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Higgason N, Soroka O, Goyal P, Mahmood SS, Pinheiro LC. Suboptimal Cardiology Follow-Up Among Patients With and Without Cancer Hospitalized for Heart Failure. Am J Cardiol 2023; 196:79-86. [PMID: 37019746 PMCID: PMC10297727 DOI: 10.1016/j.amjcard.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 04/07/2023]
Abstract
Many patients hospitalized for heart failure (HF) do not receive recommended follow-up cardiology care, and non-White patients are less likely to receive follow-up than White patients. Poor HF management may be particularly problematic in patients with cancer because cardiovascular co-morbidity can delay cancer treatments. Therefore, we sought to describe outpatient cardiology care patterns in patients with cancer hospitalized for HF and to determine if receipt of follow-up varied by race/ethnicity. SEER (Surveillance, Epidemiology, and End Results) data from 2007 to 2013 linked to Medicare claims from 2006 to 2014 were used. We included patients aged 66+ years with breast, prostate, or colorectal cancer, and preexisting HF. Patients with cancer were matched to patients in a noncancer cohort that included individuals with HF and no cancer. The primary outcome was receipt of an outpatient, face-to-face cardiologist visit within 30 days of HF hospitalization. We compared follow-up rates between cancer and noncancer cohorts, and stratified analyses by race/ethnicity. A total of 2,356 patients with cancer and 2,362 patients without cancer were included. Overall, 43% of patients with cancer and 42% of patients without cancer received cardiologist follow-up (p = 0.30). After multivariable adjustment, White patients were 15% more likely to receive cardiology follow-up than Black patients (95% confidence interval [CI] 1.02 to 1.30). Black patients with cancer were 41% (95% CI 1.11 to 1.78) and Asian patients with cancer were 66% (95% CI 1.11 to 2.49) more likely to visit a cardiologist than their noncancer counterparts. In conclusion, less than half of patients with cancer hospitalized for HF received recommended follow-up with a cardiologist, and significant race-related differences in cardiology follow-up exist. Future studies should investigate the reasons for these differences.
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Affiliation(s)
- Noel Higgason
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Orysya Soroka
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York; Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Syed S Mahmood
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Ayele TA, Alamneh TS, Shibru H, Sisay MM, Yilma TM, Melak MF, Bisetegn TA, Belachew T, Haile M, Zeru T, Asres MS, Shitu K. Effect of COVID-19 pandemic on missed medical appointment among adults with chronic disease conditions in Northwest Ethiopia. PLoS One 2022; 17:e0274190. [PMID: 36194566 PMCID: PMC9531804 DOI: 10.1371/journal.pone.0274190] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND COVID-19 had affected the health-care-seeking behavior of people with chronic medical conditions. The impact is even worse in resource-limited settings like Ethiopia. Therefore, this study was aimed to assess the extent and correlates of missed appointments among adults with chronic disease conditions before and during the COVID-19 pandemic in the Northwest Ethiopia. METHODS A retrospective chart review and cross-sectional survey were conducted from December 2020 to February 2021. A total of 1833 patients with common chronic disease were included by using a stratified systematic random sampling technique. Web-based data collection was done using Kobo collect. The data were explored using descriptive statistical techniques, the rate of missed appointments s before and during the COVID-19 pandemic was determined. A negative binomial regression model was fitted to identify the factors of missed appointment. An incidence rate ratio with its 95% confidence interval (CI) and p-value of the final model were reported. RESULTS The rate of missed appointments was 12.5% (95% CI: 11.13%, 14.20%) before the pandemic, increased to 26.8% (95% CI: 24.73%, 28.82%) during the pandemic (p-value < 0.001). Fear of COVID-19 infection and lack of transport was the most common reasons for missing appointments. Older patients (Adjusted Incidence Rate Ratio (AIRR) = 1.01, 95% CI: 1.001; 1.015), having treatment follow up more than 5 years (AIRR = 1.36, 95%CI: 1.103; 1.69), shorter frequency of follow-up (AIRR = 2.22, 95% CI: 1.63; 2.49), covering expense out of pocket (AIRR = 2.26, 95%CI: 1.41; 2.95), having a sedentary lifestyle (AIRR = 1.36, 95%CI: 1.12; 1.71), and history of missed appointments before COVID-19 pandemic (AIRR = 4.27, 95%CI: 3.35; 5.43) were positively associated with the incidence of missed appointments. CONCLUSION The rate of missed appointment increased significantly during the COVID-19 pandemic. Older age, longer duration of follow up, more frequent follow-up, out-of-pocket expenditure for health service, history of poor follow-up, and sedentary lifestyle had positive relationship with missed appointments during the pandemic. Therefore, it is important to give special emphasis to individuals with these risk factors while designing and implementing policies and strategies for peoples with chronic diseases to ensure the continuity of care and to avoid the long-term impact on their health.
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Affiliation(s)
- Tadesse Awoke Ayele
- Epidemiology & Biostatistics Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Epidemiology & Biostatistics Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtewold Shibru
- Internal Medicine Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Malede Mequanent Sisay
- Epidemiology & Biostatistics Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfahun Melese Yilma
- Health Informatics Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkitu Fentie Melak
- Nutrition Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale Bisetegn
- Health Education & Behavioral Science Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | | | - Taye Zeru
- Amhara Public Health Institute, Bahir-Dar, Ethiopia
| | - Mezgebu Selamsew Asres
- Internal Medicine Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kegnie Shitu
- Health Education & Behavioral Science Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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5
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MacLeod KE, Chapel JM, McCurdy M, Minaya-Junca J, Wirth D, Onwuanyi A, Lane RI. The implementation cost of a safety-net hospital program addressing social needs in Atlanta. Health Serv Res 2021; 56:474-485. [PMID: 33580501 DOI: 10.1111/1475-6773.13629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To describe the cost of integrating social needs activities into a health care program that works toward health equity by addressing socioeconomic barriers. DATA SOURCES/STUDY SETTING Costs for a heart failure health care program based in a safety-net hospital were reported by program staff for the program year May 2018-April 2019. Additional data sources included hospital records, invoices, and staff survey. STUDY DESIGN We conducted a retrospective, cross-sectional, case study of a program that includes health education, outpatient care, financial counseling and free medication; transportation and home services for those most in need; and connections to other social services. Program costs were summarized overall and for mutually exclusive categories: health care program (fixed and variable) and social needs activities. DATA COLLECTION Program cost data were collected using a activity-based, micro-costing approach. In addition, we conducted a survey that was completed by key staff to understand time allocation. PRINCIPAL FINDINGS Program costs were approximately $1.33 million, and the annual per patient cost was $1455. Thirty percent of the program costs was for social needs activities: 18% for 30-day supply of medications and addressing socioeconomic barriers to medication adherence, 18% for mobile health services (outpatient home visits), 53% for navigating services through a financial counselor and community health worker, and 12% for transportation to visits and addressing transportation barriers. Most of the program costs were for personnel: 92% of the health care program fixed, 95% of the health care program variable, and 78% of social needs activities. DISCUSSION Historically, social and health care services are funded by different systems and have not been integrated. We estimate the cost of implementing social needs activities into a health care program. This work can inform implementation for hospitals attempting to address social determinants of health and social needs in their patient population.
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Affiliation(s)
- Kara E MacLeod
- ASRT, Inc., Atlanta, Georgia, USA.,Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John M Chapel
- Department of Economics, University of Southern California, Los Angeles, California, USA
| | - Matthew McCurdy
- Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia, USA
| | - Jasmin Minaya-Junca
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Diane Wirth
- Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Anekwe Onwuanyi
- Grady Memorial Hospital, Atlanta, Georgia, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Rashon I Lane
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Breathett K, D'Amico R, Adesanya TMA, Hatfield S, Willis S, Sturdivant RX, Foraker RE, Smith S, Binkley P, Abraham WT, Peterson PN. Patient Perceptions on Facilitating Follow-Up After Heart Failure Hospitalization. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004099. [PMID: 28615367 DOI: 10.1161/circheartfailure.117.004099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Timely follow-up after hospitalization for heart failure (HF) is recommended. However, follow-up is suboptimal, especially in lower socioeconomic groups. Patient-centered solutions for facilitating follow-up post-HF hospitalization have not been extensively evaluated. METHODS AND RESULTS Face-to-face surveys were conducted between 2015 and 2016 among 83 racially diverse adult patients (61% African American, 34% Caucasian, and 5% Other) hospitalized for HF at a university hospital centered in a low-income area of Columbus, Ohio. Patient perceptions of methods to facilitate follow-up post-HF hospitalization and likelihood of using interventions were investigated using a Likert scale: 1=very much to 5=not at all. Results were analyzed by Wilcoxon signed-rank test with Bonferroni correction. The response rate was 82%. The annual household income was <$35 000 for 49% of patients. An appointment near the patient's home was the most desired intervention (77%), followed by reminder message (73%), transportation to appointment (63%), and elimination of copayment (59%). Interventions most likely to be used if provided were similarly ranked: reminder message (48%), appointment near home (46%), elimination of copay (46%), and transportation to appointment (39%). There were significant differences (P=0.001) in high-ranking interventions related to location (appointment near home, transportation, home appointment) and reminder for visit compared with low-ranking interventions related to time (weekend appointment, appointment after 5 pm) and telemedicine. CONCLUSIONS Among this cohort of racially diverse low-income patients hospitalized with HF, an appointment near the patient's home and a reminder message were the most desired interventions to facilitate follow-up. Further study of similar populations nationwide is warranted.
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Affiliation(s)
- Khadijah Breathett
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.).
| | - Rachel D'Amico
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - T M Ayodele Adesanya
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Stefanie Hatfield
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Shannon Willis
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Rodney X Sturdivant
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Randi E Foraker
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Sakima Smith
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Philip Binkley
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - William T Abraham
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Pamela N Peterson
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
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