1
|
Nakamura Y, Sakurai K, Ishikawa S, Horinouchi T, Hashimoto N, Kusumi I. Outpatient visit behavior in patients with epilepsy: Generalized Epilepsy is more frequently non-attendance than Focal Epilepsy. Epilepsy Behav 2023; 145:109345. [PMID: 37441983 DOI: 10.1016/j.yebeh.2023.109345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients with epilepsy (PWE), especially those with Idiopathic Epilepsy (GE), are at a high risk of disadvantage caused by non-adherence. It has been suggested that medical visit behavior may be a surrogate indicator of medication adherence. We hypothesized that patients with IGE would adhere poorly to visits. METHODS This was a retrospective study of PWE who visited the Department of Psychiatry and Neurology at Hokkaido University Hospital between January 2017 and December 2019. Demographic and clinical information on PWE were extracted from medical records and visit data from the medical information system. Non-attendance of outpatient appointments was defined as "not showing up for the day of an appointment without prior notice." Mixed-effects logistic regression analysis was conducted with non-attendance as the objective variable. RESULTS Of the 9151 total appointments, 413 were non-attendances, with an overall non-attendance rate of 4.5%. IGE was a more frequent non-attendance than Focal Epilepsy (FE) (odds ratio (OR) 1.94; 95% confidence interval (CI) 1.17-3.21; p = 0.010). History of public assistance receipt was associated with higher non-attendance (OR 2.04; 95% CI 1.22-3.43; p = 0.007), while higher education (OR 0.64; 95% CI 0.43-0.93; p = 0.021) and farther distance to a hospital (OR 0.33; 95% CI 0.13-0.88; p = 0.022), and higher frequency of visits (OR 0.18; 95% CI 0.04-0.86; p = 0.031) were associated with fewer non-attendances. In a subgroup analysis of patients with GE, women were associated with fewer non-attendance (OR 0.31; 95% CI 0.14-0.72; p = 0.006). CONCLUSIONS GE was more frequent in the non-attendance group than in the FE group. Among patients with GE, females were found to have non-attendance less frequently; however, there was no clear difference in the odds of non-attendance between Juvenile Myoclonic Epilepsy (JME) and IGE other than JME.
Collapse
Affiliation(s)
- Yuichi Nakamura
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan.
| | - Kotaro Sakurai
- Department of Neuropsychiatry, Aichi Medical University, 1-1, Karimata, Yazako, Nagakute-shi, Aichi 480-1195, Japan
| | - Shuhei Ishikawa
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| | - Toru Horinouchi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| |
Collapse
|
2
|
Weber K, DaSilva AF, Dault JT, Eber R, Huner K, Jones D, Kornman K, Ramaswamy V, Snyder M, Ward BB, Nalliah RP. Using business intelligence and data visualization to understand the characteristics of failed appointments in dental school clinics. J Dent Educ 2021; 85:521-530. [PMID: 33508149 DOI: 10.1002/jdd.12538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVES Broken appointments are an important cause of waste in health care. Patients who fail to attend incur costs to providers, deny trainees learning opportunities, and impact their own health as well as that of other patients who are waiting for care. METHODS A total of 410,000 appointment records over 3 years were extracted from our electronic health record. We conducted exploratory data analysis and assessed correlations between appointment no-shows and other attributes of the appointment and the patient. The University of Michigan Medical School's Committee on Human Research reviewed the study and deemed that no Institutional Review Board oversight was necessary for this quality improvement project that was, retrospectively, turned into a study with previously de-identified data. RESULTS The patient's previous attendance record is the single most significant correlation with attendance. We found that patients who said they are "scared" of dental visits were 62% as likely to attend as someone reporting "no problem." Patients over 65 years of age have better attendance rates. There was a positive association between receiving email/text confirmation and attendance. A total of 94.9% of those emailed a reminder and 92.2% of those who were texted attended their appointment. CONCLUSION(S) We were able to identify relationships of several variables to failed and attended appointments that we were previously unknown to us. This knowledge enabled us to implement interventions to support better attendance at Dental Clinics at the University of Michigan, improving patient health, student training, and efficient use of resources.
Collapse
Affiliation(s)
- Kate Weber
- Health Infrastructures and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandre F DaSilva
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Jean T Dault
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Robert Eber
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Kim Huner
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Darlene Jones
- Dental Hygiene, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Kenneth Kornman
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Vidya Ramaswamy
- Assessment, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Mark Snyder
- Vertically Integrated Clinic, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Brent B Ward
- Oral Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Romesh P Nalliah
- Patient Services, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| |
Collapse
|
3
|
White LJ, Butler-Howell KE, Nadon-Hoysted N, Schulz MC, Kroon J. Impact of demographics and appointment characteristics on patient attendance in a university dental clinic. J Dent Educ 2020; 85:615-622. [PMID: 33368257 DOI: 10.1002/jdd.12514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/15/2020] [Accepted: 12/04/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Failed patient attendance in a university dental clinic is detrimental to the student learning experience, the university as a business, and to members of the public awaiting urgent dental treatment. PURPOSE This study aimed to identify the demographic, appointment characteristics, and time-related factors associated with patient attendance in a university dental clinic from 2015 to 2019. METHODS A 5-year retrospective analysis was conducted in 2020 on data extracted from the Griffith University Dental Clinic patient management system. Following data cleaning and categorization, the dataset was downloaded into SPSS for statistical analysis. Frequencies, odds ratio, and chi squared were used to determine the demographic and time-related factors of patients who had completed, cancelled, and failed to attend (FTA) appointments. RESULTS A total of 23.4% of appointments were cancelled, and 6.6% were FTA. Demographics associated with cancellations include females, adults aged 25 to 44, and private paying patients. FTA were higher in young adults aged 19 to 24, low to mid-range socioeconomic status (SES) and those eligible for publicly funded dental treatment. Mondays and Fridays experienced the greatest number of FTA and cancellations, respectively. Emergency appointments had the greatest attendance rates and endodontic procedures the lowest. CONCLUSION The loss of clinical teaching hours, resources, and revenue necessitates the implementation of targeted strategies to minimize cancellations and FTA based on demographic and appointment characteristics that may render individual as high risk for failed attendance.
Collapse
Affiliation(s)
- Laura Jade White
- School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Kate Ellise Butler-Howell
- School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Naomie Nadon-Hoysted
- School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Madeleine Carly Schulz
- School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Jeroen Kroon
- School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| |
Collapse
|
4
|
Mahmood S, Jalal Z, Hadi MA, Shah KU. Association between attendance at outpatient follow-up appointments and blood pressure control among patients with hypertension. BMC Cardiovasc Disord 2020; 20:458. [PMID: 33087065 PMCID: PMC7579965 DOI: 10.1186/s12872-020-01741-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/13/2020] [Indexed: 01/23/2023] Open
Abstract
Objective The aim of this study was to assess the impact of regularity in treatment follow-up appointments on treatment outcomes among hypertensive patients attending different healthcare settings in Islamabad, Pakistan. Additionally, factors associated with regularity in treatment follow-up were also identified.
Methods A cross-sectional study was undertaken in selected primary, secondary and tertiary healthcare settings between September, 2017 and December, 2018 in Islamabad, Pakistan. A structured data collection form was used to gather sociodemographic and clinical data of recruited patients. Binary logistic regression analyses were undertaken to determine association between regularity in treatment follow-up appointments and blood pressure control and to determine covariates significantly associated with regularity in treatment follow-up appointments. Results A total of 662 patients with hypertension participated in the study. More than half 346 (52%) of the patients were females. The mean age of participants was 54 ± 12 years. Only 274 (41%) patients regularly attended treatment follow-up appointments. Regression analysis found that regular treatment follow-up was an independent predictor of controlled blood pressure (OR 1.561 [95% CI 1.102–2.211; P = 0.024]). Gender (OR 1.720 [95% CI 1.259–2.350; P = 0.001]), age (OR 1.462 [CI 95%:1.059–2.020; P = 0.021]), higher education (OR 1.7 [95% CI 1.041–2.778; P = 0.034]), entitlement to free medical care (OR 3.166 [95% CI 2.284–4.388; P = 0.0001]), treatment duration (OR 1.788 [95% CI 1.288–2.483; P = 0.001]), number of medications (OR 1.585 [95% CI 1.259–1.996; P = 0.0001]), presence of co-morbidity (OR 3.214 [95% CI 2.248–4.593; P = 0.0001]) and medication adherence (OR 6.231 [95% CI 4.264–9.106; P = 0.0001]) were significantly associated with regularity in treatment follow-up appointments. Conclusion Attendance at follow-up visits was alarmingly low among patients with hypertension in Pakistan which may explain poor treatment outcomes in patients. Evidence-based targeted interventions should be developed and implemented, considering local needs, to improve attendance at treatment follow-up appointments.
Collapse
Affiliation(s)
- Sajid Mahmood
- Department of Pharmacy, Quaid-E-Azam University, Islamabad, 45320, Pakistan
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Muhammad Abdul Hadi
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Kifayat Ullah Shah
- Department of Pharmacy, Quaid-E-Azam University, Islamabad, 45320, Pakistan.
| |
Collapse
|
5
|
Stormon N, Sowa PM, Anderson J, Ford PJ. Facilitating Access to Dental Care for People Experiencing Homelessness. JDR Clin Trans Res 2020; 6:420-429. [PMID: 32853528 DOI: 10.1177/2380084420952350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Fear, lack of information, and lower health literacy are prominent barriers preventing people experiencing homelessness from accessing dental services. Most of this population are eligible for free dental treatment in Australia, yet few access care. This study evaluated 3 models for facilitating access to dental services for people experiencing homelessness. METHODS Three facilitated access models were developed and implemented at 4 community organizations. In model 1, dental appointments were booked on the spot after a screening by dental practitioners. Model 2 also involved dental screenings followed by appointments made via phone call from the service. In model 3, the community organizations referred clients directly to the service where appointments were made via a phone call to the client. The models were trialed with community organizations between 2017 and 2019. For each model, participant demographic information, attendance at subsequent dental appointments, and program operation resource use were collected. Cost-effectiveness was assessed as an incremental cost per additional person attending a dental appointment. RESULTS A total of 76 people participated in model 1, 66 in model 2, and 43 in model 3. Model 1 was the most effective, leading to 84.2 (confidence interval, 75.8-92.7) of every 100 participants attending a dental appointment. Model 2 had a lower effectiveness of 56.1 (44.6-67.6), and model 3 was the least effective, with a mean of 29.3 (15.0-43.6) per 100 participants attending. Incremental cost-effectiveness ratios were $51 per additional person attending a dental appointment for model 3 (compared to no strategy) and $173 per additional person attending for model 1 (compared to model 3). CONCLUSIONS Model 3 was the most cost-effective strategy of increasing access to dental care for people experiencing homelessness. Decision makers who find the effectiveness of model 3 insufficient should look instead to employ model 1 or a combination of these 2 models. The importance of face-to-face engagement to foster trust between the individual and health care practitioner was evident. KNOWLEDGE TRANSFER STATEMENT This study provides a range of models for dental and community services to facilitate access to dental care for people experiencing homelessness. Decision makers should consider the needs of vulnerable populations, alternative model designs, and their cost-effectiveness when implementing models of facilitated access to dental care. Face-to-face engagement between clients and dental practitioners by inclusion of a screening stage appears to be instrumental in overcoming barriers to access clinical care.
Collapse
Affiliation(s)
- N Stormon
- School of Dentistry, Oral Health Centre, University of Queensland, Brisbane, Australia
| | - P M Sowa
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
| | - J Anderson
- Queensland Health, Oral Health Services, Community and Oral Health Directorate, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - P J Ford
- School of Dentistry, Oral Health Centre, University of Queensland, Brisbane, Australia
| |
Collapse
|
6
|
Storrs MJ, Ramov HM, Lalloo R. An Investigation into Patient Non-Attendance and Use of a Short-Message Reminder System at a University Dental Clinic. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.1.tb06055.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mark J. Storrs
- Menzies Health Institute of Queensland and Lecturer in General Dental Practice; School of Dentistry and Oral Health; Griffith University; Queensland Australia
| | | | - Ratilal Lalloo
- School of Dentistry; University of Queensland; Queensland Australia
- Australian Research Centre for Population Oral Health; University of Adelaide; South Australia Australia
| |
Collapse
|