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Barnett A, Catapan SDC, Jegatheesan DK, Conley MM, Keating SE, Mayr HL, Webb L, Brown RCC, Coombes JS, Macdonald GA, Isbel NM, Burton NW, Campbell KL, Hickman IJ, Kelly JT. Patients' acceptability of self-selected digital health services to support diet and exercise among people with complex chronic conditions: Mixed methods study. Digit Health 2024; 10:20552076241245278. [PMID: 38854917 PMCID: PMC11162125 DOI: 10.1177/20552076241245278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/19/2024] [Indexed: 06/11/2024] Open
Abstract
Objective The acceptability of being offered a choice from a suite of digital health service options to support optimal diet and exercise behaviors in adults with complex chronic conditions was evaluated. This study sought to understand many areas of acceptability including satisfaction, ease of use, usefulness and user appropriateness and perceived effectiveness. Methods This mixed-methods study was embedded within a randomized-controlled feasibility trial providing digital health services managing diet and exercise for adults from specialist kidney and liver disease clinics. Post study surveys and semistructured interviews were used to determine patients' acceptability of the trial interventions. Quantitative (surveys) and qualitative (surveys and interviews) results were merged using integrative analysis and mapped to each construct of the modified version of the Theoretical Framework of Acceptability. Results Seventeen interviews (intervention group) and 50 surveys (n = 24 intervention, n = 26 comparator) completed from a possible 67 participants were analyzed. In the intervention group, the survey results revealed high areas of acceptability for the digital health services including overall support received, ease of use, timely advice and feeling safe. The interviews also revealed high areas of acceptability including convenience, ability to adopt healthier behaviors and having regular interactions with health professionals. However, the interviews also revealed lower areas of acceptability as a result of absence of individualization, low digital literacy, and limitations from life circumstances. Conclusions Recipients of digital health services that supported diet and exercise interventions found these useful, effective, and safe. Individualized care, technical support and patient confidence remain important to improve the acceptability of digital health service interventions.
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Affiliation(s)
- Amandine Barnett
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Soraia de Camargo Catapan
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Dev K Jegatheesan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Marguerite M Conley
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research on Exercise, Physical Activity & Health, The University of Queensland, Brisbane, QLD, Australia
| | - Hannah L Mayr
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Lindsey Webb
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Riley C C Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research on Exercise, Physical Activity & Health, The University of Queensland, Brisbane, QLD, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research on Exercise, Physical Activity & Health, The University of Queensland, Brisbane, QLD, Australia
| | - Graeme A Macdonald
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nicole M Isbel
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
- Centre for Mental Health, Griffith University Mount Gravatt, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Katrina L Campbell
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane QLD, Australia
| | - Ingrid J Hickman
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
- ULTRA Team, The University of Queensland Clinical Trials Capability, Herston, Brisbane, Australia
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
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Kerr G, Greenfield G, Hayhoe B, Gaughran F, Halvorsrud K, Pinto da Costa M, Rehill N, Raine R, Majeed A, Costelloe C, Neves AL, Beaney T. Attendance at remote versus in-person outpatient appointments in an NHS Trust. J Telemed Telecare 2023:1357633X231216501. [PMID: 38128925 DOI: 10.1177/1357633x231216501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION With the growing use of remote appointments within the National Health Service, there is a need to understand potential barriers of access to care for some patients. In this observational study, we examined missed appointments rates, comparing remote and in-person appointments among different patient groups. METHODS We analysed adult outpatient appointments at Imperial College Healthcare NHS Trust in Northwest London in 2021. Rates of missed appointments per patient were compared between remote versus in-person appointments using negative binomial regression models. Models were stratified by appointment type (first or a follow-up). RESULTS There were 874,659 outpatient appointments for 189,882 patients, 29.5% of whom missed at least one appointment. Missed rates were 12.5% for remote first appointments and 9.2% for in-person first appointments. Remote and in-person follow-up appointments were missed at similar rates (10.4% and 10.7%, respectively). For remote and in-person appointments, younger patients, residents of more deprived areas, and patients of Black, Mixed and 'other' ethnicities missed more appointments. Male patients missed more in-person appointments, particularly at younger ages, but gender differences were minimal for remote appointments. Patients with long-term conditions (LTCs) missed more first appointments, whether in-person or remote. In follow-up appointments, patients with LTCs missed more in-person appointments but fewer remote appointments. DISCUSSION Remote first appointments were missed more often than in-person first appointments, follow-up appointments had similar attendance rates for both modalities. Sociodemographic differences in outpatient appointment attendance were largely similar between in-person and remote appointments, indicating no widening of inequalities in attendance due to appointment modality.
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Affiliation(s)
- Gabriele Kerr
- Department of Primary Care and Public Health, Imperial College London, London, UK
- NIHR Applied Research Collaboration Northwest London, London, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, UK
- NIHR Applied Research Collaboration Northwest London, London, UK
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London, London, UK
- NIHR Applied Research Collaboration Northwest London, London, UK
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Mariana Pinto da Costa
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- NIHR Applied Research Collaboration South London, London, UK
| | | | - Rosalind Raine
- NIHR Applied Research Collaboration North Thames, London, UK
- Department of Applied Health Research, University College London (UCL), London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
- NIHR Applied Research Collaboration Northwest London, London, UK
| | - Ceire Costelloe
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Institute of Cancer Research, Sutton, UK
| | - Ana Luisa Neves
- Department of Primary Care and Public Health, Imperial College London, London, UK
- NIHR Applied Research Collaboration Northwest London, London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
- NIHR Applied Research Collaboration Northwest London, London, UK
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Fystro JR, Feiring E. Mapping out the arguments for and against patient non-attendance fees in healthcare: an analysis of public consultation documents. JOURNAL OF MEDICAL ETHICS 2023; 49:844-849. [PMID: 36944503 PMCID: PMC10715470 DOI: 10.1136/jme-2022-108856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patients not attending their appointments without giving notice burden healthcare services. To reduce non-attendance rates, patient non-attendance fees have been introduced in various settings. Although some argue in narrow economic terms that behavioural change as a result of financial incentives is a voluntary transaction, charging patients for non-attendance remains controversial. This paper aims to investigate the controversies of implementing patient non-attendance fees. OBJECTIVE The aim was to map out the arguments in the Norwegian public debate concerning the introduction and use of patient non-attendance fees at public outpatient clinics. METHODS Public consultation documents (2009-2021) were thematically analysed (n=84). We used a preconceived conceptual framework based on the works of Grant to guide the analysis. RESULTS A broad range of arguments for and against patient non-attendance fees were identified, here referring to the acceptability of the fees' purpose, the voluntariness of the responses, the effects on the individual character and institutional norms and the perceived fairness and comparative effectiveness of patient non-attendance fees. Whereas the aim of motivating patients to keep their appointments to avoid poor utilisation of resources and increased waiting times was widely supported, principled and practical arguments against patient non-attendance fees were raised. CONCLUSION A narrow economic understanding of incentives cannot capture the breadth of arguments for and against patient non-attendance fees. Policy makers may draw on this insight when implementing similar incentive schemes. The study may also contribute to the general debate on ethics and incentives.
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Affiliation(s)
- Joar Røkke Fystro
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Eli Feiring
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Khan M, Khoza-Shangase K, Thusi AB, Hoosain R, Balton S. Original Research Clinical attendance rate at a tertiary adult audiological service in South Africa. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2023; 70:e1-e9. [PMID: 38044862 PMCID: PMC10696643 DOI: 10.4102/sajcd.v70i1.967] [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: 02/07/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Clinical non-attendance to audiological appointments may negatively affect early diagnosis and intervention as well as treatment outcomes for adults with hearing impairments. OBJECTIVES This study aimed to explore the attendance rate and factors influencing attendance and non-attendance at an adult audiology diagnostic clinic at a tertiary hospital in Gauteng, South Africa. METHOD A mixed-methods research design, utilising structured questionnaires and a retrospective record review was adopted. A total of 31 adult patients at a diagnostic audiology clinic were interviewed. RESULTS Findings revealed an attendance rate of 47.62%, with 52.38% rate failure to return for follow-up appointments. Key reasons for attendance included understanding the need for appointments (57%), staff attitudes (42%) and appointment reminders (17%), and those for non-attendance included multiple appointments (33%), work commitments (28%), transport (8%) and forgetting about the appointment (8%). Six reasons for non-attendance were prominent in the current study: having multiple appointments (33%), work commitments (28%), forgetting the appointment (8%), transport difficulties (8%), attitudes and/or perceptions of the healthcare system (4%) and sequelae of hearing impairment (8%). CONCLUSION This study reinforces previous research findings while highlighting that health literacy and Batho Pele (people first) ethos by staff positively influence attendance.Contribution: Current findings contribute towards contextually relevant evidence on the attendance rate in this sector for ear and hearing care, as well as additional insights into factors influencing this within the South African context. This information is crucial for clinical services provision planning as well as for policy formulation around resource allocation in the public healthcare sector.
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Affiliation(s)
- Mubina Khan
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Hospital Speech Therapy and Audiology, Johannesburg.
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Schwalbe D, Sodemann M, Iachina M, Nørgård BM, Chodkiewicz NH, Ammentorp J. Causes of Patient Nonattendance at Medical Appointments: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46227. [PMID: 37723870 PMCID: PMC10656653 DOI: 10.2196/46227] [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: 02/02/2023] [Revised: 06/29/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Approximately one-third of patient appointments in Danish health care result in failures, leading to patient risk and sizable resource waste. Existing interventions to alleviate no-shows often target the patients. The underlying reason behind these interventions is a view that attendance or nonattendance is solely the patient's problem. However, these interventions often prove to be ineffective and can perpetuate social biases and health inequalities, leaving behind patients who are more vulnerable or disadvantaged (in terms of social, economical, and linguistic factors, etc). A more holistic understanding of no-shows is needed to optimize processes, reduce waste, and support patients who are vulnerable. OBJECTIVE This study aims to gain a deep and more comprehensive understanding of the causes, mechanisms, and recurring patterns and elements contributing to nonattendance at Danish hospitals in the Region of Southern Denmark. It emphasizes the patient perspective and analyzes the relational and organizational processes surrounding no-shows in health care. In addition, the study aims to identify effective communicative strategies and organizational processes that can support the development and implementation of successful interventions. METHODS The study uses mixed quantitative-qualitative methods, encompassing 4 analytical projects focusing on nonattendance patterns, patient knowledge and behavior, the management of hospital appointments, and in situ communication. To address the complexity of no-shows in health care, the study incorporates various data sources. The quantitative data sources include the electronic patient records, Danish central registries, Danish National Patient Registry, and Register of Medicinal Product Statistics. Baseline characteristics of patients at different levels are compared using chi-square tests and Kruskal-Wallis tests. The qualitative studies involve observational data, individual semistructured interviews with patients and practitioners, and video recordings of patient consultations. RESULTS This paper presents the protocol of the study, which was funded by the Novo Nordisk Foundation in July 2022. Recruitment started in February 2023. It is anticipated that the quantitative data analysis will be completed by the end of September 2023, with the qualitative investigation starting in October 2023. The first study findings are anticipated to be available by the end of 2024. CONCLUSIONS The existing studies of nonattendance in Danish health care are inadequate in addressing relational and organizational factors leading to hospital no-shows. Interventions have had limited effect, highlighting the Danish health care system's failure to accommodate patients who are vulnerable. Effective interventions require a qualitative approach and robust ethnographic data to supplement the description and categorization of no-shows at hospitals. Obtaining comprehensive knowledge about the causes of missed patient appointments will yield practical benefits, enhancing the safety, coherence, and quality of treatment in health care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46227.
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Affiliation(s)
- Daria Schwalbe
- Centre for Patient Communication (CFPK), Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Centre for Culture and the Mind (DNRF Centre of Excellence), Department of English, German and Romance Studies, University of Copenhagen, Copenhagen, Denmark
| | - Morten Sodemann
- The Migrant Health Outpatient Clinic, Odense University Hospital, Odense, Denmark
- Research Unit of Infectious Diseases, Department of Clinical Studies, University of Southern Denmark, Odense, Denmark
| | - Maria Iachina
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nina Høy Chodkiewicz
- Centre for Patient Communication (CFPK), Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jette Ammentorp
- Centre for Patient Communication (CFPK), Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Winter N, McMillan K, Finch J, da Silva D, Whitehead A, Harvey D, McBride LJ, Hickson L, Theodoros D, Russell T. Evaluation of a teleaudiology service in regional Australia. Int J Audiol 2023; 62:964-972. [PMID: 35980839 DOI: 10.1080/14992027.2022.2108913] [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: 01/26/2022] [Accepted: 07/24/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Evaluate accessibility, effectiveness, acceptability and efficiency of a student- assisted teleaudiology model of care in a regional hospital in Queensland, Australia. DESIGN Prospective mixed method service evaluation study. STUDY SAMPLE Demographic, service and satisfaction data were collected from 233 patients (children aged ≥5 and adults) who received teleaudiology assessment. Satisfaction data was collected from 27 hospital clinic staff (medical, nursing and clinic assistants) and 28 university audiology clinical educator participants. Experience and satisfaction data were collected from 16 teleaudiology clinic university students. Quantitative data was analysed using SPSS software. Qualitative data were analysed using inductive content analysis. RESULTS Following introduction of the teleaudiology service in 2017 and evaluation during the first 6 months, 95% of patients were able to access audiology assessments on the same day as their Ear, Nose and Throat appointments. New referrals to the service were seen within a month. The audiology assessment battery was completed 95% of the time within an average of 33 minutes by the end of the study period. Patients, hospital and university staff and students reported high satisfaction with their experiences of teleaudiology, including its convenience and efficiency. CONCLUSIONS A student-assisted teleaudiology model of care can deliver accessible, effective, and efficient services with high levels of satisfaction by participants.
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Affiliation(s)
- Natalie Winter
- Queensland Department of Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - Katie McMillan
- Queensland Department of Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - Jennifer Finch
- Queensland Department of Health, Allied Health Professions Office of Queensland, Brisbane, Australia
| | - David da Silva
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
| | - Andrea Whitehead
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
| | - Desley Harvey
- Queensland Department of Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
- College of Healthcare Sciences, James Cook University, Cairns, Australia
| | - Liza-Jane McBride
- Queensland Department of Health, Allied Health Professions Office of Queensland, Brisbane, Australia
| | - Louise Hickson
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
| | - Deborah Theodoros
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
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Lee DJ, Gailey RS, Fernandez-Fernandez A, Litwin BA. Development and validation of the Self-Management Assessment for the Residuum and prosThesis system designed for persons with limb loss (SMART). Prosthet Orthot Int 2023; 47:537-543. [PMID: 36723403 DOI: 10.1097/pxr.0000000000000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 12/29/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop a system of reliable and valid knowledge assessments of self-management in persons with lower limb loss, along with the accompanying targeted educational interventions (TEIs), known as the Self-Management Assessment for the Residuum and prosThesis (SMART) system. DESIGN This 2-phase study used mixed methodology. Phase 1 was development, face validation, and content validation of the 60-item knowledge assessment measure (SMART 60) and the TEI. Phase 2 assessed internal consistency reliability using Kuder-Richardson Formula 20 and the creation of the SMART system, consisting of modules developed from the SMART 60. Validity of the measures using known groups' comparison was analyzed by comparing clinicians (prosthetists and physical therapists) with persons with lower limb loss. Participants were recruited from the Amputee Coalition National Conference in 2018 and 2019. RESULTS A total of 140 participants completed this study. Four modules from the SMART 60 were created and designed to integrate as a system. Face validity survey average scores found that 9/10 participants either agreed or strongly agreed that the SMART system has high readability, perceived usefulness, and value for both new and experienced prosthetic users. Measure length ranged from 10 to 45 items with a reliability ranging from Kuder-Richardson Formula 20 = 0.70-0.82. The SMART system demonstrated known-groups validity ( p < 0.05). CONCLUSION The SMART system is an integrated series of self-management knowledge assessments with reasonable to good internal consistency reliability and known-groups validity. The TEIs provide directed solutions to identified knowledge gaps on the assessments.
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Affiliation(s)
- Daniel J Lee
- Department of Physical Therapy, Touro University, Central Islip, NY, USA
| | - Robert S Gailey
- Department of Physical Therapy, Univ of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Bini A Litwin
- Department of Physical Therapy, Nova Southeastern University, Ft. Lauderdale, FL, USA
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Tong CYM, Koh RYV, Lee ES. A scoping review on the factors associated with the lost to follow-up (LTFU) amongst patients with chronic disease in ambulatory care of high-income countries (HIC). BMC Health Serv Res 2023; 23:883. [PMID: 37608296 PMCID: PMC10464417 DOI: 10.1186/s12913-023-09863-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/31/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Despite the importance of long term follow-up care for patients with chronic disease, many patients fail to adhere to their follow-ups, which increase their risk of further health complications. Therefore, the purpose of this scoping review was to find out the factors associated with lost to follow-up (LTFU) amongst patients with chronic disease in the ambulatory care setting of high-income countries (HICs) to gain insights for better quality of care. Understanding the definition of LTFU is imperative in informing patients, health professionals and researchers for clinical and research purposes. This review also provided an overview of the terms and definitions used to describe LTFU. METHODS The following databases: CINAHL, EMBASE, Medline, PsycINFO and Web of Science were searched for studies investigating the factors associated to LTFU from the date of inception until 07 January 2022. RESULTS Five thousand one hundred and seven records were obtained across the databases and 3,416 articles were screened after removing the duplicates. 25 articles met the inclusion criteria, of which 17 were cohort studies, five were cross-sectional studies and three were case-control studies. A total of 32 factors were found to be associated with LTFU and they were categorised into patient factors, clinical factors and healthcare provider factors. CONCLUSION Overall, the factors associated with LTFU were generally inconsistent across studies. However, some factors such as financial factors (i.e., no insurance coverage) and low accessibility of care were consistently associated with LTFU for both mental and physical chronic conditions. The operational definitions of LTFU also varied greatly across studies. Given the mixed findings, future research using qualitative aproaches would be pivotal in understanding LTFU for specific chronic diseases and the development of targeted interventions. Additionally, there is a need to standardise the operational definition of LTFU for research as well as clinical practice purposes.
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Affiliation(s)
| | | | - Eng Sing Lee
- National Healthcare Group Polyclinics, Singapore, Singapore
- MOH Office for Healthcare Transformation, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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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.
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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
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Shibukawa BMC, Rissi GP, Uema RTB, Furtado MD, Merino MDFGL, Higarashi IH. Absenteeism in child health services: a systematic review. Rev Bras Enferm 2023; 76Suppl 2:e20210805. [PMID: 37255183 DOI: 10.1590/0034-7167-2021-0805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 11/15/2022] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES to analyze data from qualitative studies related to the phenomenon of health follow-up dropout of newborns, infants and preschoolers in child health services. METHODS systematic review, carried out in 19 information bases. Studies were included that portray the reasons for dropping out health follow-up of children up to five years old. The JBI methodology was used for systematic reviews of qualitative evidence. RESULTS we identified 20,199 studies. After applying the eligibility criteria, 81 were selected. Seven were excluded due to duplicity, resulting in 74 articles that were read in full. After this phase, three articles were selected for the final sample and later after reading their references, one more was included, totaling four articles for critical analysis. CONCLUSIONS the synthesized findings highlight that health follow-up dropout is based on personal knowledge and beliefs, the family routine dynamics and access to services.
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11
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Harmon J, Kelly S, Acheson R, Keegan D, McMahon S, Kavanagh H, O’Toole L. The Effect on Patients' Visual Acuity and Grade, Secondary to Non-Attendance at Treatment Centers, Post Referral from Diabetic RetinaScreen Ireland. Clin Ophthalmol 2023; 17:183-190. [PMID: 36660306 PMCID: PMC9843507 DOI: 10.2147/opth.s388988] [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: 09/16/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
Background Patient non-attendance following referral to hospital is a significant challenge, in particular, for persons with diabetes. Aim We sought to determine the impact on both visual acuity and the subsequent follow-up retinopathy grade of patients when they fail to attend Diabetic Retinopathy Treatment (DRT) Centers following referral from Diabetic RetinaScreen (DRS). Methods A retrospective analysis of patients discharged from DRT due to multiple consecutive missed appointments between January 2016 and June 2021. Patients discharged for non-attendance were compared with patients discharged from completed treatment. Results Of the 24,945 NEC patients referred to DRT, 5900 (24%) and 9345 (37%) were discharged back to DRS due to non-attendance and completed treatment, respectively. Those discharged for non-attendance were younger (60.7 v 63.4, p < 0.001) and had higher proportions of males (67% v 63%, p < 0.001) and people with type 1 diabetes (27% v 18%, p < 0.001). After attending rescreening after discharge, those discharged for non-attendance were significantly more likely to have a worsening of DR grade (26% v 8%, p < 0.001). Conclusion Despite being notified that further investigation (with possible treatment) was required post DRS, many diabetic patients failed to attend for further management of their eye care in DRT. These patients had worse visual outcomes compared to those that attended. Improved patient education and communication are required to mitigate against the consequences of non-attendance.
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Affiliation(s)
| | - Stephen Kelly
- Diabetic RetinaScreen, Heath Service Executive, Dublin, Ireland
| | | | - David Keegan
- Diabetic RetinaScreen, Heath Service Executive, Dublin, Ireland
| | | | - Helen Kavanagh
- Diabetic RetinaScreen, Heath Service Executive, Dublin, Ireland
| | - Louise O’Toole
- NEC Care, Cork, Ireland,Correspondence: Louise O’Toole, NEC Care, 55 South Mall (2nd Floor), Cork, T12 RR44, Ireland, Tel +35318858656, Fax +35318858658, Email
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12
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Oikonomidi T, Norman G, McGarrigle L, Stokes J, van der Veer SN, Dowding D. Predictive model-based interventions to reduce outpatient no-shows: a rapid systematic review. J Am Med Inform Assoc 2022; 30:559-569. [PMID: 36508503 PMCID: PMC9933067 DOI: 10.1093/jamia/ocac242] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Outpatient no-shows have important implications for costs and the quality of care. Predictive models of no-shows could be used to target intervention delivery to reduce no-shows. We reviewed the effectiveness of predictive model-based interventions on outpatient no-shows, intervention costs, acceptability, and equity. MATERIALS AND METHODS Rapid systematic review of randomized controlled trials (RCTs) and non-RCTs. We searched Medline, Cochrane CENTRAL, Embase, IEEE Xplore, and Clinical Trial Registries on March 30, 2022 (updated on July 8, 2022). Two reviewers extracted outcome data and assessed the risk of bias using ROB 2, ROBINS-I, and confidence in the evidence using GRADE. We calculated risk ratios (RRs) for the relationship between the intervention and no-show rates (primary outcome), compared with usual appointment scheduling. Meta-analysis was not possible due to heterogeneity. RESULTS We included 7 RCTs and 1 non-RCT, in dermatology (n = 2), outpatient primary care (n = 2), endoscopy, oncology, mental health, pneumology, and an magnetic resonance imaging clinic. There was high certainty evidence that predictive model-based text message reminders reduced no-shows (1 RCT, median RR 0.91, interquartile range [IQR] 0.90, 0.92). There was moderate certainty evidence that predictive model-based phone call reminders (3 RCTs, median RR 0.61, IQR 0.49, 0.68) and patient navigators reduced no-shows (1 RCT, RR 0.55, 95% confidence interval 0.46, 0.67). The effect of predictive model-based overbooking was uncertain. Limited information was reported on cost-effectiveness, acceptability, and equity. DISCUSSION AND CONCLUSIONS Predictive modeling plus text message reminders, phone call reminders, and patient navigator calls are probably effective at reducing no-shows. Further research is needed on the comparative effectiveness of predictive model-based interventions addressed to patients at high risk of no-shows versus nontargeted interventions addressed to all patients.
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Affiliation(s)
- Theodora Oikonomidi
- Corresponding Author: Theodora Oikonomidi, PhD, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK;
| | - Gill Norman
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK,Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Laura McGarrigle
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK,Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jonathan Stokes
- Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, UK,MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK,National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK
| | - Dawn Dowding
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK,Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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13
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Hanson P, Lange M, Oduro-Donkor D, Shuttlewood E, Weickert MO, Randeva HS, Menon V, Alexander RT, Basset P, Shankar R, Barber TM. The role of mindfulness training in sustaining weight reduction: retrospective cohort analysis. BJPsych Open 2022; 8:e198. [PMID: 36377522 PMCID: PMC9707508 DOI: 10.1192/bjo.2022.602] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Psychological stress has an established bi-directional relationship with obesity. Mindfulness techniques reduce stress and improve eating behaviours, but their long-term impact remains untested. CALMPOD (Compassionate Approach to Living Mindfully for Prevention of Disease) is a psychoeducational mindfulness-based course evidenced to improve eating patterns across a 6-month period, possibly by reducing stress. However, no long-term evaluation of impact exists. AIMS This study retrospectively evaluates 2-year outcomes of CALMPOD on patient engagement, weight and metabolic markers. METHOD All adults with a body mass index >35 kg/m2 attending an UK obesity service during 2016-2020 were offered CALMPOD. Those who refused CALMPOD were offered standard lifestyle advice. Routine clinic data over 2 years, including age, gender, 6-monthly appointment attendance, weight, haemoglobin A1C and total cholesterol, were pooled and analysed to evaluate CALMPOD. RESULTS Of 289 patients, 163 participated in the CALMPOD course and 126 did not. No baseline demographic differences existed between the participating and non-participating groups. The CALMPOD group had improved attendance across all 6-monthly appointments compared with the non-CALMPOD group (P < 0.05). Mean body weight reduction at 2 years was 5.6 kg (s.d. 11.2, P < 0.001) for the CALMPOD group compared with 3.9 kg (s.d. 10.5, P < 0.001) for the non-CALMPOD group. No differences in haemoglobin A1C and fasting serum total cholesterol were identified between the groups. CONCLUSIONS The retrospective evaluation of CALMPOD suggests potential for mindfulness and compassion-based group educational techniques to improve longer-term patient and clinical outcomes. Prospective large-scale studies are needed to evaluate the impact of stress on obesity and the true impact of CALMPOD.
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Affiliation(s)
- Petra Hanson
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK; and NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - Maria Lange
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK; and NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - Dominic Oduro-Donkor
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK; and NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - Emma Shuttlewood
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - Martin O Weickert
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK; NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK; and Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, UK
| | - Harpal S Randeva
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK; NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK; and Aston Medical Research Institute, Aston Medical School, Aston University, UK
| | - Vinod Menon
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - Regi T Alexander
- Adult Learning Disability Services, Hertfordshire Partnership University NHS Foundation Trust, Little Plumstead Hospital, Norwich, UK; and School of Life and Medical Sciences, University of Hertfordshire, UK
| | | | - Rohit Shankar
- Cornwall Institute of Intellectual Disability Research (CIDER), Peninsula Medical School, University of Plymouth, UK and Cornwall Partnership NHS Foundation Trust, UK
| | - Tom M Barber
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK; and NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK
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14
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Wilson R, Winnard Y. Causes, impacts and possible mitigation of non-attendance of appointments within the National Health Service: a literature review. J Health Organ Manag 2022; ahead-of-print. [PMID: 35918282 DOI: 10.1108/jhom-11-2021-0425] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Missed appointments within the National Health Service (NHS) are a drain on resources, associated with not only considerable time and cost implications, but also sub-optimal health outcomes. This literature review aims to explore non-attendance within the NHS in relation to causes, impacts and possible mitigation of negative effects of missed appointments. DESIGN/METHODOLOGY/APPROACH MEDLINE, CINAHL Plus and PubMed were searched with a date range of 2016-2021. Databases were searched for peer-reviewed articles published in English addressing non-attendance of adults within the NHS. Studies were excluded if they were theoretical papers, dissertations or research concerning patients aged under 18. A total of 21 articles met the inclusion criteria and were selected for analysis. FINDINGS The results indicate a significant association of non-attendance and poor health outcomes. Patients from a lower socioeconomic status, adults aged over 85 and those with multiple co-morbidities are more likely to miss appointments. The most commonly reported patient-centred reasons for failing to attend were forgetfulness, transportation difficulties, and family commitments. Practice-specific reasons were cited as inefficiencies of the appointment booking system, failure of traditional reminders and inconvenient timings. Interventions included text reminder services, the inclusion of costs within reminders and enhanced patient involvement with the booking process. ORIGINALITY/VALUE Non-attendance is complex, and to secure maximum attendance, targeted interventions are required by healthcare facilities to ensure patient needs are met. The adaption of scheduling systems and healthcare services can assist in reducing DNA rates.
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Affiliation(s)
| | - Yvette Winnard
- School of Allied Health, Anglia Ruskin University, Cambridge, UK
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15
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Yılmaz H, Kocyigit B. Factors associated with non-attendance at appointments in the gastroenterology endoscopy unit: a retrospective cohort study. PeerJ 2022; 10:e13518. [PMID: 35910767 PMCID: PMC9332409 DOI: 10.7717/peerj.13518] [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: 12/27/2021] [Accepted: 05/09/2022] [Indexed: 01/17/2023] Open
Abstract
Background and Aims Gastrointestinal (GI) endoscopy is a limited health resource because of a scarcity of qualified personnel and limited availability of equipment. Non-adherence to endoscopy appointments therefore wastes healthcare resources and may compromise the early detection and treatment of GI diseases. We aimed to identify factors affecting non-attendance at scheduled appointments for GI endoscopy and thus improve GI healthcare outcomes. Methods This was a single-center retrospective cohort study performed at a tertiary hospital gastroenterology endoscopy unit, 12 months before and 12 months after the start of the COVID-19 pandemic. We used multiple logistic regression analysis to identify variables associated with non-attendance at scheduled appointments. Results Overall, 5,938 appointments were analyzed, and the non-attendance rate was 18.3% (1,088). The non-attendance rate fell significantly during the pandemic (22.6% vs. 11.6%, p < 0.001). Multivariable regression analysis identified the absence of deep sedation (OR: 3.253, 95% CI [2.386-4.435]; p < 0.001), a referral from a physician other than a gastroenterologist (OR: 1.891, 95% CI [1.630-2.193]; p < 0.001), a longer lead time (OR: 1.006, 95% CI [1.004-1.008]; p < 0.001), and female gender (OR: 1.187, 95% CI [1.033-1.363]; p = 0.015) as associated with appointment non-attendance. Conclusions Female patients, those undergoing endoscopic procedures without deep sedation, those referred by physicians other than gastroenterologists, and with longer lead time were less likely to adhere to appointments. Precautions should be directed at patients with one or more of these risk factors, and for those scheduled for screening procedures during the COVID-19 pandemic.
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Affiliation(s)
- Hasan Yılmaz
- Department of Gastroenterology, Kocaeli University, İzmit, Kocaceli, Turkey,Department of Internal Medicine, Kocaeli University, İzmit, Kocaceli, Turkey
| | - Burcu Kocyigit
- Department of Internal Medicine, Kocaeli University, İzmit, Kocaceli, Turkey
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16
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Development of a Short Questionnaire for the Screening for Vitamin D Deficiency in Italian Adults: The EVIDENCe-Q Project. Nutrients 2022; 14:nu14091772. [PMID: 35565739 PMCID: PMC9101103 DOI: 10.3390/nu14091772] [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] [Received: 03/25/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 12/19/2022] Open
Abstract
Background: To develop and validate a questionnaire for the screening of Vitamin D in Italian adults (Evaluation Vitamin D dEficieNCy Questionnaire, EVIDENCe-Q). Methods: 150 participants, attending the 11Clinical Nutrition and Dietetics Operative Unit, Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri IRCCS, of Pavia were enrolled. Demographic variables and serum levels of vitamin D were recorded. The EVIDENCe-Q included information regarding factors affecting the production, intake, absorption and metabolism of Vitamin D. The EVIDENCe-Q score ranged from 0 (the best status) to 36 (the worst status). Results: Participants showed an inadequate status of Vitamin D, according to the current Italian reference values. A significant difference (p < 0.0001) in the EVIDENCe-Q score was found among the three classes of vitamin D status (severe deficiency, deficiency and adequate), being the mean score higher in severe deficiency and lower in the adequate one. A threshold value for EVIDENCe-Q score of 23 for severe deficiency, a threshold value of 21 for deficiency and a threshold value of 20 for insufficiency were identified. According to these thresholds, the prevalence of severe deficiency, deficiency and insufficiency was 22%, 35.3% and 43.3% of the study population, respectively. Finally, participants with EVIDENCe-Q scores <20 had adequate levels of vitamin D. Conclusions: EVIDENCe-Q can be a useful and easy screening tool for clinicians in their daily practice at a reasonable cost, to identify subjects potentially at risk of vitamin D deficiency and to avoid unwarranted supplementation and/or costly blood testing.
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17
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Valero-Bover D, González P, Carot-Sans G, Cano I, Saura P, Otermin P, Garcia C, Gálvez M, Lupiáñez-Villanueva F, Piera-Jiménez J. Reducing non-attendance in outpatient appointments: predictive model development, validation, and clinical assessment. BMC Health Serv Res 2022; 22:451. [PMID: 35387675 PMCID: PMC8985245 DOI: 10.1186/s12913-022-07865-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Non-attendance to scheduled hospital outpatient appointments may compromise healthcare resource planning, which ultimately reduces the quality of healthcare provision by delaying assessments and increasing waiting lists. We developed a model for predicting non-attendance and assessed the effectiveness of an intervention for reducing non-attendance based on the model. Methods The study was conducted in three stages: (1) model development, (2) prospective validation of the model with new data, and (3) a clinical assessment with a pilot study that included the model as a stratification tool to select the patients in the intervention. Candidate models were built using retrospective data from appointments scheduled between January 1, 2015, and November 30, 2018, in the dermatology and pneumology outpatient services of the Hospital Municipal de Badalona (Spain). The predictive capacity of the selected model was then validated prospectively with appointments scheduled between January 7 and February 8, 2019. The effectiveness of selective phone call reminders to patients at high risk of non-attendance according to the model was assessed on all consecutive patients with at least one appointment scheduled between February 25 and April 19, 2019. We finally conducted a pilot study in which all patients identified by the model as high risk of non-attendance were randomly assigned to either a control (no intervention) or intervention group, the last receiving phone call reminders one week before the appointment. Results Decision trees were selected for model development. Models were trained and selected using 33,329 appointments in the dermatology service and 21,050 in the pneumology service. Specificity, sensitivity, and accuracy for the prediction of non-attendance were 79.90%, 67.09%, and 73.49% for dermatology, and 71.38%, 57.84%, and 64.61% for pneumology outpatient services. The prospective validation showed a specificity of 78.34% (95%CI 71.07, 84.51) and balanced accuracy of 70.45% for dermatology; and 69.83% (95%CI 60.61, 78.00) for pneumology, respectively. The effectiveness of the intervention was assessed on 1,311 individuals identified as high risk of non-attendance according to the selected model. Overall, the intervention resulted in a significant reduction in the non-attendance rate to both the dermatology and pneumology services, with a decrease of 50.61% (p<0.001) and 39.33% (p=0.048), respectively. Conclusions The risk of non-attendance can be adequately estimated using patient information stored in medical records. The patient stratification according to the non-attendance risk allows prioritizing interventions, such as phone call reminders, to effectively reduce non-attendance rates. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07865-y.
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Affiliation(s)
- Damià Valero-Bover
- Catalan Health Service, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System DS3 - IDIBELL, Barcelona, Spain
| | - Pedro González
- Faculty of Informatics, Telecommunications and Multimedia, Universitat Oberta de Catalunya, Barcelona, Spain.,Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Gerard Carot-Sans
- Catalan Health Service, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System DS3 - IDIBELL, Barcelona, Spain
| | - Isaac Cano
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, Universitat de Barcelona (UB), Barcelona, Spain
| | - Pilar Saura
- Faculty of Medicine, Universidad Alfonso X El Sabio, Madrid, Spain
| | | | | | | | | | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain. .,Digitalization for the Sustainability of the Healthcare System DS3 - IDIBELL, Barcelona, Spain. .,Faculty of Informatics, Telecommunications and Multimedia, Universitat Oberta de Catalunya, Barcelona, Spain.
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18
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Liu TL, Yeo AL, Ravi A, Patabendige G, Lim TW, Bell S, Morand E, Le S. The impact of COVID-19 telehealth on outpatient test completion. Intern Med J 2021; 51:1614-1618. [PMID: 34139787 PMCID: PMC8447330 DOI: 10.1111/imj.15425] [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: 02/25/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pathology and imaging tests are frequently requested in the outpatient setting despite historically poor completion rates. The impact of COVID-19 telehealth on test completion rates is unknown. AIMS To examine the impact of the COVID-19 pandemic and telehealth transition on pathology and imaging test request and completion rates in Australian outpatient clinics. METHODS We performed a prospective cohort study with historical controls between March-May 2019 and March-May 2020. Pathology and imaging request and completion rates were collected in review consultation patients attending Gastroenterology and Rheumatology outpatient clinics at a tertiary healthcare system prior and during the early phases of the COVID-19 pandemic in Melbourne. RESULTS 1376 patients were included in the study. Pathology tests were requested more frequently in the COVID-19 group (n = 582/684, 85.2%) than control group (n = 492/692, 71.1%, p < 0.001) but completion rates were lower in the COVID-19 group (n = 443/582, 76.1%) than control group (n = 426/492 (86.6%), p < 0.001). Imaging tests were requested more frequently in the COVID-19 group (n = 345/682, 50.6%) than control group (n = 295/692, 42.6%, p = 0.003) with lower rates of completion in the COVID-19 group (n = 229/345, 66.4%) then control group (n = 247/295, 83.7%, p < 0.001). CONCLUSIONS The COVID-19 pandemic and telehealth transition has resulted in more frequent pathology and imaging requests but fewer test completion in the outpatients setting. This study has identified new clinical risks associated with the abrupt transition to telehealth during COVID-19 that should be explored in future studies and appropriately mitigated. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Ai Li Yeo
- Monash University, School of Clinical Sciences.,Monash Health, Department of Rheumatology
| | | | | | | | - Sally Bell
- Monash Health, Department of Gastroenterology
| | - Eric Morand
- Monash University, School of Clinical Sciences.,Monash Health, Department of Rheumatology
| | - Suong Le
- Monash Health, Department of Gastroenterology
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Tambakis G, Lee T, Shah R, Wright E, Connell W, Miller A, Demediuk B, Ryan M, Howell J, Tsoi E, Lust M, Basnayake C, Ding N, Croagh C, Hong T, Kamm M, Farrell A, Papaluca T, MacIsaac M, Iser D, Mahady S, Holt B, Thompson A, Holmes J. Low failure to attend rates and increased clinic capacity with Telehealth: A highly effective outpatient model that should continue beyond the COVID-19 pandemic. J Gastroenterol Hepatol 2021; 36:1136-1137. [PMID: 33338284 DOI: 10.1111/jgh.15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/09/2022]
Affiliation(s)
- G Tambakis
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Lee
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - R Shah
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Wright
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - W Connell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Miller
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - B Demediuk
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Ryan
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - J Howell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Tsoi
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Lust
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Basnayake
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - N Ding
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Croagh
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Hong
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Kamm
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Farrell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Papaluca
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M MacIsaac
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - D Iser
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - S Mahady
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - B Holt
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Thompson
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - J Holmes
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
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Kelly M, Higgins A, Murphy A, McCreesh K. A telephone assessment and advice service within an ED physiotherapy clinic: a single-site quality improvement cohort study. Arch Physiother 2021; 11:4. [PMID: 33550990 PMCID: PMC7868119 DOI: 10.1186/s40945-020-00098-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/26/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In response to issues with timely access and high non-attendance rates for Emergency Department (ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvement project. This telehealth option requires minimal resources, with the added benefit of allowing the healthcare professional streamline care. A primary aim was to investigate whether this service model can reduce wait times and non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability. METHODS This was a single-site quality improvement cohort study that compares data on wait time to first physiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, XMercy University Hospital, Cork, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study. RESULTS Those that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3-8 days) compared to those that opted for usual care (median 35 days; 19-39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction. CONCLUSION A telephone assessment and advice service may be useful in minimising delays for advice for those referred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadly acceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-face consultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial is warranted to confirm these findings.
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Affiliation(s)
- Marie Kelly
- Department of Physiotherapy, Mercy University Hospital, Grenville Place, Cork, T12 WE28 Ireland
| | - Anna Higgins
- Department of Physiotherapy, Mercy University Hospital, Grenville Place, Cork, T12 WE28 Ireland
| | - Adrian Murphy
- Emergency Department, Mercy University Hospital, Cork, Ireland
| | - Karen McCreesh
- School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Brewster S, Bartholomew J, Holt RIG, Price H. Non-attendance at diabetes outpatient appointments: a systematic review. Diabet Med 2020; 37:1427-1442. [PMID: 31968127 DOI: 10.1111/dme.14241] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-attendance at diabetes outpatient appointments is a sizeable problem worldwide and has been associated with suboptimal health outcomes. We aimed to describe the characteristics, health outcomes and reasons given for non-attendance at doctor- or nurse-led diabetes appointments, and interventions to improve attendance. METHODS PubMed, EMBASE, CINAHL and PsychInfo were searched from database inception to February 2019. Included articles were peer-reviewed, published in English, related to adults or young people with type 1 or type 2 diabetes, and addressed one of the above aspects of non-attendance. Studies were excluded if reporting on other types of diabetes or reviewing attendance at structured education, retinal screening, paediatric, antenatal, podiatry or dietetic clinics. RESULTS Thirty-four studies of varied designs were identified (15 observational, 1 randomized control trial, 9 qualitative, 5 surveys, 4 service improvements). The definition of non-attendance varied. Younger adults, smokers and those with financial pressures were less likely to attend. Non-attendance was associated with higher HbA1c ; other outcomes were varied but typically worse in non-attenders. Reasons for non-attendance in qualitative studies fell into three categories: balancing the costs and benefits of attendance, coping strategies, and the relationships between the person with diabetes and healthcare professionals. Interventions included appointment management strategies, service improvements, patient navigators and WebCam appointments. CONCLUSIONS Non-attendance is only partially explained by logistical issues. Qualitative studies suggest complex psychosocial factors are involved. Interventions have progressed from simple appointment reminders in an attempt to address some of the psycho-social determinants, but more work is needed to improve attendance.
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Affiliation(s)
- S Brewster
- Research and Development Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, UK
| | - J Bartholomew
- CRN Wessex, NIHR Clinical Research Network (CRN), University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - H Price
- Research and Development Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, UK
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Colucci N, Gregoris A, Meyer J, Naiken SP, Staszewicz W, Gialamas E, Toso C, Abbassi Z. Introduction of a specialized consultation prior to insertion of totally implantable access venous devices: Impact on cancellation rate and patient satisfaction. Vascular 2020; 28:816-820. [PMID: 32508290 DOI: 10.1177/1708538120930470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Preoperative consultation is usually not performed before insertion of a totally implantable venous access device (TIVAD). In our experience, an incomplete preoperative assessment, a predictable medical condition contraindicating surgery, or no-show patients the day of surgery led to several surgery cancellations. Therefore, we introduced a specific preoperative surgical consultation for TIVAD that took place shortly before surgery. The aim of the present study is to evaluate the patients' satisfaction and to establish the rate of cancellation after the adoption of this strategy. METHODS Two-hundred and four patients who benefited from the preoperative consultation before TIVAD insertion from August 2014 to August 2016 were included. Satisfaction of patients and cancellation rate were documented. RESULTS With that strategy, no TIVAD insertion was either delayed or cancelled. The overall level of satisfaction was high (91.8%); 184 patients (90.2%) judged the consultation useful in preparation for the surgery. The surgical procedure met their expectations in 92.2% of cases. Patients known for a psychiatric comorbidity were more likely to express dissatisfaction. CONCLUSIONS The introduction of a specific preoperative surgical consultation for TIVAD insertion led to a high level of patients' satisfaction. After the preoperative consultation, no cancellation was recorded. Special approaches have to be considered for patients with a psychiatric comorbidity.
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Affiliation(s)
- Nicola Colucci
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, 19001University of Pavia, Pavia, Italy
| | - Adrien Gregoris
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Jeremy Meyer
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Surennaidoo Perumal Naiken
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Wojciech Staszewicz
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Christian Toso
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Ziad Abbassi
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
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Abstract
Introduction Despite all the advances in medicine and attempts to delay and prevent amputations, the number of amputations remains high. The state of South Carolina has one of the highest rates of major limb amputation in the country, with Florence and neighboring counties particularly affected. Education level has been associated with an increased number of amputations and worse outcomes post-amputation. The aim of this study was to investigate the education level among patients with major upper and lower limb amputation within the Florence and neighboring counties, which is a part of the Pee Dee region of the state of South Carolina. Materials and methods This is a retrospective chart review study conducted at the outpatient hospital-based Physical Medicine and Rehabilitation clinic. All consecutive amputee patients visiting our outpatient amputee clinic from January 2018 to January 2019 and who met the study inclusion criteria were included in the study. The main outcome measure was the education level. Results Of the sample, 26% had below high school education, 33.8% had high school education, 14.2% had some college education, 19.7% had a college education, and 6.3% had an advanced college degree. Conclusions Patients with major limb amputation have a lower education level compared to the general population. Lower education level as a part of the broader and more complex socioeconomic status may be a possible barrier in the process of post-amputation rehabilitation and long-term care of patients with major limb amputation.
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Affiliation(s)
- Ivan Chernev
- Orthopedics, Medical University of South Carolina (MUSC) Health Florence Medical Center, Florence, USA.,Physical Medicine and Rehabilitation, Palmetto Amputee Network, Florence, USA
| | - Alexandra Chernev
- Physical Medicine and Rehabilitation, Palmetto Amputee Network, Florence, USA
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