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Zaloum SA, Paris A, Mair D, Gutteridge C, Ayling RM, Onen BL, Walton J, Workman A, Villanueva N, Noyce AJ. Evaluation of an ambulatory care pathway for patients with nitrous oxide-induced myeloneuropathy. BMJ Neurol Open 2024; 6:e000737. [PMID: 38835539 PMCID: PMC11149123 DOI: 10.1136/bmjno-2024-000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction Cases of nitrous oxide (N2O)-induced myeloneuropathy are increasing at UK hospitals. At our centre, a dedicated ambulatory care pathway, endorsed nationally, was established to treat and monitor patients with N2O-myeloneuropathy in 2021 and refined through three audit cycles. We analysed the outcomes of patients on this pathway to better understand factors associated with non-engagement. Alongside, a novel approach using WhatsApp for questionnaire delivery was trialled in an attempt to improve engagement with treatment. Methods Patients on the N2O ambulatory care pathway were identified from MDT meeting lists from 9 September 2022 to 25 April 2023. Clinical data were collected via electronic clinical records, including the most recent neurological examination and reason for discharge from the pathway. Patients identified from MDT lists from 27 January 2023 to 14 March 2023 were approached to participate in weekly 12-item surveys, delivered via WhatsApp. This was approved as a service development project with approval for WhatsApp use given by the chief clinical information officer. Results 35/56 (62.5%) patients were discharged from ambulatory care due to non-attendance and 17/56 (30.4%) completed their treatment course. The median time from initial presentation to discharge was 49 days. 24/40 (60.0%) of patients with a final neurological examination documented had a residual deficit, with objective sensory deficits most common. 12 patients were approached to receive weekly questionnaires via WhatsApp. 5/8 who expressed interest returned a consent form. All participants were withdrawn due to non-response or participant choice. 1/5 returned more than two surveys. Conclusion Despite poor participation in surveys delivered via WhatsApp, novel approaches are needed to improve engagement with patients on the N2O ambulatory care pathway.
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Affiliation(s)
- Safiya A Zaloum
- Centre for Preventive Neurology, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Alvar Paris
- Centre for Preventive Neurology, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
- University of Cambridge, Cambridge, UK
| | - Devan Mair
- Centre for Preventive Neurology, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | | | | | | | | | | | - Alastair J Noyce
- Centre for Preventive Neurology, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
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2
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Santos J, Camplain C, Pollitt AM, Baldwin JA. A formative assessment of client characteristics associated with missed appointments in integrated primary care services in rural Arizona. J Eval Clin Pract 2024; 30:243-250. [PMID: 37933799 PMCID: PMC11299713 DOI: 10.1111/jep.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Integrating primary care services in mental healthcare facilities is an uncommon model of care in the United States that could bring several benefits (e.g., improved access to physical healthcare) for vulnerable populations experiencing mental health conditions, especially those living in underserved regions like rural Arizona. AIM This formative assessment aimed to understand the sociodemographic and clinical characteristics of clients accessing integrated primary care (IPC) services implemented in 2021 at a community mental healthcare facility in rural Arizona and to explore the proportion of missed appointments. Additionally, we analysed the association between client characteristics and IPC missed appointments. METHODS The authors collaborated with a community mental health facility in rural Arizona, which provided deidentified data from 280 clients who accessed IPC services from June 2021 to February 2022. RESULTS Most clients were White and of vulnerable socioeconomic status, with a substantial proportion of Native Americans (23.58%). The majority of clients (55.75%) had a mental health disorder (MHD), 23.74% had a substance use disorder (SUD), and 15.10% had comorbid MHD and SUD. Linear regression revealed that experiencing comorbid MHD and SUD was significantly associated with missed appointments. Compared with White clients, Native Americans missed fewer appointments. CONCLUSION Future studies conducted from a culturally-centred perspective are crucial to guide strategies to reduce missed appointments in rural IPC services.
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Affiliation(s)
- Jeffersson Santos
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Carolyn Camplain
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Amanda Marie Pollitt
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Julie Ann Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
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3
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Werner K, Alsuhaibani SA, Alsukait RF, Alshehri R, Herbst CH, Alhajji M, Lin TK. Behavioural economic interventions to reduce health care appointment non-attendance: a systematic review and meta-analysis. BMC Health Serv Res 2023; 23:1136. [PMID: 37872612 PMCID: PMC10594857 DOI: 10.1186/s12913-023-10059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/24/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Appointment non-attendance - often referred to as "missed appointments", "patient no-show", or "did not attend (DNA)" - causes volatility in health systems around the world. Of the different approaches that can be adopted to reduce patient non-attendance, behavioural economics-oriented mechanisms (i.e., psychological, cognitive, emotional, and social factors that may impact individual decisions) are reasoned to be better suited in such contexts - where the need is to persuade, nudge, and/ or incentivize patients to honour their scheduled appointment. The aim of this systematic literature review is to identify and summarize the published evidence on the use and effectiveness of behavioural economic interventions to reduce no-shows for health care appointments. METHODS We systematically searched four databases (PubMed/Medline, Embase, Scopus, and Web of Science) for published and grey literature on behavioural economic strategies to reduce no-shows for health care appointments. Eligible studies met four criteria for inclusion; they were (1) available in English, Spanish, or French, (2) assessed behavioural economics interventions, (3) objectively measured a behavioural outcome (as opposed to attitudes or preferences), and (4) used a randomized and controlled or quasi-experimental study design. RESULTS Our initial search of the five databases identified 1,225 articles. After screening studies for inclusion criteria and assessing risk of bias, 61 studies were included in our final analysis. Data was extracted using a predefined 19-item extraction matrix. All studies assessed ambulatory or outpatient care services, although a variety of hospital departments or appointment types. The most common behaviour change intervention assessed was the use of reminders (n = 56). Results were mixed regarding the most effective methods of delivering reminders. There is significant evidence supporting the effectiveness of reminders (either by SMS, telephone, or mail) across various settings. However, there is a lack of evidence regarding alternative interventions and efforts to address other heuristics, leaving a majority of behavioural economic approaches unused and unassessed. CONCLUSION The studies in our review reflect a lack of diversity in intervention approaches but point to the effectiveness of reminder systems in reducing no-show rates across a variety of medical departments. We recommend future studies to test alternative behavioural economic interventions that have not been used, tested, and/or published before.
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Affiliation(s)
- Kalin Werner
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Sara Abdulrahman Alsuhaibani
- Nudge Unit, Ministry of Health, Riyadh, KSA, Saudi Arabia
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, KSA, Saudi Arabia
| | - Reem F Alsukait
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, KSA, Saudi Arabia
- Health, Nutrition and Population Global Practice, The World Bank, Washington, D.C, USA
| | - Reem Alshehri
- Nudge Unit, Ministry of Health, Riyadh, KSA, Saudi Arabia
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, Washington, D.C, USA
| | - Mohammed Alhajji
- Nudge Unit, Ministry of Health, Riyadh, KSA, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, KSA, Saudi Arabia
| | - Tracy Kuo Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
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Chaves ACC, Scherer MDDA, Conill EM. What contributes to Primary Health Care effectiveness? Integrative literature review, 2010-2020. CIENCIA & SAUDE COLETIVA 2023; 28:2537-2551. [PMID: 37672445 DOI: 10.1590/1413-81232023289.15342022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/11/2023] [Indexed: 09/08/2023] Open
Abstract
Primary Health Care (PHC) intends to rearrange services to make it more effective. Nevertheless, effectiveness in PHC is quite a challenge. This study reviews several articles regarding the effectiveness improvements in PHC between 2010 and 2020. Ninety out of 8,369 articles found in PubMed and the Virtual Health Library databases search were selected for thematic analysis using the Atlas.ti® 9.0 software. There were four categories identified: strategies for monitoring and evaluating health services, organizational arrangements, models and technologies applied to PHC. Studies concerning the sensitive conditions indicators were predominant. Institutional assessment programs, PHC as a structuring policy, appropriate workforce, measures to increase access and digital technologies showed positive effects. However, payment for performance is still controversial. The expressive number of Brazilian publications reveals the broad diffusion of PHC in the country and the concern on its performance. These findings reassure well-known aspects, but it also points to the need for a logical model to better define what is intended as effectiveness within primary health care as well as clarify the polysemy that surrounds the concept. We also suggest substituting the term "resolvability", commonly used in Brazil, for "effectiveness".
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Sumarsono A, Case M, Kassa S, Moran B. Telehealth as a Tool to Improve Access and Reduce No-Show Rates in a Large Safety-Net Population in the USA. J Urban Health 2023; 100:398-407. [PMID: 36884183 PMCID: PMC9994401 DOI: 10.1007/s11524-023-00721-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 03/09/2023]
Abstract
Low-income populations are at higher risk of missing appointments, resulting in fragmented care and worsening disparities. Compared to face-to-face encounters, telehealth visits are more convenient and could improve access for low-income populations. All outpatient encounters at the Parkland Health between March 2020 and June 2022 were included. No-show rates were compared across encounter types (face-to-face vs telehealth). Generalized estimating equations were used to evaluate the association of encounter type and no-show encounters, clustering by individual patient and adjusting for demographics, comorbidities, and social vulnerability. Interaction analyses were performed. There were 355,976 unique patients with 2,639,284 scheduled outpatient encounters included in this dataset. 59.9% of patients were of Hispanic ethnicity, while 27.0% were of Black race. In a fully adjusted model, telehealth visits were associated with a 29% reduction in odds of no-show (aOR 0.71, 95% CI: 0.70-0.72). Telehealth visits were associated with significantly greater reductions in probability of no-show among patients of Black race and among those who resided in the most socially vulnerable areas. Telehealth encounters were more effective in reducing no-shows in primary care and internal medicine subspecialties than surgical specialties or other non-surgical specialties. These data suggest that telehealth may serve as a tool to improve access to care in socially complex patient populations.
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Affiliation(s)
- Andrew Sumarsono
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Division of Hospital Medicine, Parkland Health, Dallas, TX, USA.
| | - Molly Case
- Virtual Care Department, Parkland Health, Dallas, TX, USA
| | | | - Brett Moran
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Clinical Informatics Department, Parkland Health, Dallas, TX, USA
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6
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Paris A, Lake L, Joseph A, Workman A, Walton J, Hayton T, Evangelou N, Lilleker JB, Ayling RM, Nicholl D, Noyce AJ. Nitrous oxide-induced subacute combined degeneration of the cord: diagnosis and treatment. Pract Neurol 2023; 23:222-228. [PMID: 36813556 DOI: 10.1136/pn-2022-003631] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 02/24/2023]
Abstract
Recreational use of nitrous oxide (N2O) has increased rapidly in recent years and is now the second most commonly used recreational drug among young people in the UK. There has been a corresponding rise in cases of nitrous oxide-induced subacute combined degeneration of the cord (N2O-SACD), a pattern of myeloneuropathy usually associated with severe vitamin B12 deficiency. This can cause serious and permanent disability in young people but, if recognised early, may be effectively treated. All neurologists should be aware of N2O-SACD and its treatment; however, there are currently no agreed guidelines. Based on our experience in East London, an area of high N2O use, we provide practical advice on its recognition, investigation and treatment.
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Affiliation(s)
- Alvar Paris
- Preventive Neurology Unit, Centre for Prevention, Diagnosis and Detection, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK.,Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Luke Lake
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Albert Joseph
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Anna Workman
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Joseph Walton
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Tom Hayton
- Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Surgical Reconstruction and Microbiology Research Centre, National Institute for Health Research, Birmingham, UK
| | - Nikos Evangelou
- Academic Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - James B Lilleker
- Muscle Diseases Unit, Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Salford, UK.,Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - Ruth M Ayling
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - David Nicholl
- Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Alastair J Noyce
- Preventive Neurology Unit, Centre for Prevention, Diagnosis and Detection, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK .,Royal London Hospital, Barts Health NHS Trust, London, UK
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7
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Predicting no-show appointments in a pediatric hospital in Chile using machine learning. Health Care Manag Sci 2023:10.1007/s10729-022-09626-z. [PMID: 36707485 DOI: 10.1007/s10729-022-09626-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/13/2022] [Indexed: 01/29/2023]
Abstract
The Chilean public health system serves 74% of the country's population, and 19% of medical appointments are missed on average because of no-shows. The national goal is 15%, which coincides with the average no-show rate reported in the private healthcare system. Our case study, Doctor Luis Calvo Mackenna Hospital, is a public high-complexity pediatric hospital and teaching center in Santiago, Chile. Historically, it has had high no-show rates, up to 29% in certain medical specialties. Using machine learning algorithms to predict no-shows of pediatric patients in terms of demographic, social, and historical variables. To propose and evaluate metrics to assess these models, accounting for the cost-effective impact of possible intervention strategies to reduce no-shows. We analyze the relationship between a no-show and demographic, social, and historical variables, between 2015 and 2018, through the following traditional machine learning algorithms: Random Forest, Logistic Regression, Support Vector Machines, AdaBoost and algorithms to alleviate the problem of class imbalance, such as RUS Boost, Balanced Random Forest, Balanced Bagging and Easy Ensemble. These class imbalances arise from the relatively low number of no-shows to the total number of appointments. Instead of the default thresholds used by each method, we computed alternative ones via the minimization of a weighted average of type I and II errors based on cost-effectiveness criteria. 20.4% of the 395,963 appointments considered presented no-shows, with ophthalmology showing the highest rate among specialties at 29.1%. Patients in the most deprived socioeconomic group according to their insurance type and commune of residence and those in their second infancy had the highest no-show rate. The history of non-attendance is strongly related to future no-shows. An 8-week experimental design measured a decrease in no-shows of 10.3 percentage points when using our reminder strategy compared to a control group. Among the variables analyzed, those related to patients' historical behavior, the reservation delay from the creation of the appointment, and variables that can be associated with the most disadvantaged socioeconomic group, are the most relevant to predict a no-show. Moreover, the introduction of new cost-effective metrics significantly impacts the validity of our prediction models. Using a prototype to call patients with the highest risk of no-shows resulted in a noticeable decrease in the overall no-show rate.
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8
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Jayaraajan K, Sivananthan A, Koomson A, Ahmad A, Haque M, Hussain M. The use of digital solutions in alleviating the burden of IAPT's waiting times. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2022; 33:S103-S110. [PMID: 35912756 PMCID: PMC9844064 DOI: 10.3233/jrs-227033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous reports have shown that there are long waiting times to commence therapy in the community-based mental health programme, IAPT (Improving Access to Psychological Therapies). OBJECTIVE This study aimed to explore both causes and potential solutions to alleviate the burden of these waits. METHODS A Systematic Literature Review (SLR) and Semi-Structured Interviews (SSIs) were conducted to identify causes and effects of these waits. Consequently, meaningful recommendations were made and tested with the aim of improving IAPT's waiting times. RESULTS SLR and SSIs revealed high 'Did Not Attend' (DNA) rates and a lack of support between initial appointments as being both a cause and effect of long waits. The identified issues were tackled with the development of an app design. Expert interviews and a mass survey fuelled the iterative process leading to a final prototype. Notable features included: therapist profile page, smart appointment reminders and patient timeline. Positive feedback was received from university students and ICS Digital, with scope to trial the app within Manchester CCG. CONCLUSIONS In the long run, the app aims to indirectly shorten waiting times by addressing treatment expectations and serving as an IAPT companion along the patient journey, thus reducing anxiety and consequently DNAs.
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Affiliation(s)
- Keerthanaa Jayaraajan
- Imperial College Business School, London, UK,Faculty of Medicine, Imperial College London, London, UK, Address for correspondence: Keerthanaa Jayaraajan, Imperial College Business School, London, UK; and Faculty of Medicine, Imperial College London, London, UK. E-mail:
| | - Ahrabbey Sivananthan
- Imperial College Business School, London, UK,Faculty of Medicine, Imperial College London, London, UK
| | - Abeku Koomson
- Imperial College Business School, London, UK,Faculty of Medicine, Imperial College London, London, UK
| | - Aznavar Ahmad
- Imperial College Business School, London, UK,Faculty of Medicine, Imperial College London, London, UK
| | - Mohammed Haque
- Imperial College Business School, London, UK,Faculty of Medicine, Imperial College London, London, UK
| | - Mohammod Hussain
- Imperial College Business School, London, UK,Newcastle University Medical School, Newcastle Upon Tyne, UK
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9
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No-Show Rates for Telemedicine Versus In-Person Appointments During the COVID-19 Pandemic: Implications for Medicaid Populations. J Ambul Care Manage 2022; 45:332-340. [PMID: 36006390 DOI: 10.1097/jac.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to assess no-show rates among in-person and telemedicine visits during the COVID-19 pandemic among Medicaid members. We analyzed data from an urban safety net hospital in Denver, Colorado. Using multivariable binomial regression models, we estimated differences in probability of no shows by patient characteristics and assessed for effect modification by telemedicine use. Overall, the no-show rate was 20.5% with increased probability of no show among Hispanic (2.3%) and non-Hispanic, Black (7.4%) patients compared with their non-Hispanic, White counterparts. Modification by telemedicine was observed, decreasing no-show rates among both groups (P < .0001). Similar patterns were observed among medically complex patients. Audio-only telemedicine significantly impacted no-show rates within certain populations.
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10
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Fridman I, Smalls A, Fleming P, Elston Lafata J. Preferences for electronic modes of communication among older primary care patients: a cross-sectional survey (Preprint). JMIR Form Res 2022; 7:e40709. [DOI: 10.2196/40709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 03/15/2023] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
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Overbury RS, Huynh K, Bohnsack J, Frech T, Hersh A. A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes. Pediatr Rheumatol Online J 2021; 19:164. [PMID: 34852832 PMCID: PMC8638174 DOI: 10.1186/s12969-021-00651-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The transition of health care from Pediatric to Adult providers for adolescents and young adults with chronic disease is associated with poor outcomes. Despite the importance of this transition, over 80% of these patients do not receive the services necessary to transition to Adult health care. In 2018, we initiated a transition clinic structure, integrating an Internal Medicine - Pediatrics trained Adult Rheumatologist in a Pediatric Rheumatology clinic to guide this transition. Our goal was to improve transition outcomes. We report the methods of this clinic and its preliminary outcomes. METHODS For patients referred to the transition clinic, the Adult Rheumatologist assumed medical management and implemented a six-part modular transition curriculum. This curriculum included a Transition Policy, Transition Readiness Assessment, medication review and education, diagnosis review and education, and counseling on differences between Pediatric and Adult-oriented care. Eligible patients and their families were enrolled in a prospective observational outcomes research registry. Initial data from this transition clinic is reported including adherence with certain aspects of the transition curriculum and clinic utilization. RESULTS The transition clinic Adult Rheumatologist saw 177 patients in 2 years, and 57 patients were eligible for, approached, and successfully enrolled in the registry. From this registry, all patients reviewed the Transition Policy with the Adult Rheumatologist and 45 (78.9%) completed at least one Transition Readiness Assessment. Of the 22 patients for whom transition was indicated, all were successfully transitioned to an Adult Rheumatologist. 17 (77.3%) continued care post-transition with the transition clinic Adult Rheumatologist, and 5 (22.7%) continued care post-transition with a different Adult Rheumatologist. The median time between the last transition clinic visit and first Adult clinic visit was 5.1 months. CONCLUSIONS Our experience demonstrated the success of our clinic model regarding participation in the transition curriculum and improved clinic utilization data. Our results are an improvement over transition rates reported elsewhere that did not implement our model. We believe that this structure could be applied to other primary care and subspecialty clinics. TRIAL REGISTRATION This research was approved by the University of Utah Institutional Review Board (IRB) in January 2019 (IRB_00115964). Patients were retrospectively registered if involved prior to this date.
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Affiliation(s)
- Rebecca S Overbury
- Division of Pediatric Rheumatology, University of Utah, 30N 1900E 4B200, Salt Lake City, UT, 84132, USA.
- Division of Rheumatology, University of Utah, 30N 1900E 4B200, Salt Lake City, UT, 84132, USA.
| | - Kelly Huynh
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - John Bohnsack
- Division of Pediatric Rheumatology, University of Utah, 30N 1900E 4B200, Salt Lake City, UT, 84132, USA
| | - Tracy Frech
- Division of Rheumatology, University of Utah, 30N 1900E 4B200, Salt Lake City, UT, 84132, USA
| | - Aimee Hersh
- Division of Pediatric Rheumatology, University of Utah, 30N 1900E 4B200, Salt Lake City, UT, 84132, USA
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Ho TW, Kung LC, Huang HY, Lai JF, Chiu HM. Overbooking for physical examination considering late cancellation and set-resource relationship. BMC Health Serv Res 2021; 21:1254. [PMID: 34801021 PMCID: PMC8605579 DOI: 10.1186/s12913-021-07148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late cancellations of physical examination has severe impact on the operations of a physical examination center since it is often too late to fill vacancy. A booking control policy that considers overbooking is then one natural solution. Unlike appointment scheduling problems for clinics and hospitals, in which treating a patient mostly requires only one type of resource, a physical examination set typically requires multiple types of resources. Traditional methods that do not consider set-resource relationship thus may be inapplicable. METHODS We formulate a stochastic mathematical programming model that maximizes the expected net reward, which is the examination revenue minus overage cost. A complete search algorithm and a greedy search algorithm are designed to search for optimal booking limits for all examination sets. To estimate the late cancellation probability for each individual consumer, we apply logistic regression to identify significant factors affecting the probability. After clustering is used to estimate individual probabilities, Monte Carlo simulation is conducted to generate probability distributions for the number of consumers without late cancellations. A discrete-event simulation is performance to evaluate the effectiveness of our proposed solution. RESULTS We collaborate with a leading physical examination center to collect real data to evaluate our proposed overbooking policies. We show that the proposed overbooking policy may significantly increase the expected net reward. Our simulation results also help us understand the impact of overbooking on the expected number of customers and expected overage. A sensitivity analysis is conducted to demonstrate that the benefit of overbooking is insensitive to the accuracy of cost estimation. A Pareto efficiency analysis gives practitioners suggestions regarding policy determination considering multiple performance indications. CONCLUSIONS Our proposed overbooking policies may greatly enhance the overall performance of a physical examination center.
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Affiliation(s)
- Te-Wei Ho
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ling-Chieh Kung
- Department of Information Management, College of Management, National Taiwan University, Taipei, Taiwan.
| | - Hsin-Ya Huang
- Department of Information Management, College of Management, National Taiwan University, Taipei, Taiwan
| | - Jui-Fen Lai
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Mo Chiu
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Greenstein J, Topp R, Etnoyer-Slaski J, Staelgraeve M, McNulty J. The effect of a mobile health app on adherence to physical health treatment. JMIR Rehabil Assist Technol 2021; 8:e31213. [PMID: 34655468 PMCID: PMC8686470 DOI: 10.2196/31213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Adhering to prescribed medical interventions predicts the efficacy of the treatment. In the physical health clinics, not adhering to prescribed therapy can take the form of not attending a scheduled clinic visit (no-show appointment) or prematurely terminating treatment against the advice of the provider (self-discharge). A variety of interventions, including mobile phone apps have been introduced with patients to increase their adherence with attending scheduled clinic visits. Limited research has examined the impact of a mobile phone app among patients attending a chiropractic and rehabilitation clinic visits. OBJECTIVE The purpose of this study was to compare adherence with prescribed physical health treatment among patients attending a chiropractic and rehabilitation clinic who did and did not choose to adopt a phone-based app to complement their treatment. METHODS The medical records of new patients who presented for care during 2019 and 2020 at five community-based chiropractic and rehabilitation clinics were reviewed for the number of kept and no-show appointments and if the patient was provider discharged or self-discharged. During this 24-month study 36.3% of the 4,126 patients seen in the targeted clinics had downloaded the Kanvas App to their mobile phone while the remaining patients chose not to download the app (Usual Care Group). The gamification component of the Kanvas App provided the patient with a point every time they attended their visits which could be redeemed for an incentive. RESULTS During both 2019 and 2020 respectively the Kanvas App Group were provider discharged at a greater rate than the Usual-Care Group. The Kanvas App Group kept a similar number of appointments compared to the Usual-Care Group in 2019 but kept significantly more appointments than the Usual-Care Group in 2020. During 2019 both groups exhibited a similar number of no-show appointments but in 2020 the Kanvas App Group demonstrated more no-show appointments than the Usual Care Group. When collapsed across years and self-discharged the Kanvas App Group had a greater number of kept appointments compared to the Usual Care Group. When provider discharged, both groups exhibited a similar number of kept appointments. The Kanvas App Group and the Usual Care Group were similar in the number of no-show appointments when provider discharged and when self-discharged the Kanvas App Group had more no-show appointments compared to the Usual Care Group. CONCLUSIONS Patients who did or did not have access to the Kanvas App and were provider discharged, exhibited a similar number of kept appointments and no-show appointments. When subjects were self-discharged and received the Kanvas App they exhibited 3.2 more kept appointments and .94 more no-show appointments than self-discharged Usual Care Group.
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Affiliation(s)
- Jay Greenstein
- Kaizenovate, Kaizo Clinical Research Institute, Kaizo Health, 827E Rockville Pike, Rockville, US
| | - Robert Topp
- University of Toledo, 3000 Arlington Ave, Toledo, US
| | | | | | - John McNulty
- Kaizenovate, Kaizo Clinical Research Institute, Kaizo Health, Rockville, US
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Philpott-Morgan S, Thakrar DB, Symons J, Ray D, Ashrafian H, Darzi A. Characterising the nationwide burden and predictors of unkept outpatient appointments in the National Health Service in England: A cohort study using a machine learning approach. PLoS Med 2021; 18:e1003783. [PMID: 34637437 PMCID: PMC8509877 DOI: 10.1371/journal.pmed.1003783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 08/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Unkept outpatient hospital appointments cost the National Health Service £1 billion each year. Given the associated costs and morbidity of unkept appointments, this is an issue requiring urgent attention. We aimed to determine rates of unkept outpatient clinic appointments across hospital trusts in the England. In addition, we aimed to examine the predictors of unkept outpatient clinic appointments across specialties at Imperial College Healthcare NHS Trust (ICHT). Our final aim was to train machine learning models to determine the effectiveness of a potential intervention in reducing unkept appointments. METHODS AND FINDINGS UK Hospital Episode Statistics outpatient data from 2016 to 2018 were used for this study. Machine learning models were trained to determine predictors of unkept appointments and their relative importance. These models were gradient boosting machines. In 2017-2018 there were approximately 85 million outpatient appointments, with an unkept appointment rate of 5.7%. Within ICHT, there were almost 1 million appointments, with an unkept appointment rate of 11.2%. Hepatology had the highest rate of unkept appointments (17%), and medical oncology had the lowest (6%). The most important predictors of unkept appointments included the recency (25%) and frequency (13%) of previous unkept appointments and age at appointment (10%). A sensitivity of 0.287 was calculated overall for specialties with at least 10,000 appointments in 2016-2017 (after data cleaning). This suggests that 28.7% of patients who do miss their appointment would be successfully targeted if the top 10% least likely to attend received an intervention. As a result, an intervention targeting the top 10% of likely non-attenders, in the full population of patients, would be able to capture 28.7% of unkept appointments if successful. Study limitations include that some unkept appointments may have been missed from the analysis because recording of unkept appointments is not mandatory in England. Furthermore, results here are based on a single trust in England, hence may not be generalisable to other locations. CONCLUSIONS Unkept appointments remain an ongoing concern for healthcare systems internationally. Using machine learning, we can identify those most likely to miss their appointment and implement more targeted interventions to reduce unkept appointment rates.
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Affiliation(s)
| | - Dixa B. Thakrar
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Joshua Symons
- NHS Digital, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Daniel Ray
- Farr Institute of Health Informatics Research, University College London, London, United Kingdom
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- * E-mail:
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Ayer R, Poudel KC, Kikuchi K, Ghimire M, Shibanuma A, Jimba M. Nurse-Led Mobile Phone Voice Call Reminder and On-Time Antiretroviral Pills Pick-Up in Nepal: A Randomized Controlled Trial. AIDS Behav 2021; 25:1923-1934. [PMID: 33389377 DOI: 10.1007/s10461-020-03122-7] [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: 12/07/2020] [Indexed: 10/22/2022]
Abstract
This study investigates the efficacy of a nurse-led mobile phone voice call reminder intervention in improving on-time antiretroviral (ARV) pills collection in Nepal. Between October and December 2017, 468 HIV-positive individuals were recruited randomly and assigned to either nurse-led mobile phone voice call reminder (intervention) group or voice call with health promotion message (control) group, 234 were allocated to each group. We assessed on-time pills pick-up at baseline and six-month follow-up and analyzed it by intention-to-treat method. In the intervention group, participants improved their on-time ARV pills pick-up from 60% (141/234) at baseline to 71% (151/234) at the six-month follow-up. After adjusting for covariates, those in the intervention group were significantly more likely to pick-up their pills on-time than those in the control group (intervention × time; adjusted odds ratio 2.02, 95% CI 1.15-3.55). Nurse-led mobile phone voice call reminder is efficacious to improve on-time ARV collection.
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16
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Consensus Bundle on Postpartum Care Basics: From Birth to the Comprehensive Postpartum Visit. Obstet Gynecol 2021; 137:33-40. [PMID: 33278281 DOI: 10.1097/aog.0000000000004206] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/09/2020] [Indexed: 01/31/2023]
Abstract
In the weeks after childbirth, a woman navigates multiple challenges. She must recover from birth, learn to care for herself and her newborn, and cope with fatigue and postpartum mood changes as well as chronic health conditions. Alongside these common morbidities, the number of maternal deaths in the United States continues to increase, and unacceptable racial inequities persist. One third of pregnancy-related deaths occur between 1 week and 1 year after delivery, with a growing proportion of these deaths due to cardiovascular disease; one fifth occur between 7 and 42 days postpartum. In addition, pregnancy-associated deaths due to self-harm or substance misuse are increasing at an alarming rate. Rising maternal mortality and morbidity rates, coupled with significant disparities in outcomes, highlight the need for tailored interventions to improve safety and well-being of families during the fourth trimester of pregnancy, which includes the period from birth to the comprehensive postpartum visit. Targeted support for growing families during this transition can improve health and well-being across generations.
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Milicevic AS, Mitsantisuk K, Tjader A, Vargas DL, Hubert TL, Scott B. Modeling Patient No-Show History and Predicting Future Appointment Behavior at the Veterans Administration's Outpatient Mental Health Clinics: NIRMO-2. Mil Med 2021; 185:e988-e994. [PMID: 32591833 DOI: 10.1093/milmed/usaa095] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION No-shows are detrimental to both patients' health and health care systems. Literature documents no-show rates ranging from 10% in primary care clinics to over 60% in mental health clinics. Our model predicts the probability that a mental health clinic outpatient appointment will not be completed and identifies actionable variables associated with lowering the probability of no-show. MATERIALS AND METHODS We were granted access to de-identified administrative data from the Veterans Administration Corporate Data Warehouse related to appointments at 13 Veterans Administration Medical Centers. Our modeling data set included 1,206,271 unique appointment records scheduled to occur between January 1, 2013 and February 28, 2017. The training set included 846,668 appointment records scheduled between January 1, 2013 and December 31, 2015. The testing set included 359,603 appointment records scheduled between January 1, 2016 and February 28, 2017. The dependent binary variable was whether the appointment was completed or not. Independent variables were categorized into seven clusters: patient's demographics, appointment characteristics, patient's attendance history, alcohol use screening score, medications and medication possession ratios, prior diagnoses, and past utilization of Veterans Health Administration services. We used a forward stepwise selection, based on the likelihood ratio, to choose the variables in the model. The predictive model was built using the SAS HPLOGISTIC procedure. RESULTS The best indicator of whether someone will miss an appointment is their historical attendance behavior. The top three variables associated with higher probabilities of a no-show were: the no-show rate over the previous 2 years before the current appointment, the no-show probability derived from the Markov model, and the age of the appointment. The top three variables that decrease the chance of no-showing were: the appointment was a new consult, the appointment was an overbook, and the patient had multiple appointments on the same day. The average of the areas under the receiver operating characteristic curves was 0.7577 for the training dataset, and 0.7513 for the test set. CONCLUSIONS The National Initiative to Reduce Missed Opportunities-2 confirmed findings that previous patient attendance is one of the key predictors of a future attendance and provides an additional layer of complexity for analyzing the effect of a patient's past behavior on future attendance. The National Initiative to Reduce Missed Opportunities-2 establishes that appointment attendance is related to medication adherence, particularly for medications used for treatment of mood disorders or to block the effects of opioids. However, there is no way to confirm whether a patient is actually taking medications as prescribed. Thus, a low medication possession ratio is an informative, albeit not a perfect, measure. It is our intention to further explore how diagnosis and medications can be better captured and used in predictive modeling of no-shows. Our findings on the effects of different factors on no-show rates can be used to predict individual no-show probabilities, and to identify patients who are high risk for missing appointments. The ability to predict a patient's risk of missing an appointment would allow for both advanced interventions to decrease no-shows and for more efficient scheduling.
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Affiliation(s)
- Aleksandra Sasha Milicevic
- Joseph M. Katz Graduate School of Business, University of Pittsburgh, 2809 Posvar Hall 230 S Bouquet St, Pittsburgh, PA 15213
| | - Kannop Mitsantisuk
- Joseph M. Katz Graduate School of Business, University of Pittsburgh, 2809 Posvar Hall 230 S Bouquet St, Pittsburgh, PA 15213
| | - Andrew Tjader
- Joseph M. Katz Graduate School of Business, University of Pittsburgh, 2809 Posvar Hall 230 S Bouquet St, Pittsburgh, PA 15213
| | - Dominic L Vargas
- Joseph M. Katz Graduate School of Business, University of Pittsburgh, 2809 Posvar Hall 230 S Bouquet St, Pittsburgh, PA 15213
| | - Terrence L Hubert
- Office of Strategic Integration, Veterans Engineering Resource Center, 1010 Delafield Road, 001VERC-A, Bldg. 70, Room BA014, Pittsburgh, PA 15215
| | - Brianna Scott
- VA Pittsburgh Healthcare System, 1010 Delafield Road, 001VERC-A, Bldg. 70, Room BA014, Pittsburgh, PA 15215
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18
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Randomized controlled study using text messages to help connect new medicaid beneficiaries to primary care. NPJ Digit Med 2021; 4:26. [PMID: 33589706 PMCID: PMC7884833 DOI: 10.1038/s41746-021-00389-5] [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] [Received: 04/22/2020] [Accepted: 01/05/2021] [Indexed: 11/08/2022] Open
Abstract
Accessing primary care is often difficult for newly insured Medicaid beneficiaries. Tailored text messages may help patients navigate the health system and initiate care with a primary care physician. We conducted a randomized controlled trial of tailored text messages with newly enrolled Medicaid managed care beneficiaries. Text messages included education about the importance of primary care, reminders to obtain an appointment, and resources to help schedule an appointment. Within 120 days of enrollment, we examined completion of at least one primary care visit and use of the emergency department. Within 1 year of enrollment, we examined diagnosis of a chronic disease, receipt of preventive care, and use of the emergency department. 8432 beneficiaries (4201 texting group; 4231 control group) were randomized; mean age was 37 years and 24% were White. In the texting group, 31% engaged with text messages. In the texting vs control group after 120 days, there were no differences in having one or more primary care visits (44.9% vs. 45.2%; difference, −0.27%; p = 0.802) or emergency department use (16.2% vs. 16.0%; difference, 0.23%; p = 0.771). After 1 year, there were no differences in diagnosis of a chronic disease (29.0% vs. 27.8%; difference, 1.2%; p = 0.213) or appropriate preventive care (for example, diabetes screening: 14.1% vs. 13.4%; difference, 0.69%; p = 0.357), but emergency department use (32.7% vs. 30.2%; difference, 2.5%; p = 0.014) was greater in the texting group. Tailored text messages were ineffective in helping new Medicaid beneficiaries visit primary care within 120 days.
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Motavalli D, Taylor JL, Childs E, Valente PK, Salhaney P, Olson J, Biancarelli DL, Edeza A, Earlywine JJ, Marshall BDL, Drainoni ML, Mimiaga MJ, Biello KB, Bazzi AR. "Health Is on the Back Burner:" Multilevel Barriers and Facilitators to Primary Care Among People Who Inject Drugs. J Gen Intern Med 2021; 36:129-137. [PMID: 32918199 PMCID: PMC7858998 DOI: 10.1007/s11606-020-06201-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/27/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The estimated 2.2 million people who inject drugs (PWID) in the USA experience significant gaps in preventive healthcare and a high burden of infectious, psychiatric, and other chronic diseases. Many PWID rely on emergency medical services, which are costly and not designed to deliver preventive services, manage chronic conditions, or address social needs. OBJECTIVE The objective of this study was to explore barriers and facilitators to primary care utilization from the perspectives of PWID in New England, a region highly affected by the overdose crisis. DESIGN Participants completed semi-structured qualitative interviews exploring substance use and healthcare utilization patterns. PARTICIPANTS We recruited 78 PWID through community-based organizations (e.g., syringe service programs) in 16 urban and non-urban communities throughout Massachusetts and Rhode Island. APPROACH Thematic analysis identified barriers and facilitators to primary care utilization at the individual, interpersonal, and systemic levels. KEY RESULTS Among 78 PWID, 48 described recent primary care experiences; 33 had positive experiences and 15 described negative experiences involving discrimination or mistrust. Individual-level barriers to primary care utilization included perceived lack of need and competing priorities (e.g., avoiding opioid withdrawal, securing shelter beds). Interpersonal-level barriers included stigma and perceived low quality of care for PWID. Systemic-level barriers included difficulty navigating healthcare systems, inadequate transportation, long wait times, and frequent provider turnover. Participants with positive primary care experiences explained how appointment reminders, flexible hours, addiction medicine-trained providers, case management services, and transportation support facilitated primary care utilization and satisfaction. CONCLUSIONS Findings regarding the multilevel barriers and facilitators to accessing primary care among PWID identify potential targets for programmatic interventions to improve primary care utilization in this population. Based on these findings, we make recommendations for improving the engagement of PWID in primary care as a means to advance individual and public health outcomes.
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Affiliation(s)
| | - Jessica L Taylor
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Ellen Childs
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Peter Salhaney
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
| | - Jennifer Olson
- Center for Health Equity Research, Brown University, Providence, RI, USA
| | - Dea L Biancarelli
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
| | - Joel J Earlywine
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, Bedford, MA, USA
| | - Matthew J Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, 02118, USA.
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Incze E, Holborn P, Higgs G, Ware A. Using machine learning tools to investigate factors associated with trends in 'no-shows' in outpatient appointments. Health Place 2020; 67:102496. [PMID: 33321455 DOI: 10.1016/j.healthplace.2020.102496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/29/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
Missed appointments are estimated to cost the UK National Health Service (NHS) approximately £1 billion annually. Research that leads to a fuller understanding of the types of factors influencing spatial and temporal patterns of these so-called "Did-Not-Attends" (DNAs) is therefore timely. This research articulates the results of a study that uses machine learning approaches to investigate whether these factors are consistent across a range of medical specialities. A predictive model was used to determine the risk-increasing and risk-mitigating factors associated with missing appointments, which were then used to assign a risk score to patients on an appointment-by-appointment basis for each speciality. Results show that the best predictors of DNAs include the patient's age, appointment history, and the deprivation rank of their area of residence. Findings have been analysed at both a geographical and medical speciality level, and the factors associated with DNAs have been shown to differ in terms of both importance and association. This research has demonstrated how machine learning techniques have real value in informing future intervention policies related to DNAs that can help reduce the burden on the NHS and improve patient care and well-being.
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Affiliation(s)
- Eduard Incze
- Faculty of Computing, Engineering and Science, University of South Wales, Pontypridd, CF37 1DL, United Kingdom
| | - Penny Holborn
- Faculty of Computing, Engineering and Science, University of South Wales, Pontypridd, CF37 1DL, United Kingdom
| | - Gary Higgs
- Faculty of Computing, Engineering and Science, University of South Wales, Pontypridd, CF37 1DL, United Kingdom.
| | - Andrew Ware
- Faculty of Computing, Engineering and Science, University of South Wales, Pontypridd, CF37 1DL, United Kingdom
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Reducing missed appointments in general practice: evaluation of a quality improvement programme in East London. Br J Gen Pract 2020; 71:e31-e38. [PMID: 33257461 PMCID: PMC7716879 DOI: 10.3399/bjgp20x713909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/23/2020] [Indexed: 01/07/2023] Open
Abstract
Background Missed appointments are common in primary care, contributing to reduced clinical capacity. NHS England has estimated that there are 7.2 million missed general practice appointments annually, at a cost of £216 million. Reducing these numbers is important for an efficient primary care sector. Aim To evaluate the impact of a system-wide quality improvement (QI) programme on the rates of missed GP appointments, and to identify effective practice interventions. Design and setting Practices within a clinical commissioning group (CCG) in East London, with an ethnically diverse and socially deprived population. Method Study practices engaged in a generic QI programme, which included sharing data on appointment systems and Did Not Attend (DNA) rates. Fourteen out of 25 practices implemented DNA reduction projects, supported by practice-based coaching. Appointment data were collected from practice electronic health records. Evaluation included comparisons of DNA rates pre- and post-intervention using interrupted times series analysis. Results In total, 25 out of 32 practices engaged with the programme. The mean DNA rate at baseline was 7% (range 2–12%); 2 years later the generic intervention DNA rates were 5.2%. This equates to a reduction of 4030 missed appointments. The most effective practice intervention was to reduce the forward booking time to 1 day. The practice that made this change reduced its mean DNA rate from 7.8% to 3.9%. Conclusion Forward booking time in days is the best predictor of practice DNA rates. Sharing appointment data produced a significant reduction in missed appointments, and behaviour change interventions with patients had a modest additional impact; in contrast, introducing structural change to the appointment system effectively reduced DNA rates. To reduce non-attendance, it appears that the appointment system needs to change, not the patient.
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Digiusto E, Friend R, Batey RG, Mattick RP. Considerations in providing shared‐care psychological treatment for clients who have alcohol or other drug misuse problems. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Erol Digiusto
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia,
| | - Rowena Friend
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia,
| | - Robert G. Batey
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia,
| | - Richard P. Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia,
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Fishbane A, Ouss A, Shah AK. Behavioral nudges reduce failure to appear for court. Science 2020; 370:science.abb6591. [PMID: 33033154 DOI: 10.1126/science.abb6591] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/24/2020] [Indexed: 11/02/2022]
Abstract
Each year, millions of Americans fail to appear in court for low-level offenses, and warrants are then issued for their arrest. In two field studies in New York City, we make critical information salient by redesigning the summons form and providing text message reminders. These interventions reduce failures to appear by 13 to 21% and lead to 30,000 fewer arrest warrants over a 3-year period. In laboratory experiments, we find that whereas criminal justice professionals see failures to appear as relatively unintentional, laypeople believe they are more intentional. These lay beliefs reduce support for policies that make court information salient and increase support for punishment. Our findings suggest that criminal justice policies can be made more effective and humane by anticipating human error in unintentional offenses.
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Affiliation(s)
| | - Aurelie Ouss
- Department of Criminology, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Anuj K Shah
- Booth School of Business, University of Chicago, Chicago, IL 60637, USA
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Alkomos MF, Mendez D, Mazzei-Pifano D, Shafeek F, Rodriguez C, Ali F, Banks C, Melki G, Michael P. Patients' reasons for missing scheduled clinic appointments and their solutions at a major urban-based academic medical center. J Community Hosp Intern Med Perspect 2020; 10:426-430. [PMID: 33235676 PMCID: PMC7671744 DOI: 10.1080/20009666.2020.1796903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Objective Patients that do not show up for scheduled clinic appointments affect the quality of healthcare provided. This study aimed to recognize the reasons behind missing scheduled appointments and understand possible solutions from the patient's perspective. Method We included 100 patients that attended the outpatient Medicine clinic in January 2020. Selection criteria were based on missing one or more of the scheduled clinic appointments in the last year. The participants answered a questionnaire to clarify the reasons for missing a scheduled clinic appointment and offer suggestions for a solution. The recruiter, in turn, answered several demographical questions. Results The study showed a statistically significant difference between the no-show rate in females at 60% compared to males at 40% (P = 0.0023). The no show rate was not significantly affected by the day of the week, time of appointment, or the weather. Forgetting about the appointment was the most common cause (36 subjects). Work-related issues were reported in 17 participants, making it the 2nd most common cause. Not notified about the appointment, Lack of transportation, childcare-related issues, along with other reasons, were less likely reported (Table 2). 11 out of 36 (30%) subjects suggested a reminder text message in their preferred language; meanwhile, 4 others suggested a weekend clinic. Conclusion The patients should be aware of different appointment reminders options and have the freedom to choose a suitable reminder. Patients should be educated about the importance of calling to cancel the appointment since some of the reasons for no show are unpreventable.
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Affiliation(s)
- Mina Fransawy Alkomos
- Internal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USA
| | - Dianelys Mendez
- Internal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USA
| | - Diana Mazzei-Pifano
- Internal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USA
| | - Fady Shafeek
- Internal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USA
| | - Carla Rodriguez
- Internal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USA
| | - Farisa Ali
- Internal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USA
| | - Chelsea Banks
- Medical school, New York Medical College, Valhalla, NY, USA
| | - Gabriel Melki
- Internal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USA
| | - Patrick Michael
- Internal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USA
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Lagman RL, Samala RV, LeGrand S, Parala-Metz A, Patel C, Neale K, Carrino C, Rybicki L, Gamier P, Mauk ME, Nowak M. "If You Call Them, They Will Come": A Telephone Call Reminder to Decrease the No-Show Rate in an Outpatient Palliative Medicine Clinic. Am J Hosp Palliat Care 2020; 38:448-451. [PMID: 32845702 DOI: 10.1177/1049909120952322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION A high outpatient clinic no-show rate affects clinical outcomes, increases healthcare costs, and reduces both access to care and provider productivity. In an effort to reduce the no-show rate at a busy palliative medicine outpatient clinic, a quality improvement project was launched consisting of a telephone call made by clinic staff prior to appointments. The study aimed to determine the effect of this intervention on the no-show rate, and assess the financial impact of a decreased no-show rate. METHODS AND MATERIALS The outpatient clinic no-show rate was measured from September 1 to December 31, 2015. Data from the first 8 months of the calendar year was removed since these could not be verified. Starting January 1, 2016, patients received a telephone call reminder 24 hours prior to their scheduled outpatient appointment for confirmation. No-show rate was again measured for the calendar year 2016. Opportunity costs were calculated for unfulfilled clinic visits. RESULTS Of the 1224 completed visits from September 1 to December 31, 2015, 271 were no-shows with an average rate of 11.8%. After the intervention, there were 4368 completed visits and 562 no-shows. The no-show rate for 2016 averaged 6.9% (p < 0.001), down 4.9% from the last 4 months of 2015. Estimated opportunity costs were about 396 no-show visits avoided, equivalent to an annual savings of about $79,200. CONCLUSION A telephone call reminder to patients 24 hours prior to their appointment decreased the no-show rate in an outpatient palliative medicine clinic. Avoiding unfulfilled visits resulted in substantial opportunity costs.
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Affiliation(s)
- Ruth L Lagman
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Renato V Samala
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Susan LeGrand
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Armida Parala-Metz
- Department of Supportive Oncology, 536516Levine Cancer Institute, Charlotte, NC, USA
| | - Chirag Patel
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Kyle Neale
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Cheryl Carrino
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Rybicki
- Department of Quantitative Health Sciences, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Pamela Gamier
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Mary Ellen Mauk
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Molly Nowak
- Department of Palliative and Supportive Care, 2569Cleveland Clinic, Cleveland, OH, USA
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Kamal S, Glass TR, Doco-Lecompte T, Locher S, Bugnon O, Parienti JJ, Cavassini M, Schneider MP. An Adherence-Enhancing Program Increases Retention in Care in the Swiss HIV Cohort. Open Forum Infect Dis 2020; 7:ofaa323. [PMID: 32913876 PMCID: PMC7473741 DOI: 10.1093/ofid/ofaa323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022] Open
Abstract
Background This study tested a theory-based adherence-enhancing intervention: the “Interprofessional Medication Adherence Program” (IMAP) to increase human immunodeficiency virus (HIV) retention in care. Methods We retrospectively compared our intervention center (intervention group [IG]) with a standard of care center (control group [CG]) both participating in the Swiss HIV Cohort Study between 2004 and 2012. Endpoints were defined as >6-month and >12-month gaps in care for intervals of care longer than 6 and 12 months without any blood draw. Inverse probability of treatment weights was used to adjust for differences between patients at the 2 centers. Viral failure was defined as ribonucleic acid ≥50 copies/mL after 24+ weeks on antiretrovirals. Results The IG included 451 patients, CG 311. In the IG, 179 (40%) patients took part in the IMAP for a median of 27 months (interquartile range, 12–45). Gaps in care of ≥6 months were significantly more likely to happen in the CG versus IG (74.6% vs 57%, P < .001). The median time until the first treatment gap was longer in the IG vs CG (120 vs 84 weeks, P < .001). Gaps in care of ≥12 months evaluated in 709 (93%) patients were significantly more likely to occur in the CG compared with the IG (22.6% vs 12.5%, P < .001). The rate of viral failure was significantly lower in the IG (8.3% vs 15.1%, P = .003). Conclusions This study, in a real-world setting, shows the effectiveness of the IMAP to reduce 6- and 12-month gaps in follow up among people with HIV. These results should be confirmed by studies in other settings.
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Affiliation(s)
- Susan Kamal
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland Geneva, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Tracy R Glass
- Clinical Statistics and Data Management Group, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Thanh Doco-Lecompte
- HIV Unit, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Sophie Locher
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland Geneva, Switzerland
| | - Olivier Bugnon
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland Geneva, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Matthias Cavassini
- Infectious Disease Service, Lausanne University Hospital, University of Lausanne, Lausanne Switzerland
| | - Marie P Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland Geneva, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Aladeemy M, Adwan L, Booth A, Khasawneh MT, Poranki S. New feature selection methods based on opposition-based learning and self-adaptive cohort intelligence for predicting patient no-shows. Appl Soft Comput 2020. [DOI: 10.1016/j.asoc.2019.105866] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Vasyukova NO, Lukina YV, Zvonareva OI, Voronina VP, Tolpygina SN, Dmitrieva NA, Lerman OV, Zagrebelny AV, Budaeva IV, Nekoshnova ES, Kutishenko NP, Martsevich SY. Assessment of adherence to medication and visits in healthcare facilities for cardiovascular patients who participated in international randomized controlled trials. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-6-107-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Yu. V. Lukina
- National Medical Research Center for Preventive Medicine
| | | | - V. P. Voronina
- National Medical Research Center for Preventive Medicine
| | | | | | - O. V. Lerman
- National Medical Research Center for Preventive Medicine
| | | | - I. V. Budaeva
- National Medical Research Center for Preventive Medicine
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Ding X, Gellad ZF, Mather C, Barth P, Poon EG, Newman M, Goldstein BA. Designing risk prediction models for ambulatory no-shows across different specialties and clinics. J Am Med Inform Assoc 2019; 25:924-930. [PMID: 29444283 PMCID: PMC6077778 DOI: 10.1093/jamia/ocy002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/07/2018] [Indexed: 12/31/2022] Open
Abstract
Objective As available data increases, so does the opportunity to develop risk scores on more refined patient populations. In this paper we assessed the ability to derive a risk score for a patient no-showing to a clinic visit. Methods Using data from 2 264 235 outpatient appointments we assessed the performance of models built across 14 different specialties and 55 clinics. We used regularized logistic regression models to fit and assess models built on the health system, specialty, and clinic levels. We evaluated fits based on their discrimination and calibration. Results Overall, the results suggest that a relatively robust risk score for patient no-shows could be derived with an average C-statistic of 0.83 across clinic level models and strong calibration. Moreover, the clinic specific models, even with lower training set sizes, often performed better than the more general models. Examination of the individual models showed that risk factors had different degrees of predictability across the different specialties. Implementation of optimal modeling strategies would lead to capturing an additional 4819 no-shows per-year. Conclusion Overall, this work highlights both the opportunity for and the importance of leveraging the available electronic health record data to develop more refined risk models.
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Affiliation(s)
- Xiruo Ding
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, 27710, USA
| | - Ziad F Gellad
- Department of Medicine, Duke University, Durham, North Carolina, 27703, USA.,Department of Medicine, Durham VA Medical Center, Durham, North Carolina, 27705, USA
| | - Chad Mather
- Department of Medicine, Duke University, Durham, North Carolina, 27703, USA
| | - Pamela Barth
- Duke Health Technology Solutions, Duke University, Durham, North Carolina, 27713, USA
| | - Eric G Poon
- Duke Health Technology Solutions, Duke University, Durham, North Carolina, 27713, USA
| | - Mark Newman
- Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, 40536, USA
| | - Benjamin A Goldstein
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, 27710, USA.,Center for Predictive Medicine, Duke Clinical Research Institute, Durham, North Carolina, 27705, USA
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Briatore A, Tarsetti EV, Latorre A, Gonzalez Bernaldo de Quirós F, Luna D, Fuentes NA, Elizondo CM, Baum A, Alonso Serena M, Giunta DH. Causes of appointment attendance, nonattendance, and cancellation in outpatient consultations at a university hospital. Int J Health Plann Manage 2019; 35:207-220. [DOI: 10.1002/hpm.2890] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Agustina Briatore
- Departamento de Informática en SaludHospital Italiano de Buenos Aires CABA Argentina
| | | | - Agustin Latorre
- Servicio de PediatríaHospital de Clínicas “José de San Martín” CABA Argentina
| | - Fernan Gonzalez Bernaldo de Quirós
- Área de Investigación en Medicina InternaHospital Italiano de Buenos Aires CABA Argentina
- Servicio de Clínica MédicaHospital Italiano de Buenos Aires CABA Argentina
| | - Daniel Luna
- Departamento de Informática en SaludHospital Italiano de Buenos Aires CABA Argentina
| | - Nora Angélica Fuentes
- Área de Investigación en Medicina InternaHospital Italiano de Buenos Aires CABA Argentina
| | - Cristina Maria Elizondo
- Área de Investigación en Medicina InternaHospital Italiano de Buenos Aires CABA Argentina
- Servicio de Clínica MédicaHospital Italiano de Buenos Aires CABA Argentina
| | - Analia Baum
- Departamento de Informática en SaludHospital Italiano de Buenos Aires CABA Argentina
| | - Marina Alonso Serena
- Área de Investigación en Medicina InternaHospital Italiano de Buenos Aires CABA Argentina
| | - Diego Hernán Giunta
- Área de Investigación en Medicina InternaHospital Italiano de Buenos Aires CABA Argentina
- Servicio de Clínica MédicaHospital Italiano de Buenos Aires CABA Argentina
- Departamento de investigaciónHospital Italiano de Buenos Aires CABA Argentina
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Ofei-Dodoo S, Kellerman R, Hartpence C, Mills K, Manlove E. Why Patients Miss Scheduled Outpatient Appointments at Urban Academic Residency Clinics: A Qualitative Evaluation. Kans J Med 2019; 12:57-61. [PMID: 31489100 PMCID: PMC6710029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/16/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Missed outpatient appointments are a common problem for academic residency clinics, and reducing their rate improves office efficiency, income, and resident education. Identifying specific reasons why some patients miss outpatient appointments may provide insight into developing targeted approaches to reducing their rates. This study sought to find reasons associated with patients' missed appointments at two family medicine residency clinics. METHODS The study utilized a qualitative research design involving patients at two urban, university-affiliated family medicine residency outpatient clinics. Twenty-five randomly selected patients who were dismissed from the clinics for missing three or more scheduled appointments during a five-year span (July 2012 to July 2017) were interviewed over the phone about reasons they did not keep their scheduled clinic appointments. The authors, individually and as a group, used an immersion-crystalization approach to analyze the content of the interviews. RESULTS Responses from 25 participants (21 females and four males) are presented. Fifty-two percent of patients were Caucasian, 32% Black, 12% Hispanic, and 4% Asian. Five themes emerged from the data analysis as major reasons the patients missed their scheduled outpatient appointments: forgetfulness, transportation issues, personal health issues, family and employer obligations, and other issues, such as anticipated long clinic wait times, bad weather, and financial problems. CONCLUSIONS The findings showed there are several logistical, situational, and clinical reasons for patients' missed scheduled outpatient appointments.
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Affiliation(s)
- Samuel Ofei-Dodoo
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita
| | - Rick Kellerman
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita
| | - Connor Hartpence
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita,Family Medicine Residency Program at Ascension Via Christi, University of Kansas School of Medicine-Wichita
| | - Kale Mills
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita
| | - Emily Manlove
- Indiana University Health Bloomington Hospital, Bloomington, IN, University of Kansas School of Medicine-Wichita
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Penzias R, Sanabia V, Shreeve KM, Bhaumik U, Lenz C, Woods ER, Forman SF. Personal Phone Calls Lead to Decreased Rates of Missed Appointments in an Adolescent/Young Adult Practice. Pediatr Qual Saf 2019; 4:e192. [PMID: 31572893 PMCID: PMC6708648 DOI: 10.1097/pq9.0000000000000192] [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] [Received: 08/17/2018] [Accepted: 06/12/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Nationally, hospital practice missed appointment rates are high. Our goal was to reduce the rate of missed appointments in an Adolescent/Young Adult Practice through quality improvement methods. METHODS During the 12-month intervention period, administrative staff called patients the day before their primary or specialty care appointments to remind them of the date, time, and location, as well as patients who did not attend their appointments to ask about the reason for their missed appointment. We implemented Plan-Do-Study-Act interventions and analyzed data to compare missed appointment rates between the 12 months before and after February 1, 2017, the project intervention date. RESULTS Results showed significant reductions in the missed appointment rate for the Adolescent/Young Adult Practice. A control chart showed a shift in the mean overall percent of completed appointments from 76.7% to 79.2%. The most common reasons for missed appointments included forgetting (39.2%), conflicts with work/school (11.0%), or emailing the provider without contacting administrative staff (7.8%). There were significant reductions in missed appointment rates for both males and females as well as patients who were ≥20 years old, identified English or Spanish as their primary language, had public or private insurance, identified as Black or Hispanic, or did or did not require an interpreter. CONCLUSION These data show that targeted interventions such as personalized reminder calls can be effective in reducing patient missed appointment rates in Adolescent/Young Adult Practices.
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Affiliation(s)
- Rebecca Penzias
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Virginia Sanabia
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Kyra M Shreeve
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Urmi Bhaumik
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
- Office of Community Health, Boston Children's Hospital, Boston, MA
| | - Caitlin Lenz
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Sara F Forman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
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Giunta DH, Alonso Serena M. Nonattendance rates of scheduled outpatient appointments in a university general hospital. Int J Health Plann Manage 2019; 34:1377-1385. [PMID: 31062463 DOI: 10.1002/hpm.2797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE We aimed to estimate nonattendance to scheduled medical ambulatory appointments rates globally and by subgroups. DESIGN AND PARTICIPANTS We designed a retrospective cohort of all adult outpatients over 18 years old who requested at least one scheduled ambulatory medical appointment from 1 January 2015 to 31 December 2016. SETTING Hospital Italiano de Buenos Aires is a university general hospital in the Autonomous City of Buenos Aires, Argentina. It includes an integrated health care network that is formed by two high complexity hospitals and 22 primary care centers. RESULTS The age median was 60.4 years, and 31.33% of the appointments were scheduled by men; 2 526 549 appointments fulfilled selection criteria, belonging to 348 420 patients. The global nonattendance rate was 27.84% (95% CI, 27.79-27.9). The nonattendance rate to general practitioner appointments was 25.53% (95% CI, 25.42-25.63); to clinical specialties, 27.78% (95% CI, 27.68-27.87); and to surgical specialties, 29.31% (95% CI, 29.23-29.4). CONCLUSIONS Because of the consistent variability of nonattendance in different settings, it is strongly recommended that local estimates are used in the design of effective interventions to improve adherence with outpatient healthcare scheduled appointments.
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Affiliation(s)
- Diego Hernan Giunta
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marina Alonso Serena
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Pasternak K, Thibeault SL. Factors Affecting Initiation of Voice Therapy for Paradoxical Vocal Fold Motion Disorder. J Voice 2019; 34:559-566. [PMID: 30660338 DOI: 10.1016/j.jvoice.2018.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate patient-level predictors of initiation of voice therapy for paradoxical vocal fold motion disorder (PVFM). STUDY DESIGN Prospective outcomes database study. METHODS Patients consented to the University of Wisconsin Voice and Swallow Clinics Outcomes Database between March 2010 and November 2016 who were diagnosed with PVFM and recommended for voice therapy were eligible. Patients who attended at least one voice therapy session were considered to have initiated therapy. Analyzed variables included age, gender, distance to the clinic, insurance status, socioeconomic factors, comorbidity score, spirometry results, presence of asthma and/or dysphonia diagnoses, length of evaluation and evaluation model, and patient scores on the Voice Handicap Index and Generalized Anxiety Disorder 7-item scale. RESULTS One-hundred seventy-eight patients met inclusion criteria. Of these, 118 initiated voice therapy as recommended (66.29%). The majority of patients were female (n = 127; 71.35%). Age was the only factor significantly associated with therapy initiation in both univariate (P = 0.0359) and multivariable (P = 0.0295) analyses, with patients aged 30-39 least likely to attend compared with other age groups. Multivariable analysis also showed that patients evaluated by a speech-language pathologist alone were an estimated three times as likely to initiate therapy compared to patients evaluated by speech-language pathologist and otolaryngologist (ENT) together (P = 0.0407). Other variables were not statistically significant for prediction of therapy initiation. CONCLUSIONS This study suggests that age group and evaluation model are associated with initiation of voice therapy for PVFM. Further study is needed to investigate social-cognitive and quality-of-life factors in predicting therapy initiation.
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Affiliation(s)
- Kevin Pasternak
- Voice and Swallow Clinics, University Hospital, Madison, Wisconsin.
| | - Susan L Thibeault
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
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Taylor D, Lunny C, Lolić P, Warje O, Geldman J, Wong T, Gilbert M, Lester R, Ogilvie G. Effectiveness of text messaging interventions on prevention, detection, treatment, and knowledge outcomes for sexually transmitted infections (STIs)/HIV: a systematic review and meta-analysis. Syst Rev 2019; 8:12. [PMID: 30621784 PMCID: PMC6323863 DOI: 10.1186/s13643-018-0921-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/18/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rates of STIs continue to rise worldwide, and novel evidence-based interventions such as text messaging aimed at improving client services are needed. We conducted a meta-analysis to evaluate text messaging to support STI/HIV prevention and treatment interventions. METHODS We included articles that reported findings from randomized controlled trials (RTCs) involving adults and youth who were at risk of acquiring (or who currently had) a STI and/or HIV, a text message and comparator intervention, and reported provided outcome data on adherence to STI/HIV treatments. Articles were excluded if they were not published in English. We only included studies that have full-text publications so certainty and risk of bias assessments could be performed. Eight databases were searched to retrieve articles published between 1996 and March 2017. The Cochrane risk of bias tool was used and certainty of the evidence was assessed using GRADE. Effect estimates were pooled using a random effects model. RESULTS A total of 35 RCTs were found, 6 of which were considered at low risk of bias. Eight studies found an increased association using text messaging in appointments attended compared to standard care (OR 1.64, 95% CI 1.28 to 2.10). Participants receiving text messages had an increase in HIV testing compared to standard care (n = 6; OR 1.73, 95% CI 1.39 to 2.15). Ten text messaging RCTs measuring adherence using micro-electro-mechanical systems (MEMS) pill counts has a non-significant association (OR 1.17, 95% CI 0.95-1.45) while five studies measuring adherence by self-report was found to be significant (OR 1.64, 95% CI 1.28-2.11). CONCLUSIONS The effectiveness of text message interventions is equivocal. While text messaging has the potential to enhance the delivery of STI/HIV interventions, program planners are encouraged to evaluate any SMS intervention to ensure it is achieving the desired result. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013006503.
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Affiliation(s)
- Darlene Taylor
- University of British Columbia, 1147 Research Road, Rm ARTS 154, Kelowna, BC, V1V 1V7, Canada.
| | - Carole Lunny
- University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Petra Lolić
- BC Centre for Disease Control, 655 W12th Ave, Vancouver, BC, Canada
| | - Orion Warje
- Vancouver Island Health Authority, 1952 Bay Street, Victoria, BC, V8R 1J8, Canada
| | - Jasmina Geldman
- University of British Columbia, 1147 Research Road, Rm ARTS 154, Kelowna, BC, V1V 1V7, Canada
| | - Tom Wong
- Health Canada/Santé Canada, 200 Eglantine Driveway, Room 1913A, Ottawa, ON, K1A 0K9, Canada
| | - Mark Gilbert
- BC Centre for Disease Control, 655 W12th Ave, Vancouver, BC, Canada
| | - Richard Lester
- University of British Columbia, Research Pavilion, Rm 566, 828 W 10th, Vancouver, BC, V5Z 1 M9, Canada
| | - Gina Ogilvie
- University of British Columbia, Box 42, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
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Addison D, Baim-Lance A, Suchman L, Katz B, Swain CA, Piersanti K, Steinbock C, Sawicki S, Agins B, Nash D. Factors Influencing the Successful Implementation of HIV Linkage and Retention Interventions in Healthcare Agencies Across New York State. AIDS Behav 2019; 23:105-114. [PMID: 29492740 DOI: 10.1007/s10461-018-2060-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
As part of the System Linkages and Access to Care Initiative, 12 HIV service delivery organizations in New York implemented one of the following three interventions to improve linkage to and retention in HIV care at their site: Peer Support, Appointment Procedures, and Anti-Retroviral Treatment and Access to Services. Aggregate process measure data describing intervention delivery, in conjunction with qualitative findings to help explain barriers and facilitators to achieving full implementation were examined. Process data from the interventions showed shortcomings in the percentage of eligible patients who went on to be enrolled, and the number of enrollees who ultimately received the components of the interventions. Factors identified in qualitative interviews that facilitated implementation and intervention delivery included: concerted buy-in and coordination of staff, building upon existing infrastructure including ensuring sufficient staff capacity, and allowing adaptability of certain parts of the intervention to better fit patient needs and clinical settings.
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Mehta K, Kumar AMV, Chawla S, Chavda P, Selvaraj K, Shringarpure KS, Solanki DM, Verma PB, Rewari BB. 'M-TRACK' (mobile phone reminders and electronic tracking tool) cuts the risk of pre-treatment loss to follow-up by 80% among people living with HIV under programme settings: a mixed-methods study from Gujarat, India. Glob Health Action 2018; 11:1438239. [PMID: 29482468 PMCID: PMC5827770 DOI: 10.1080/16549716.2018.1438239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: In 2016, the National AIDS Control Programme (NACP) in Gujarat, India implemented an innovative intervention called ‘M-TRACK’ (mobile phone reminders once every week for four weeks after diagnosis and electronic patient tracking tool) to reduce pre-treatment loss to follow-up (LFU) among people living with HIV (PLHIV) in Vadodara district while other districts received standard of care. Objectives: To assess the effectiveness of M-TRACK in reducing pre-treatment LFU (proportion of diagnosed PLHIV not registering for HIV care by four weeks after diagnosis) and to explore the implementation enablers and challenges from health care providers’ and PLHIV perspective. Methods: An explanatory mixed-methods study design was used wherein the quantitative phase (cohort study with two groups: Vadodara district exposed to M-TRACK and Rajkot district as unexposed) was followed by a qualitative phase (descriptive study involving group interview with 16 health care providers, personal interviews with two programme managers and telephonic interviews with 16 PLHIV). Data were collected during October 2016 to February 2017. Results: During the pre-M-TRACK period (July–September 2016), the LFU proportion was similar [13% (25/191) in Vadodara; 15% (21/141) in Rajkot (p = 0.8)]. During the M-TRACK period (October–December 2016), LFU decreased to 4% (9/209) in Vadodara (exposed), whereas it remained similar at 16% (18/113) in Rajkot (unexposed) district (p = 0.02). PLHIV exposed to M-TRACK had an 80% lower risk of LFU (aRR 0.2; 95% CI: 0.1–0.5) compared with standard care, after adjusting for socio-demographics, time and clustering at district level. During interviews, M-TRACK was welcomed by both PLHIV and the counsellors. The latter felt it saved time by obviating the need for home visits and helped in documentation. Inconvenience of using landline phone available at the health facility, lack of budgets for reimbursement of mobile call expenses and internet connectivity problems were the key implementation challenges. Conclusion: M-TRACK was highly effective in reducing the gap between diagnosis and treatment. It may be considered for scale-up after addressing the challenges noted.
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Affiliation(s)
- Kedar Mehta
- a Department of Community Medicine , GMERS Medical College , Vadodara , India
| | - Ajay M V Kumar
- b Centre for Operational Research , International Union Against Tuberculosis and Lung Disease (The Union) , Paris , France.,c Centre for Operational Research , International Union Against Tuberculosis and Lung Disease (The Union) , New Delhi , India
| | - Sudhir Chawla
- d Care, Support and Treatment Department , Gujarat State AIDS Control Society , Ahmedabad , India
| | - Paragkumar Chavda
- a Department of Community Medicine , GMERS Medical College , Vadodara , India
| | - Kalaiselvi Selvaraj
- e Department of Community Medicine , Pondicherry Institute of Medical Sciences , Puducherry , India
| | | | - Dipak M Solanki
- a Department of Community Medicine , GMERS Medical College , Vadodara , India
| | - Pramod B Verma
- d Care, Support and Treatment Department , Gujarat State AIDS Control Society , Ahmedabad , India
| | - B B Rewari
- g Research Department , World Health Organization , New Delhi , India
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Taylor BS, Fornos L, Tarbutton J, Muñoz J, Saber JA, Bullock D, Villarreal R, Nijhawan AE. Improving HIV Care Engagement in the South from the Patient and Provider Perspective: The Role of Stigma, Social Support, and Shared Decision-Making. AIDS Patient Care STDS 2018; 32:368-378. [PMID: 30179530 DOI: 10.1089/apc.2018.0039] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Initial linkage to medical care is a critical step in the HIV care continuum leading to improved health outcomes, reduced morbidity and mortality, and decreased HIV transmission risk. We explored differences in perspectives on engagement in HIV care between people living with HIV who attended (Arrived) their initial medical provider visit (IMV) and those who did not (Missed), and between patients and providers. The study was conducted in two large majority/minority HIV treatment centers in the United States (US) south, a geographical region disproportionately impacted by HIV. The Theory of Planned Behavior informed semistructured interviews eliciting facilitators and barriers to engagement in care from 53 participants: 40 patients in a structured sample of 20 Missed and 20 Arrived, and 13 care providers. Using Grounded Theory to frame analysis, we found similar perspectives for all groups, including beliefs in the following: patients' control over care engagement, a lack of knowledge regarding HIV within the community, and the impact of structural barriers to HIV care such as paperwork, transportation, housing, and substance use treatment. Differences were noted by care engagement status. Missed described HIV-related discrimination, depression, and lack of social support. Arrived worried what others think about their HIV status. Providers focused on structural barriers and process, while patients focused on relational aspects of HIV care and personal connection with clinics. Participants proposed peer navigation and increased contact from clinics as interventions to reduce missed IMV. Context-appropriate interventions informed by these perspectives are needed to address the expanding southern HIV epidemic.
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Affiliation(s)
- Barbara S. Taylor
- Department of Medicine, Division of Infectious Diseases, UT Health Science Center San Antonio, San Antonio, Texas
| | - Laura Fornos
- Department of Research and Information Management, University Health System, San Antonio, Texas
| | - Jesse Tarbutton
- Department of Medicine, Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas
| | - Jana Muñoz
- Round Rock Cancer Center, Baylor Scott & White Health, Round Rock, Texas
| | - Julie A. Saber
- HIV/STD Care Services Group, Texas Department of State Health Services, Austin, Texas
| | - Delia Bullock
- Department of Medicine, Division of Infectious Diseases, UT Health Science Center San Antonio, San Antonio, Texas
| | - Roberto Villarreal
- Department of Research and Information Management, University Health System, San Antonio, Texas
| | - Ank E. Nijhawan
- Department of Medicine, Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas
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Barry V, Steffens C, Mattis S, Sidonio RF, Tran DQ, Kempton CL. A cross-sectional study of non-attendance among patients at a US hemophilia treatment center 2010-2014. Haemophilia 2018; 24:902-910. [DOI: 10.1111/hae.13553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 12/30/2022]
Affiliation(s)
- V. Barry
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - C. Steffens
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - S. Mattis
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - R. F. Sidonio
- Division of Hematology/Oncology; Department of Pediatrics; Aflac Blood and Cancer Disorders; Emory University School of Medicine; Atlanta GA USA
| | - D. Q. Tran
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - C. L. Kempton
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
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Parente CA, Salvatore D, Gallo GM, Cipollini F. Using overbooking to manage no-shows in an Italian healthcare center. BMC Health Serv Res 2018; 18:185. [PMID: 29544481 PMCID: PMC5856203 DOI: 10.1186/s12913-018-2979-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/01/2018] [Indexed: 11/13/2022] Open
Abstract
Background In almost all healthcare systems, no-shows (scheduled appointments missed without any notice from patients) have a negative impact on waiting lists, costs and resource utilization, impairing the quality and quantity of cares that could be provided, as well as the revenues from the corresponding activity. Overbooking is a tool healthcare providers can resort to reduce the impact of no-shows. Methods We develop an overbooking algorithm, and we assess its effectiveness using two methods: an analysis of the data coming from a practical implementation in an healthcare center; a simulation experiment to check the robustness and the potential of the strategy under different conditions. The data of the study, which includes personal and administrative information of patients, together with their scheduled and attended examinations, was taken from the electronic database of a big outpatient center. The attention was focused on the Magnetic Resonance (MR) ward because it uses expensive equipment, its services need long execution times, and the center has actually used it to implement an overbooking strategy aimed at reducing the impact of no-shows. We propose a statistical model for the patient’s show/no-show behavior and we evaluate the ensuing overbooking procedure implemented in the MR ward. Finally, a simulation study investigates the effects of the overbooking strategy under different scenarios. Results The first contribution is a list of variables to identify the factors performing the best to predict no-shows. We classified the variables in three groups: “Patient’s intrinsic factors”, “Exogenous factors” and “Factors associated with the examination”. The second contribution is a predictive model of no-shows, which is estimated on context-specific data using the variables just discussed. Such a model represents a fundamental ingredient of the overbooking strategy we propose to reduce the negative effects of no-shows. The third contribution is the assessment of that strategy by means of a simulation study under different scenarios in terms of number of resources and no-show rates. The same overbooking strategy was also implemented in practice (giving the opportunity to consider it as a quasi-experiment) to reduce the negative impact caused by non attendance in the MR ward. Both the quasi-experiment and the simulation study demonstrated that the strategy improved the center’s productivity and reduced idle time of resources, although it increased slightly the patient’s waiting time and the staff’s overtime. This represents an evidence that overbooking can be suitable to improve the management of healthcare centers without adversely affecting their costs and the quality of cares offered. Conclusions We shown that a well designed overbooking procedure can improve the management of medical centers, in terms of a significant increase of revenue, while keeping patient’s waiting time and overtime under control. This was demonstrated by the results of a quasi-experiment (practical implementation of the strategy in the MR ward) and a simulation study (under different scenarios). Such positive results took advantage from a predictive model of no-show carefully designed around the medical center data. Electronic supplementary material The online version of this article (10.1186/s12913-018-2979-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Domenico Salvatore
- Department of Accounting, Management and Economics, University of Naples Parthenope, Via Generale Parisi, 13, 80132, Naples, Italy
| | - Giampiero Maria Gallo
- Corte dei conti, Sezione regionale di controllo per la Lombardia, via Marina 5, 20121, Milan, Italy
| | - Fabrizio Cipollini
- Department of Statistics, Informatics and Applications (DiSIA) G. Parenti, University of Florence, Viale Giovanni Battista Morgagni, 59, 50134, Florence, Italy
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van der Kop ML, Muhula S, Nagide PI, Thabane L, Gelmon L, Awiti PO, Abunah B, Kyomuhangi LB, Budd MA, Marra C, Patel A, Karanja S, Ojakaa DI, Mills EJ, Ekström AM, Lester RT. Effect of an interactive text-messaging service on patient retention during the first year of HIV care in Kenya (WelTel Retain): an open-label, randomised parallel-group study. Lancet Public Health 2018; 3:e143-e152. [PMID: 29361433 PMCID: PMC5884138 DOI: 10.1016/s2468-2667(17)30239-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Retention of patients in HIV care is crucial to ensure timely treatment initiation, viral suppression, and to avert AIDS-related deaths. We did a randomised trial to determine whether a text-messaging intervention improved retention during the first year of HIV care. METHODS This unmasked, randomised parallel-group study was done at two clinics in informal settlements in Nairobi, Kenya. Eligible participants were aged 18 years or older, HIV-positive, had their own mobile phone or access to one, and were able to use simple text messaging (or have somebody who could text message on their behalf). Participants were randomly assigned (1:1), with random block sizes of 2, 4, and 6, to the intervention or control group. Participants in the intervention group received a weekly text message from the automated WelTel service for 1 year and were asked to respond within 48 h. Participants in the control group did not receive text messages. Participants in both groups received usual care, which comprised psychosocial support and counselling; patient education; CD4 cell count; treatment; screening for tuberculosis, opportunistic infections, and sexually transmitted infections; prevention of mother-to-child transmission and family planning services; and up to two telephone calls for missed appointments. The primary outcome was retention in care at 12 months (ie, clinic attendance 10-14 months after the first visit). Participants who did not attend this 12-month appointment were traced, and we considered as retained those who were confirmed to be active in care elsewhere. The data analyst and clinic staff were masked to the group assignment, whereas participants and research nurses were not. We analysed the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01630304. FINDINGS Between April 4, 2013, and June 4, 2015, we screened 1068 individuals, of whom 700 were recruited. 349 people were allocated to the intervention group and 351 to the control group. Participants were followed up for a median of 55 weeks (IQR 51-60). At 12 months, 277 (79%) of 349 participants in the intervention group were retained, compared with 285 (81%) of 351 participants in the control group (risk ratio 0·98, 95% CI 0·91-1·05; p=0·54). There was one mild adverse event related to the intervention, a domestic dispute that occurred when a participant's partner became suspicious of the weekly messages and follow-up calls. INTERPRETATION This weekly text-messaging service did not improve retention of people in early HIV care. The intervention might have a modest role in improving self-perceived health-related quality of life in individuals in HIV care in similar settings. FUNDING National Institutes of Health and Canadian Institutes of Health Research Canadian HIV Trials Network.
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Affiliation(s)
- Mia Liisa van der Kop
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Stockholm, Sweden; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | | | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lawrence Gelmon
- Department of Medical Microbiology, University of Manitoba, Basic Medical Science Building, Winnipeg, MB, Canada
| | - Patricia Opondo Awiti
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Stockholm, Sweden
| | | | | | - Matthew A Budd
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Carlo Marra
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Anik Patel
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - David I Ojakaa
- University of Eldoret, Eldoret-Ziwa Road, Eldoret, Kenya
| | - Edward J Mills
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Anna Mia Ekström
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Richard Todd Lester
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Abstract
National HIV prevention goals call for interventions that address Continuum of HIV Care (CoC) for persons living with HIV. Electronic health (eHealth) can leverage technology to rapidly develop and disseminate such interventions. We conducted a qualitative review to synthesize (a) technology types, (b) CoC outcomes, (c) theoretical frameworks, and (d) behavior change mechanisms. This rapid review of eHealth, HIV-related articles (2007-2017) focused on technology-based interventions that reported CoC-related outcomes. Forty-five studies met inclusion criteria. Mobile texting was the most commonly reported technology (44.4%, k = 20). About 75% (k = 34) of studies showed proven or preliminary efficacy for improving CoC-related outcomes. Most studies (60%, k = 27) focused on medication adherence; 20% (k = 9) measured virologic suppression. Many eHealth interventions with preliminary or proven efficacy relied on mobile technology and integrated knowledge/cognition as behavior change mechanisms. This review identified gaps in development and application of eHealth interventions regarding CoC.
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Bashshur RL, Howell JD, Krupinski EA, Harms KM, Bashshur N, Doarn CR. The Empirical Foundations of Telemedicine Interventions in Primary Care. Telemed J E Health 2017; 22:342-75. [PMID: 27128779 DOI: 10.1089/tmj.2016.0045] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION This article presents the scientific evidence for the merits of telemedicine interventions in primary care. Although there is no uniform and consistent definition of primary care, most agree that it occupies a central role in the healthcare system as first contact for patients seeking care, as well as gatekeeper and coordinator of care. It enables and supports patient-centered care, the medical home, managed care, accountable care, and population health. Increasing concerns about sustainability and the anticipated shortages of primary care physicians have sparked interest in exploring the potential of telemedicine in addressing many of the challenges facing primary care in the United States and the world. MATERIALS AND METHODS The findings are based on a systematic review of scientific studies published from 2005 through 2015. The initial search yielded 2,308 articles, with 86 meeting the inclusion criteria. Evidence is organized and evaluated according to feasibility/acceptance, intermediate outcomes, health outcomes, and cost. RESULTS The majority of studies support the feasibility/acceptance of telemedicine for use in primary care, although it varies significantly by demographic variables, such as gender, age, and socioeconomic status, and telemedicine has often been found more acceptable by patients than healthcare providers. Outcomes data are limited but overall suggest that telemedicine interventions are generally at least as effective as traditional care. Cost analyses vary, but telemedicine in primary care is increasingly demonstrated to be cost-effective. CONCLUSIONS Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment. Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost, but patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.
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Affiliation(s)
- Rashid L Bashshur
- 1 University of Michigan Health System, University of Michigan , Ann Arbor, Michigan
| | - Joel D Howell
- 2 Department of Internal Medicine, University of Michigan , Ann Arbor, Michigan.,3 Department of History and Health Management and Policy, University of Michigan , Ann Arbor, Michigan
| | | | - Kathryn M Harms
- 5 Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Noura Bashshur
- 1 University of Michigan Health System, University of Michigan , Ann Arbor, Michigan
| | - Charles R Doarn
- 6 Department of Family and Community Medicine, University of Cincinnati , Cincinnati, Ohio
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Sant' Ana AM. Pesquisa operativa para adequação das agendas num serviço de Atenção Primária. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2017. [DOI: 10.5712/rbmfc12(39)1459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: Em 2014 a Unidade de Saúde Mãe Curitibana adotou o modelo “carve-out” de organização das agendas, destinando metade das consultas para agendamentos e metade às denominadas consultas de acolhimento, que são reservadas para atendimentos no mesmo dia. Objetivos: Avaliar a proporção de utilização das consultas agendadas e de acolhimento ofertadas. Métodos: Estudo observacional descritivo aplicando formulário de variáveis à totalidade dos pacientes registrados na agenda eletrônica da área denominada “Verde” da Unidade de Saúde Mãe Curitibana, no período de 22 de junho a 24 de julho de 2015. Resultados: Foram 393 mulheres (67%) e 194 homens (33%), com 35,43% das consultas sendo de pessoas acima de 60 anos. Um total de 451 (77%) registros eram de pacientes da área e 136 (23%) de outras áreas. Houve faltas a 13% das consultas. A taxa de aproveitamento de consultas (número de comparecimentos/total de consultas ofertadas) foi de 78,77% (271/344) para as consultas agendadas e 67,89% (239/352) para os acolhimentos. Dos acolhimentos realizados, 45% foram destinados a pacientes de outras áreas. Conclusão: A taxa de aproveitamento é maior para as consultas agendadas, demonstrando uma necessidade de ajuste na oferta de consultas. A proporção de pacientes de outras áreas às consultas de acolhimento compromete a continuidade do cuidado.
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Reducing Missed Primary Care Appointments in a Learning Health System: Two Randomized Trials and Validation of a Predictive Model. Med Care 2017; 54:689-96. [PMID: 27077277 DOI: 10.1097/mlr.0000000000000543] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Collaborations between clinical/operational leaders and researchers are advocated to develop "learning health systems," but few practical examples are reported. OBJECTIVES To describe collaborative efforts to reduce missed appointments through an interactive voice response and text message (IVR-T) intervention, and to develop and validate a prediction model to identify individuals at high risk of missing appointments. RESEARCH SUBJECTS AND DESIGN Random assignment of 8804 adults with primary care appointments to a single IVR-T reminder or no reminder at an index clinic (IC) and 7497 at a replication clinic (RC) in an integrated health system in Denver, CO. MEASURES Proportion of missed appointments; demographic, clinical, and appointment-specific predictors of missed appointments. RESULTS Patients receiving IVR-T had a lower rate of missed appointments than those receiving no reminder at the IC (6.5% vs. 7.5%, relative risk=0.85, 95% confidence interval, 0.72-1.00) and RC (8.2% vs. 10.5%, relative risk=0.76, 95% confidence interval, 0.65-0.89). A 10-variable prediction model for missed appointments demonstrated excellent discrimination (C-statistic 0.90 at IC, 0.89 at RC) and calibration (P=0.99 for Osius and McCullagh tests). Patients in the 3 lowest-risk quartiles missed 0.4% and 0.4% of appointments at the IC and RC, respectively, whereas patients in the highest-risk quartile missed 24.1% and 28.9% of appointments, respectively. CONCLUSIONS A single IVR-T call reduced missed appointments, whereas a locally validated prediction model accurately identified patients at high risk of missing appointments. These rigorous studies promoted dissemination of the intervention and prompted additional research questions from operational leaders.
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Nijhawan AE, Liang Y, Vysyaraju K, Muñoz J, Ketchum N, Saber J, Buchberg M, Venegas Y, Bullock D, Jain MK, Villarreal R, Taylor BS. Missed Initial Medical Visits: Predictors, Timing, and Implications for Retention in HIV Care. AIDS Patient Care STDS 2017; 31:213-221. [PMID: 28488891 DOI: 10.1089/apc.2017.0030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
HIV disproportionately affects racial/ethnic minorities and individuals living in the southern United States, and missed clinic visits account for much of this disparity. We sought to evaluate: (1) predictors of missed initial HIV medical visits, (2) time to initial visit, and (3) the association between initial visit attendance and retention in HIV care. Chart reviews were conducted for 200 consecutive HIV-infected patients (100 in Dallas, 100 in San Antonio) completing case management (CM) intake. Of these, 52 (26%) missed their initial visit, with 22 (11%) never presenting for care. Mean age was 40 years, 85% were men, >70% were of minority race/ethnicity, and 28% had a new HIV diagnosis. Unemployment (OR [95% CI] = 2.33 [1.04-5.24], p = 0.04) and lower attendance of CM visits (OR = 3.08 [1.43-6.66], p = 0.004) were associated with missing the initial medical visit. A shorter time to visit completion was associated with CD4 ≤ 200 (HR 1.90 [1.25-2.88], p = 0.003), Dallas study site (HR = 1.48 [1.03-2.14], p = 0.04), and recent hospitalization (HR = 2.18 [1.38-3.43], p < 0.001). Patients who did not complete their initial medical visit within 90 days of intake were unlikely to engage in care. Initial medical visit attendance was associated with higher proportion of visits attended (p = 0.04) and fewer gaps in care (p = 0.01). Missed medical visits were common among HIV patients initiating or reinitiating care in Texas. Employment and CM involvement predicted initial medical visit attendance, which was associated with retention in care. New, early engagement strategies are needed to decrease missed visits and reduce HIV health disparities.
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Affiliation(s)
- Ank E. Nijhawan
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
- Parkland Health and Hospital Systems, Dallas, Texas
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kranthi Vysyaraju
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jana Muñoz
- Department of Infectious Diseases, University Health System, San Antonio, Texas
| | - Norma Ketchum
- Department of Internal Medicine, UT Health San Antonio, San Antonio, Texas
| | - Julie Saber
- Department of Infectious Diseases, University Health System, San Antonio, Texas
| | - Meredith Buchberg
- Department of Internal Medicine, UT Health San Antonio, San Antonio, Texas
| | - Yvonne Venegas
- Department of Infectious Diseases, University Health System, San Antonio, Texas
| | - Delia Bullock
- Department of Infectious Diseases, University Health System, San Antonio, Texas
- Department of Internal Medicine, UT Health San Antonio, San Antonio, Texas
| | - Mamta K. Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
- Parkland Health and Hospital Systems, Dallas, Texas
| | - Roberto Villarreal
- Department of Research and Information Management, University Health System, San Antonio, Texas
| | - Barbara S. Taylor
- Department of Internal Medicine, UT Health San Antonio, San Antonio, Texas
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Ratmansky M, Hai N, Schlossberg T, Mimouni-Bloch A, Schweiger A. Does pain take holidays? Non-attendance rates at a hospital-based pain clinic are elevated during the Jewish high-holidays. Isr J Health Policy Res 2017; 6:11. [PMID: 28373903 PMCID: PMC5374672 DOI: 10.1186/s13584-017-0132-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/11/2017] [Indexed: 12/17/2022] Open
Abstract
Background Patient non-attendance is an expensive and persistent problem worldwide with rates between 5–39% reported in the literature. The objective of the study was to assess whether there is a higher incidence of non-attendance in a hospital-based pain clinic during the period of the Jewish High Holidays (Rosh-Hashanah to Sukkot) and whether this is further compounded by other factors, such as demographic characteristics and previous visits to the clinic. Methods Records were taken from the Lowenstein Rehabilitation Hospital appointment scheduling system. Data was gathered from two time-periods: High-Holidays and Control for each year, over a total of 6 years 2008–2013. Non-attendance was analyzed by period, by age, by gender and by previous visits to the clinic. Results In the entire population studied (666 distinct records), the non-attendance rate was higher during the High-Holidays as compared to the Control period (32 vs. 24.1%; p = 0.030). Non-attendance rates were significantly higher during the Holidays among repeating patients (28.6 vs. 14.8%; p = 0.002) and among women (34.6 vs. 20.7%; p = 0.004). Discussion Our data suggest that non-attendance is elevated during the High-Holidays in specific groups of patients, namely, repeating patients and women. Despite no direct inquiry into the reasons for non-attendance, we speculate that the elevated well-being and familial support during the holidays contribute to the patients’ ability to cope with persistent pain and possibly directly reduce the amount of pain, leading to patients missing their pain clinic appointments. Conclusion Our results, provided they can be corroborated by larger-scale studies, can assist in scheduling policy adjustments such as avoidance of appointments during the High-holidays for specific patient populations and more rigorous reminder efforts during these times of the year that may lead to reduction in overall non-attendance rates in the pain clinic. Further, our data provide an impetus for further studies of non-attendance patterns among pain clinic patients, in order to acquire a better understanding of the reasons for non-attendance and develop strategies to reduce it and thus contribute to the continuous improvement of the Israeli health systems as well as others worldwide. Electronic supplementary material The online version of this article (doi:10.1186/s13584-017-0132-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Motti Ratmansky
- Pain Unit, Loewenstein Rehabilitation Hospital, 278 Ahuza Street, 43100 Raanana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nitzan Hai
- The Academic College of Tel Aviv, Tel Aviv, Israel
| | - Tzion Schlossberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Leumit health fund, Jerusalem, Israel
| | - Aviva Mimouni-Bloch
- Pain Unit, Loewenstein Rehabilitation Hospital, 278 Ahuza Street, 43100 Raanana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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48
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Sutcliffe CG, Thuma PE, van Dijk JH, Sinywimaanzi K, Mweetwa S, Hamahuwa M, Moss WJ. Use of mobile phones and text messaging to decrease the turnaround time for early infant HIV diagnosis and notification in rural Zambia: an observational study. BMC Pediatr 2017; 17:66. [PMID: 28270134 PMCID: PMC5341427 DOI: 10.1186/s12887-017-0822-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early infant diagnosis of HIV infection is challenging in rural sub-Saharan Africa as blood samples are sent to central laboratories for HIV DNA testing, leading to delays in diagnosis and treatment initiation. Simple technologies to rapidly deliver results to clinics and notify mothers of test results would decrease many of these delays. The feasibility of using mobile phones to contact mothers was evaluated. In addition, the first two years of implementation of a national short message service (SMS) reporting system to deliver test results from the laboratory to the clinic were evaluated. METHODS The study was conducted in Macha, Zambia from 2013 to 2015 among mothers of HIV-exposed infants. Mothers were interviewed about mobile phone use and willingness to be contacted directly or through their rural health center. Mothers were contacted according to their preferred method of communication when test results were available. Mothers of positive infants were asked to return to the clinic as soon as possible. Dates of sample collection, delivery of test results to the clinic and notification of mothers were documented in addition to test results. RESULTS Four hundred nineteen mothers and infants were enrolled. Only 30% of mothers had ever used a mobile phone. 96% of mobile phone owners were reached by study staff and 98% of mothers without mobile phones were contacted through their rural health center. Turnaround times for mothers of positive infants were approximately 2 weeks shorter than for mothers of negative infants. Delivery of test results by the national SMS system improved from 2013 to 2014, with increases in the availability of texted results (38 vs. 91%) and arrival of the texted result prior to the hardcopy report (27 vs. 83%). Texted results arriving at the clinic before the hardcopy were received a median of 19 days earlier. Four discrepancies between texted and hardcopy results were identified out of 340 tests. CONCLUSIONS Mobile phone and text messaging technology has the potential to improve early infant diagnosis but challenges to widespread implementation need to be addressed, including low mobile phone ownership, use and coverage in rural areas.
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Affiliation(s)
- Catherine G Sutcliffe
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, USA.
| | | | - Janneke H van Dijk
- Macha Research Trust, Macha Hospital, Choma, Zambia.,Department of Immunology and Infectious Diseases, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | | | - William J Moss
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, USA
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Jong S, Cuca Y, Thompson LM. Meta-analysis of Mobile Phone Reminders on HIV Patients' Retention to Care. JOURNAL OF MOBILE TECHNOLOGY IN MEDICINE 2017; 6:5-18. [PMID: 30197685 PMCID: PMC6124685 DOI: 10.7309/jmtm.6.1.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS This research aims to systematically review the current clinical evidence of the efficacy of mobile phone reminders on retention to care among HIV patients. This study also seeks to determine an effect size of the intervention and presents implications for future studies. BACKGROUND Use of mobile technologies is an innovative and affordable approach to HIV prevention and care, particularly in resource limited settings. Approximately two-thirds of people who are initially diagnosed with HIV are lost to follow-up before starting HIV treatment in low and middle-income countries, posing serious global health concerns. While mobile text message reminders for HIV medication adherence have shown positive health outcomes, it is not well understood whether the reminders can also improve patients' retention to care. METHODS The authors conducted a meta-analysis of literature in the following databases: PubMed, CINAHL, ProQuest, and Web of Science. Of the 667 peer-reviewed research articles reviewed, nine studies were included in the final analysis. Stata version 13 was used for the analysis. RESULTS Nine studies (5 randomized controlled and 4 before and after studies) from 7 countries included 3,004 HIV patients. Random-effect meta-analysis (I-squared = 94.1%) found that HIV patients who received mobile phone reminders for their follow-up appointments were two times more likely to return to care than those who didn't receive reminders (pooled odd ratio (OR)=2.04, 95% CI: 0.97-4.27). Our sub-group analysis of 5 randomized controlled studies showed a significant effect of mobile phone reminders (OR=2.04, 95% CI: 1.11-3.74). Six studies in Africa showed that HIV patients (mostly women) receiving mobile phone reminders were three times more likely to return to care than those who received no reminders (OR=2.92, 95% CI: 1.13-7.53). CONCLUSION Mobile phone reminders are an effective intervention to improve retention to HIV care. Women with HIV living in resource limited settings benefit significantly from the intervention. Also, mobile phone reminders using text messages are as effective as phone calls to improve retention to HIV care.
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Affiliation(s)
- SoSon Jong
- School of Nursing, University of California, San Francisco
| | - Yvette Cuca
- School of Nursing, University of California, San Francisco
| | - Lisa M Thompson
- School of Nursing, Global Health Sciences, University of California, San Francisco
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50
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Robotham D, Satkunanathan S, Reynolds J, Stahl D, Wykes T. Using digital notifications to improve attendance in clinic: systematic review and meta-analysis. BMJ Open 2016; 6:e012116. [PMID: 27798006 PMCID: PMC5093388 DOI: 10.1136/bmjopen-2016-012116] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Assess the impact of text-based electronic notifications on improving clinic attendance, in relation to study quality (according to risk of bias), and to assess simple ways in which notifications can be optimised (ie, impact of multiple notifications). DESIGN Systematic review, study quality appraisal assessing risk of bias, data synthesised in meta-analyses. DATA SOURCES MEDLINE, EMBASE, PsycINFO, Web of Science and Cochrane Database of Systematic Reviews (01.01.05 until 25.4.15). A systematic search to discover all studies containing quantitative data for synthesis into meta-analyses. ELIGIBILITY CRITERIA Studies examining the effect of text-based electronic notifications on prescheduled appointment attendance in healthcare settings. Primary analysis included experimental studies where randomisation was used to define allocation to intervention and where a control group consisting of 'no reminders' was used. Secondary meta-analysis included studies comparing text reminders with voice reminders. Studies lacking sufficient information for inclusion (after attempting to contact study authors) were excluded. OUTCOME MEASURES Primary outcomes were rate of attendance/non-attendance at healthcare appointments. Secondary outcome was rate of rescheduled and cancelled appointments. RESULTS 26 articles were included. 21 included in the primary meta-analysis (8345 patients receiving electronic text notifications, 7731 patients receiving no notifications). Studies were included from Europe (9), Asia (7), Africa (2), Australia (2) and America (1). Patients who received notifications were 23% more likely to attend clinic than those who received no notification (risk ratio=1.23, 67% vs 54%). Those receiving notifications were 25% less likely to 'no show' for appointments (risk ratio=.75, 15% vs 21%). Results were similar when accounting for risk of bias, region and publication year. Multiple notifications were significantly more effective at improving attendance than single notifications. Voice notifications appeared more effective than text notifications at improving attendance. CONCLUSIONS Electronic text notifications improve attendance and reduce no shows across healthcare settings. Sending multiple notifications could improve attendance further.
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Affiliation(s)
- Dan Robotham
- Institute of Psychiatry, Psychology & Neuroscience, King's College London (KCL), London, UK
| | - Safarina Satkunanathan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London (KCL), London, UK
| | - John Reynolds
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Daniel Stahl
- Institute of Psychiatry, Psychology & Neuroscience, King's College London (KCL), London, UK
| | - Til Wykes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London (KCL), London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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