- Dawn Donahue Profit
- Dawn Donahue Profit, PhD, RN, is Staff Development Specialist, Nursing Staff Development, UK HealthCare, Lexington, Kentucky
| |
Collapse
|
3
|
Wang CW, Mclean I R, Cheng YW, Kim S, Terdiman J, Kathpalia P, Beck KR. Racial Disparities in Endoscopy Cancellations During the COVID-19 Pandemic. Dig Dis Sci 2023; 68:729-735. [PMID: 35732970 PMCID: PMC9216287 DOI: 10.1007/s10620-022-07575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/20/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION The coronavirus disease 19 (COVID-19) pandemic has disrupted healthcare delivery including elective endoscopy. We aimed to determine the prevalence of endoscopy cancellations in the COVID-19 era and identify patient characteristics associated with cancellation due to the pandemic. METHODS Medical charts were reviewed for adults who cancelled an outpatient endoscopic procedure from 5/2020 to 8/2020. The association of patient characteristics with cancellation of endoscopy due to COVID-19 was assessed using logistic regression. RESULTS There were 652 endoscopy cancelations with 211 (32%) due to COVID-19, 384 (59%) due to non-COVID reasons, and 57 (9%) undetermined. Among COVID-19 related cancellations, 75 (36%) were COVID-19 testing logistics related, 121 (57%) were COVID-19 fear related, and 15 (7%) were other. On adjusted analysis, the odds of cancellation due to COVID-19 was significantly higher for black patients (OR 2.04, 95% CI 1.07-3.88, p = 0.03), while patients undergoing EGD (OR 0.56, 95% CI 0.31-0.99, p = 0.05) or advanced endoscopy (OR 0.18, 95% CI 0.07-0.49, p = 0.001) had lower odds of cancellation. The odds of cancelling due to COVID-19 testing logistics was significantly higher among black patients (OR 3.12, 95% CI 1.03-9.46, p = 0.05) and patients with Medi-Cal insurance (OR 2.89, 95% CI 1.21-6.89, p = 0.02). CONCLUSION Black race is associated with an increased risk of COVID-19 related cancellation. Specifically, black patients and those with Medi-Cal are at increased risk of cancellation related to logistics of obtaining pre-endoscopy COVID-19 testing. Racial and socioeconomic disparities in access to endoscopy may be further amplified by the COVID-19 pandemic and warrant further study.
Collapse
Affiliation(s)
- Connie W. Wang
- grid.266102.10000 0001 2297 6811Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143 USA
| | - Richard Mclean I
- grid.266102.10000 0001 2297 6811Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143 USA
| | - Yao-Wen Cheng
- grid.266102.10000 0001 2297 6811Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143 USA
| | - Stephanie Kim
- grid.266102.10000 0001 2297 6811University of California San Francisco School of Medicine, San Francisco, CA USA
| | - Jonathan Terdiman
- grid.266102.10000 0001 2297 6811Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143 USA
| | - Priya Kathpalia
- grid.266102.10000 0001 2297 6811Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143 USA
| | - Kendall R. Beck
- grid.266102.10000 0001 2297 6811Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143 USA
| |
Collapse
|
4
|
Broder E, Davies A, Alrubaiy L. Using Information Videos to Improve Patient Satisfaction in Endoscopy: A Prospective Service Improvement Project. Cureus 2022; 14:e24108. [PMID: 35518531 PMCID: PMC9065946 DOI: 10.7759/cureus.24108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Endoscopy is a rapidly developing discipline with new techniques and procedures being introduced each year. The consenting process is central to patient perception; using information videos as additional tools to aid consent and improve the quality of care in endoscopy is not well established. Our aim was to develop, implement and validate the use of patient educational videos to improve patients’ satisfaction and experience in endoscopy. Methods and analysis: This was a prospective service quality improvement study. Eligible patients were invited to watch the educational videos in addition to standard practice. We compared this group with a matched cohort of patients who were receiving standard care of postal information leaflets. Patient satisfaction was measured through the validated Gastrointestinal Endoscopy Satisfaction Questionnaire (GESQ). Results: Patients in the intervention group scored four questions relating to pre-procedural information significantly higher than the control (p=0.038). The total mean GESQ score was also higher in the intervention group compared to the control, however this was not statistically significant (p=0.397). The intervention group had significantly lower cancellation rate (4%) compared to the control group (20%), p=0.023. Conclusions: Patients who watched educational videos were more satisfied with pre-procedural information in the consenting period than those who did not. Further research is still needed to determine if they reduce patient anxiety. Meanwhile, it would be appropriate to implement these videos into routine practice as a cost-effective method of improving patient satisfaction.
Collapse
|
5
|
Szymański M, Marek I, Wilczyński M, Janczy A, Bigda J, Kaska Ł, Proczko-Stepaniak M. Evaluation of esophageal pathology in a group of patients 2 years after one-anastomosis gastric bypass (OAGB) — Cohort study. Obes Res Clin Pract 2021; 16:82-86. [DOI: 10.1016/j.orcp.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/21/2021] [Accepted: 12/12/2021] [Indexed: 12/11/2022]
|
6
|
She R, Luo S, Lau MM, Lau JTF. The mechanisms between illness representations of COVID-19 and behavioral intention to visit hospitals for scheduled medical consultations in a Chinese general population. J Health Psychol 2021; 27:1846-1860. [PMID: 33878946 DOI: 10.1177/13591053211008217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Testing the Common-Sense Model, this random telephone survey examined the associations between illness representations of COVID-19 and behavioral intention to visit hospitals for scheduled medical consultations (BI-VHSMC), and the mediations via coping and fear of nosocomial infection among 300 Chinese adults. The prevalence of BI-VHSMC was 62.3%. Mediation analysis found that maladaptive coping (rumination and catastrophizing) and fear of nosocomial infection mediated the associations between various dimensions of illness representations of COVID-19 (e.g. consequence and controllability) and BI-VHSMC, both indirectly and serially. Illness representations, coping, and fear should be considered when planning related health promotion during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Rui She
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Sitong Luo
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Mason Mc Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Joseph Tak Fai Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
7
|
Lam TYT, Hui AJ, Sia F, Wong MY, Lee CCP, Chung KW, Lau JYW, Wu PI, Sung JJY. Short Message Service reminders reduce outpatient colonoscopy nonattendance rate: A randomized controlled study. J Gastroenterol Hepatol 2021; 36:1044-1050. [PMID: 32803820 DOI: 10.1111/jgh.15218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/22/2020] [Accepted: 08/11/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM Nonattendance of outpatient colonoscopy leads to inefficient use of health-care resources. We aimed to study the effectiveness of using Short Message Service (SMS) reminder prior in patients scheduled for outpatient colonoscopy on their nonattendance rate. METHODS Patients who scheduled for an outpatient colonoscopy and had access of SMS were recruited from three clinics in Hong Kong. Patients were randomized to SMS group and standard care (SC) group. All patients were given a written appointment slip on the booking date. In addition, patients in the SMS group received an SMS reminder 7-10 days before their colonoscopy appointment. Patients' demographics, attendance, colonoscopy completion, and bowel preparation quality were recorded. Logistic regression was performed to identify predictors of nonattendance. RESULTS From November 2013 to October 2019, a total of 2225 eligible patients were recruited. A total of 1079 patients were allocated to the SMS group and 1146 to the SC group. The nonattendance rate of patients in the SMS group was significantly lower than that in the SC group (8.9% vs 11.9%, P = 0.022). There were no significant differences in their baseline characteristics and colonoscopy completion rate and bowel preparation quality. A trend towards a higher rate of adequate bowel preparation was observed in the SMS group when compared with the SC group (69.9% vs 65.8%, P = 0.053). Independent predictors for nonattendance included younger age, underprivilege, and existing diabetes. CONCLUSIONS An SMS reminder for outpatient colonoscopy is effective in reducing the nonattendance rate and may potentially improve the bowel preparation quality.
Collapse
Affiliation(s)
- Thomas Y T Lam
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Aric J Hui
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Felix Sia
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Mei Y Wong
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | | | - Ka W Chung
- Wong Siu Ching Family Medicine Centre, Hong Kong
| | - James Y W Lau
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | - Peter I Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.,Department of Gastroenterology and Hepatology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
8
|
Zhao L, Zhang X, Chen Y, Wang Y, Zhang W, Lu W. Does self-reported symptom questionnaire play a role in nonadherence to colonoscopy for risk-increased population in the Tianjin colorectal cancer screening programme? BMC Gastroenterol 2021; 21:117. [PMID: 33750307 PMCID: PMC7944887 DOI: 10.1186/s12876-021-01701-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/28/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A colorectal cancer screening programme (CCSP) was implemented from 2012 to 2017 in Tianjin, China. Residents with a positive faecal immunochemical test (FIT) or positive self-reported symptom questionnaire (SRSQ) were recommended to undergo colonoscopy. The objective was to investigate the potential factors associated with nonadherence to colonoscopy among a risk-increased population. METHODS Data were obtained from the CCSP database, and 199,522 residents with positive FIT or positive SRSQ during two screening rounds (2012-2017) were included in the analysis. Logistic regression analysis was performed to assess the association between nonadherence to colonoscopy and potential predictors. RESULTS A total of 152,870 (76.6%) individuals did not undergo colonoscopy after positive FIT or positive SRSQ. Residents with positive SRSQ but without positive FIT were more likely not to undergo colonoscopy (negative FIT: OR, 2.35; 95% CI, 2.29-2.41, no FIT: OR, 1.27; 95% CI, 1.24-1.31). Patients without a cancer history were less likely to undergo colonoscopy even if they received risk-increased reports based on the SRSQ. CONCLUSION In the CCSP, seventy-seven percent of the risk-increased population did not undergo colonoscopy. FIT should be recommended since positive FIT results are related to improved adherence to colonoscopy. Residents with negative FIT but positive SRSQ should be informed of the potential cancer risk to ensure adherence to colonoscopy.
Collapse
Affiliation(s)
- Lizhong Zhao
- Department of Gastroenterology, Tianjin Union Medical Center, Tianjin, China
| | - Xiaorui Zhang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Yongjie Chen
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Weihua Zhang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.
| |
Collapse
|
9
|
Seoane A, Font X, Pérez JC, Pérez R, Enriquez CF, Parrilla M, Riu F, Dedeu JM, Barranco LE, Duran X, Ibáñez IA, Álvarez MA. Evaluation of an educational telephone intervention strategy to improve non-screening colonoscopy attendance: A randomized controlled trial. World J Gastroenterol 2020; 26:7568-7583. [PMID: 33384555 PMCID: PMC7754547 DOI: 10.3748/wjg.v26.i47.7568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/16/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes. Within these programmes, educative interventions with bidirectional contact carried out by trained personnel have been proved to be an important tool for colonoscopy attendance improvement, and because of its huge clinical and economic impact, they have been widely implemented. However, outside of this population programmes, educative measures to improve colonoscopy attendance have been poorly studied and no navigation interventions are usually performed.
AIM To investigate the clinical and economic impacts of an educational telephone intervention on colonoscopy attendance outside colorectal cancer screening programmes.
METHODS This randomized controlled trial included consecutive patients referred to colonoscopy from primary care centres from November 2017 to May 2018. The intervention group (IG) received a telephone intervention, while the control group (CG) did not. Patients assigned to the IG received an educational telephone call 7 d before the colonoscopy appointment. The intervention was carried out by two nurses with deep endoscopic knowledge who were previously trained for a telephone educational intervention for colonoscopy. The impact on patient compliance with preparedness protocols related to bowel cleansing, anti-thrombotic management, and sedation scheduling was also evaluated. A second call was conducted to assess patient satisfaction. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed.
RESULTS A total of 738 and 746 patients were finally included in the IG and CG respectively. Six hundred thirteen (83%) patients were contacted in the IG. The non-attendance rate was lower in the IG, both in the ITT analysis (IG 8.4% vs CG 14.3%, P < 0.001) and in the PP analysis (4.4% vs 14.3%, P < 0.001). In a multivariable analysis, belonging to the control group increased the risk of non-attendance in both, the ITT analysis (OR 1.81, 95%CI: 1.27 to 2.58, P = 0.001) and the PP analysis (OR 3.56, 95%CI: 2.25 to 5.64, P < 0.001). There was also a significant difference in compliance with preparedness protocols [bowel cleansing: IG 61.7% vs CG 52.6% (P = 0.001), antithrombotic management: IG 92.5% vs CG 62.8% (P = 0.001), and sedation scheduling: IG 78.8% vs CG 0% (P ≤ 0.001)]. We observed a net benefit of €55600/year after the intervention. The information given before the procedure was rated as excellent by 26% (CG) and 51% (IG) of patients, P ≤ 0.001.
CONCLUSION Educational telephone nurse intervention improves attendance, protocol compliance and patient satisfaction in the non-screening colonoscopy setting and has a large economic impact, which supports its imple-mentation and maintenance over time.
Collapse
Affiliation(s)
- Agustín Seoane
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
- Colorectal Cancer Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
| | - Xènia Font
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
| | - Juan C Pérez
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
| | - Rocío Pérez
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
| | - Carlos F Enriquez
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
| | - Miriam Parrilla
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
| | - Faust Riu
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
- Colorectal Cancer Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
| | - Josep M Dedeu
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
- Colorectal Cancer Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona 08003, Spain
| | - Luis E Barranco
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
- Colorectal Cancer Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
| | - Xavier Duran
- Consulting Service on Methodology for Biomedical Research, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
| | - Inés A Ibáñez
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
| | - Marco A Álvarez
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
- Colorectal Cancer Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona 08003, Spain
| |
Collapse
|
10
|
Alnasser R, Alkhowaiter S, Alhusaini S, Aljarallah B. Factors Associated with Missed and Cancelled Appointments in the Endoscopy Unit: Descriptive Study. Cureus 2020; 12:e7264. [PMID: 32292676 PMCID: PMC7153807 DOI: 10.7759/cureus.7264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and aim Canceled and missed appointments at the endoscopy unit affect the quality of the provided services and can negatively impact patient outcomes. Assessing the association between the various factors relating to nonattendance will show whether the defective aspects are organizational or personal, which is essential to improve the quality of the healthcare system. Moreover, this study will be of value in our region due to the current scarcity of studies in the Middle East. Methods A descriptive study was conducted at King Khaled University Hospital in Riyadh, Saudi Arabia. A database of participants was established from those who missed/canceled their outpatient endoscopy clinic appointment; purposive sampling was applied, excluding those who are under 14 years old. Demographic data and organizational factors (e.g., referred clinic and the lead time) were collected from the patients' files and a structured interview done by phone within 7-14 days of the missed/canceled appointment. Results A total of 919 endoscopy procedures were scheduled in an eight-week period, and 179 procedures were missed/canceled (19.48%); 84% were missed, and 16% were canceled. The highest percentage of the population had a high-school diploma or less. The results showed that roughly half of the patients were unemployed. More than two-thirds of the patients had undergone an endoscopy within the past year or less. The majority stated that they underwent the procedure in a different facility, which might be due to various reasons, one of which could be justified as long lead time. Conclusion An annual update of patients' files is suggested. Text messages can help serve as a reminder in addition to clear appointment instructions that will aid in minimizing the absence rates. Overbooking is recommended to decrease the lead time and increase clinic efficiency. Raising patients' awareness regarding the effect of missing appointments as well as upgrading the communication methods will assist in decreasing the rate of missed appointments.
Collapse
Affiliation(s)
| | - Saad Alkhowaiter
- Gastroenterology, King Khalid University Hospital, Riyadh, SAU.,Medicine, King Saud University, Riyadh, SAU
| | | | - Badr Aljarallah
- Hepatology and Gastroenterology, Qassim University Medical City, Qassim, SAU
| |
Collapse
|
11
|
Using Patients' Social Network to Improve Compliance to Outpatient Screening Colonoscopy Appointments Among Blacks: A Randomized Clinical Trial. Am J Gastroenterol 2019; 114:1671-1677. [PMID: 31478919 PMCID: PMC6776677 DOI: 10.14309/ajg.0000000000000387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patient navigation improves colorectal cancer screening among underserved populations, but limited resources preclude widespread adoption in minority-serving institutions. We evaluated whether a patient's self-selected social contact person can effectively facilitate outpatient screening colonoscopy. METHODS From September 2014 to March 2017 in an urban tertiary center, 399 black participants scheduled for outpatient screening colonoscopy self-selected a social contact person to be a facilitator and provided the person's phone number. Of these, 201 participants (50.4%) were randomly assigned to the intervention arm for their social contact persons to be engaged by phone. The study was explained to the social contact person with details about colonoscopy screening and bowel preparation process. The social contacts were asked to assist the participants, provide support, and encourage compliance with the procedures. The social contact person was not contacted in the usual care arm, n = 198 (49.6%). We evaluated attendance to the scheduled outpatient colonoscopy and adequacy of bowel preparation. Analysis was performed by intention to treat. RESULTS The social contact person was reached and agreed to be involved for 130 of the 201 participants (64.7%). No differences were found in the proportion of participants who underwent screening colonoscopy (77.3% vs 77.2%; relative risk = 1.01; 95% confidence interval: 0.91-1.12), but there was a modest increase in the proportion with adequate bowel preparation with social contact involvement (89.1% vs 80.9%; relative risk = 1.10; 95% confidence interval: 1.00-1.21). DISCUSSION Engaging a patient's social network to serve in the role of a patient navigator did not improve compliance to outpatient screening colonoscopy but modestly improved the adequacy of bowel preparation.
Collapse
|
12
|
Abstract
BACKGROUND/OBJECTIVES Noncompliance with physician and procedure appointments is associated with poor disease control and worse disease outcomes. This also impacts the quality of care, decreases efficiency, and affects revenue. Studies have shown that no-show rates are higher in clinics caring for underserved populations and may contribute to poorer health outcomes in this group. METHODS We performed a 17-month retrospective observational cohort study of patients scheduled for outpatient procedures in the Gastroenterology endoscopy suite at the University of Florida Health, Jacksonville. Multivariate logistic regression analysis was performed to evaluate associations between attendance and predictors of no-show. RESULTS In total, 6157 patients were scheduled to undergo different GI procedures during the study period. A total of 4388 (71%) patients completed their procedure, whereas 2349 (29%) failed to attend their appointment and were considered "no-show". There was a significant relationship between the visit attendance and race, insurance, gender, and marital status. Males had a higher no-show rate compared with females (30% vs. 28%; P<0.05). African Americans had the highest no-show rate (32%; P<0.05) amongst different races. Patients scheduled for surveillance colonoscopy (ie, history of polyps, IBD, Colon cancer) were more likely to show (78%) than those obtaining initial colorectal cancer screening (74%) or other indications (71%) (P<0.05).In the logistic regression model, patients with commercial insurance are more likely to show for their appointments than those with noncommercial insurance (eg, Medicare, Medicaid, City contract etc) [odds ratio (OR), 2.6; 95% confidence interval (CI), 2.2-3.0]. The odds of showing up are 1.7 times higher for married men compared with single men (OR, 1.7; 95% CI, 1.3-2.0). Similarly, married females are more likely to show up for appointment than single females (OR, 1.1; 95% CI, 0.9-1.3). We did not find significant association between the type of GI procedure (eg, colonoscopy vs. esophagogastroduodenoscopy vs. advanced endoscopic procedures) (P>0.05). CONCLUSIONS Predictors of no-shows for endoscopic gastrointestinal procedures included unpartnered or single patients, African American race and noncommercial insurance providers. Patients scheduled for surveillance colonoscopy had better adherence than initial screening. Further studies are required to better characterize these factors and improve adherence to the outpatient appointments based on the identified predictors.
Collapse
|
13
|
Shrestha MP, Hu C, Taleban S. Appointment Wait Time, Primary Care Provider Status, and Patient Demographics are Associated With Nonattendance at Outpatient Gastroenterology Clinic. J Clin Gastroenterol 2017; 51:433-438. [PMID: 27661970 DOI: 10.1097/mcg.0000000000000706] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOALS We intended to identify the factors associated with missed appointments at a gastroenterology (GI) clinic in an academic setting. BACKGROUND Missed clinic appointments reduce clinic efficiency, waste resources, and increase costs. Limited data exist on subspecialty clinic attendance. STUDY We performed a case-control study using data from the electronic health record of patients scheduled for an appointment at the adult GI clinic at the Banner University Medical Center between March and October of 2014. Patients who missed their appointment during the study period served as cases. Controls were randomly selected from patients who completed their appointment during the study period. Analysis included univariate and multivariate logistic regression analysis. RESULTS Of 2331 scheduled clinic appointments, 195 (8.4%) were missed appointments. Longer waiting time from referral to scheduled appointment was significantly associated with missed appointment (AOR=1.014; 95% CI, 1.01-1.02; P<0.001). Patients with primary care providers (PCPs) were less likely to miss their appointment than those without PCPs (AOR=0.35; 95% CI, 0.18-0.66; P=0.001). Among patient demographic characteristics, ethnicity and marital status were associated with missed appointment. CONCLUSIONS Wait time, ethnicity, marital status, and PCP status were associated with missed GI clinic appointments. Further investigations are needed to assess the effects of intervention strategies directed at reducing appointment wait time and increasing PCP-based care.
Collapse
Affiliation(s)
- Manish P Shrestha
- *Department of Medicine, University of Arizona College of Medicine †Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, AZ
| | | | | |
Collapse
|
14
|
Comorbid Illness, Bowel Preparation, and Logistical Constraints Are Key Reasons for Outpatient Colonoscopy Nonattendance. Can J Gastroenterol Hepatol 2016; 2016:2179354. [PMID: 27478818 PMCID: PMC4958479 DOI: 10.1155/2016/2179354] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/08/2016] [Accepted: 06/26/2016] [Indexed: 02/08/2023] Open
Abstract
Background. Colonoscopy nonattendance is a challenge for outpatient clinics globally. Absenteeism results in a potential delay in disease diagnosis and loss of hospital resources. This study aims to determine reasons for colonoscopy nonattendance from a Canadian perspective. Design. Demographic data, reasons for nonattendance, and patient suggestions for improving compliance were elicited from 49 out of 144 eligible study participants via telephone questionnaire. The 49 nonattenders were compared to age and sex matched controls for several potential contributing factors. Results. Nonattendance rates were significantly higher in winter months; the OR of nonattendance was 5.2 (95% CI, 1.6 to 17.0, p < 0.001) in winter versus other months. Being married was positively associated with attendance. There was no significant association between nonattendance and any of the other variables examined. The top 3 reasons for nonattendance were being too unwell to attend the procedure, being unable to complete bowel preparation, or experiencing logistical challenges. Conclusions. Colonoscopy attendance rates appear to vary significantly by season and it may be beneficial to book more colonoscopies in the summer or overbook in the winter. Targets for intervention include more tailored teaching sessions, reminders, taxi chits, and developing a hospital specific colonoscopy video regarding procedure and bowel preparation requirements.
Collapse
|