1
|
Hirsh-Yechezkel G, Glasser S, Gabis LV, Eden A, Savitzki D, Farhi A, Luxenburg O, Levitan G, Lerner-Geva L. Missed initial appointments at Israeli child development centres: Rate, reasons, and associated characteristics. Int J Health Plann Manage 2022; 37:2779-2793. [PMID: 35709352 PMCID: PMC9544127 DOI: 10.1002/hpm.3503] [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: 08/15/2021] [Revised: 02/09/2022] [Accepted: 04/29/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Missed appointments (MAs) at child development centres (ChDCs) cause multiple problems: they preclude timely diagnosis and treatment of both the invited child and children whose appointment was delayed due to overbooking, as well as disrupting efficient organisational management. The aim of this study was to assess the rate and describe the reasons for missed appointments at Israeli ChDCs, and to evaluate the association of socio-demographic, clinical, and administrative variables with MA rates. METHODS This nested case-control study included all children scheduled for initial appointments (N = 1143) at three centres during 1 year. Parents of children who missed their appointment and a sample of those who attended were interviewed by telephone. RESULTS The rate of missed appointments was 26.6%, and the most frequent reasons were unexpected events (26.0%) and lack of insurance coverage (23.4%). Variables associated with lower MA rates were: having had ≥3 types of rehabilitative interventions (odds ratios (OR) = 0.26; 95% confidence interval [CI] 0.16-0.44), detailed referral letter (OR = 0.48; 95%CI 0.30-0.75), telephone reminder (OR = 0.37; 95%CI 0.24-0.57) and health maintenance organisations or private insurance coverage (OR = 0.12; 95%CI 0.06-0.17 and OR = 0.56; 95% CI 0.38-0.89, respectively). CONCLUSION Encouraging physician's referral letters and personal-contact reminders can reduce missed appointments. Understanding the family's and the child's personal characteristics, and the organisational/administrative aspects of missed appointments may guide efforts to ensure timely care for every child.
Collapse
Affiliation(s)
- Galit Hirsh-Yechezkel
- Women & Children's Health Research Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Saralee Glasser
- Women & Children's Health Research Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Lidia V Gabis
- Weinberg Child Development Center, Sheba Medical Center, The Edmond & Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Avi Eden
- Barzilai Medical Center, Child Development Institute, Ashkelon, Israel
| | - David Savitzki
- Pediatric Neurology and Child Development Unit, Galilee Medical Center, Nahariya, Israel
| | - Adel Farhi
- Women & Children's Health Research Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Gila Levitan
- Women & Children's Health Research Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Liat Lerner-Geva
- Women & Children's Health Research Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Affiliated with Tel Aviv University, Ramat Gan, Israel.,School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
2
|
Haderlein TP, Dobalian A, Raja PV, Der-Martirosian C. Association Between Virtual Care Use and Same-Day Primary Care Access in VA Primary Care-Mental Health Integration. J Prim Care Community Health 2022; 13:21501319221091430. [PMID: 35426344 PMCID: PMC9016585 DOI: 10.1177/21501319221091430] [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] [Indexed: 11/17/2022] Open
Abstract
Introduction: Same-day referrals from primary care to mental health increase subsequent
mental health treatment engagement. VA Primary Care-Mental Health
Integration (PC-MHI) clinics offer integrated mental health services
embedded in primary care clinics, providing a key entry point to mental
health care. Although telehealth use expanded rapidly after the onset of
COVID-19, the impact of telehealth on same-day primary care access among new
PC-MHI mental health patients is unknown. To address this knowledge gap, we
examined associations between telehealth use and same-day primary care
access in VA PC-MHI. Methods: We examined electronic health record data to identify same-day primary care
appointments among PC-MHI patients who initiated care during 3/1/2018 to
10/29/2021. We used logistic regression analyses to evaluate the effect of
telehealth on same-day primary care access. Time, demographic
characteristics, mental health diagnoses (PTSD and depression), and
substance use disorder diagnosis were evaluated as covariates. Results: New PC-MHI patients who were seen via telehealth were less likely to receive
same-day primary care access than patients seen in person (OR: 0.54; 95% CI:
0.41-0.71; P < .001). Conclusions: Despite the potential advantages of using telehealth to increase access, VA
patients with an initial PC-MHI visit via telehealth were less likely than
patients seen in person to be referred from primary care. Telehealth may
adversely affect primary care referrals to mental health services, an
outcome that could ultimately reduce specialty mental health care
continuity. There is an urgent need to identify strategies to facilitate
PC-MHI care coordination in the telehealth context.
Collapse
Affiliation(s)
- Taona P Haderlein
- U.S. Department of Veterans Affairs, North Hills, CA, USA.,Greater Los Angeles VA Medical Center, Los Angeles, CA, USA
| | - Aram Dobalian
- U.S. Department of Veterans Affairs, North Hills, CA, USA.,The Ohio State University, Columbus, OH, USA
| | - Pushpa V Raja
- Greater Los Angeles VA Medical Center, Los Angeles, CA, USA
| | - Claudia Der-Martirosian
- U.S. Department of Veterans Affairs, North Hills, CA, USA.,Greater Los Angeles VA Medical Center, Los Angeles, CA, USA
| |
Collapse
|
3
|
White LJ, Butler-Howell KE, Nadon-Hoysted N, Schulz MC, Kroon J. Impact of demographics and appointment characteristics on patient attendance in a university dental clinic. J Dent Educ 2020; 85:615-622. [PMID: 33368257 DOI: 10.1002/jdd.12514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/15/2020] [Accepted: 12/04/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Failed patient attendance in a university dental clinic is detrimental to the student learning experience, the university as a business, and to members of the public awaiting urgent dental treatment. PURPOSE This study aimed to identify the demographic, appointment characteristics, and time-related factors associated with patient attendance in a university dental clinic from 2015 to 2019. METHODS A 5-year retrospective analysis was conducted in 2020 on data extracted from the Griffith University Dental Clinic patient management system. Following data cleaning and categorization, the dataset was downloaded into SPSS for statistical analysis. Frequencies, odds ratio, and chi squared were used to determine the demographic and time-related factors of patients who had completed, cancelled, and failed to attend (FTA) appointments. RESULTS A total of 23.4% of appointments were cancelled, and 6.6% were FTA. Demographics associated with cancellations include females, adults aged 25 to 44, and private paying patients. FTA were higher in young adults aged 19 to 24, low to mid-range socioeconomic status (SES) and those eligible for publicly funded dental treatment. Mondays and Fridays experienced the greatest number of FTA and cancellations, respectively. Emergency appointments had the greatest attendance rates and endodontic procedures the lowest. CONCLUSION The loss of clinical teaching hours, resources, and revenue necessitates the implementation of targeted strategies to minimize cancellations and FTA based on demographic and appointment characteristics that may render individual as high risk for failed attendance.
Collapse
Affiliation(s)
- Laura Jade White
- School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Kate Ellise Butler-Howell
- School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Naomie Nadon-Hoysted
- School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Madeleine Carly Schulz
- School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Jeroen Kroon
- School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| |
Collapse
|
4
|
Houtepen JABM, Sijtsema JJ, Van der Lem R, Scheres A, Bogaerts S. Cognitive-motivational, interpersonal, and behavioral functioning in relationship to treatment and research engagement in forensic patients with ADHD. J Clin Psychol 2020; 76:2345-2371. [PMID: 32659042 PMCID: PMC7689781 DOI: 10.1002/jclp.23016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/31/2020] [Accepted: 06/06/2020] [Indexed: 02/04/2023]
Abstract
Objectives To provide more insight into treatment and research responsivity in offenders with attention‐deficit hyperactivity disorder (ADHD). Method Via self‐reports and patients' scores on cognitive computer tasks, it was examined whether poorer cognitive‐motivational, interpersonal, and behavioral functioning were related to treatment no‐shows, longer treatment time duration intervals, and no‐show at the research appointment in 52 forensic outpatients with ADHD (Mage = 35.3, SD = 9.38). Treatment adherence was tracked for 10 appointments after research participation. Results Regression analyses showed that higher self‐reported impulsivity was associated with research no‐show, and more alcohol use with longer treatment time intervals. Yet, self‐reported delay aversion was associated with fewer treatment no‐shows, and, uncontrolled for alcohol use, impulsivity was associated with shorter treatment time intervals in a subsample of patients. Conclusions These preliminary results indicate that externalizing behaviors increase the risk for nonadherence in forensic ADHD patients, but that cognitive‐motivational problems also motivate patients to be more engaged.
Collapse
Affiliation(s)
- Jenny A B M Houtepen
- Fivoor Research and Treatment Innovation, Forensic Outpatient Center Rotterdam, Rotterdam, The Netherlands.,Department of Developmental Psychology, School of Social and Behavioral Sciences, Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Jelle J Sijtsema
- Fivoor Research and Treatment Innovation, Forensic Outpatient Center Rotterdam, Rotterdam, The Netherlands.,Department of Developmental Psychology, School of Social and Behavioral Sciences, Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Rosalind Van der Lem
- Fivoor Research and Treatment Innovation, Forensic Outpatient Center Rotterdam, Rotterdam, The Netherlands
| | - Anouk Scheres
- Department of Developmental Psychology, Radboud University, Radboud, The Netherlands
| | - Stefan Bogaerts
- Fivoor Research and Treatment Innovation, Forensic Outpatient Center Rotterdam, Rotterdam, The Netherlands.,Department of Developmental Psychology, School of Social and Behavioral Sciences, Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
5
|
Millings A, Carnelley KB, Cavanagh K, Wilderspin A, Wiseman H, Rowe AC. Priming attachment security improves attitudes towards a range of therapies. Br J Psychol 2018; 110:15-39. [PMID: 29984408 DOI: 10.1111/bjop.12334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 11/28/2022]
Abstract
We sought to understand how attachment orientation influenced attitudes towards different types of psychological therapies. In two studies, we (1) examined attachment orientation as a predictor of attitudes towards different therapies and (2) tested whether attachment security priming could improve attitudes. Study 1 (n = 339) found associations between attachment orientation and attitudes towards, and likelihood of using different therapies. Positive and negative attitudes about different therapies mediated the relationship between attachment avoidance and likelihood of use. Study 2 (n = 412) showed that primed security (vs. neutral prime) improved attitudes towards relational, non-relational and distanced-relational therapies for those with a fearful-avoidant attachment orientation. For relational and distanced-relational therapies, the mechanism of this effect was increased cognitive openness. Attachment orientation is a determinant of therapy attitudes and anticipated help-seeking behaviour. Priming security may promote open-minded decision-making about some therapies. Findings are discussed with relevance to attachment theory, research and clinical practice.
Collapse
|
6
|
Clough BA, Nazareth SM, Casey LM. The Therapy Attitudes and Process Questionnaire: A Brief Measure of Factors Related to Psychotherapy Appointment Attendance. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:237-250. [PMID: 27718132 DOI: 10.1007/s40271-016-0199-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient non-attendance and dropout remains problematic in mental health settings. The theory of planned behavior (TPB) has proven useful in understanding such challenges in a variety of healthcare settings, but the absence of an adequate measure in mental health has hampered research in this area. OBJECTIVE The aim of the current study was to develop and conduct an initial psychometric investigation of a brief measure, the Therapy Attitudes and Process Questionnaire (TAP), utilizing the TPB to understand factors associated with attendance in mental health settings. METHODS We used a quantitative survey-based design and administered the TAP to 178 adult participants who were engaged in individual or group psychotherapy. A subsample also provided data to assess validity and reliability. RESULTS A four-factor solution was revealed through exploratory factor analysis and accounted for approximately 75 % of the variance in scores. Factors corresponded to those predicted by the TPB. Analyses supported the reliability, validity, and internal consistency of the measure. CONCLUSIONS Results suggest that the TAP may be a useful tool for examining patients' attitudes and beliefs about attending psychotherapy appointments. The TAP can be used to better understand patients' intentions, attitudes, perceptions of behavioral control, and subjective norms relating to psychotherapy attendance. This understanding may facilitate improved outcomes for patients and clinicians.
Collapse
Affiliation(s)
- Bonnie A Clough
- School of Psychology and Counselling, Institute for Resilient Regions, University of Southern Queensland, 37 Sinnathamby Boulevard, Springfield Central, QLD, 4300, Australia.
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia.
| | - Sonia M Nazareth
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia
| | - Leanne M Casey
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia
| |
Collapse
|
7
|
White MM, Clough BA, Casey LM. What do help-seeking measures assess? Building a conceptualization framework for help-seeking intentions through a systematic review of measure content. Clin Psychol Rev 2017; 59:61-77. [PMID: 29153743 DOI: 10.1016/j.cpr.2017.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/28/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022]
Abstract
Mental health services are underutilised by people who could benefit from treatment. Research into help-seeking intentions (HSI) is required to support interventions to increase service use. Existing HSI measures are not psychometrically robust and problems with content validity undermine research in this field. Our purpose was to create a clear conceptualization of HSI and systematically review the content of existing measures. Previous researchers had defined help-seeking and intentions separately, so the first step was to create a more comprehensive definition. Seven theoretical perspectives identified in the HSI literature were mapped onto the new definition and aggregated to form a conceptual framework that reflects expert opinion. This framework guided an analysis of item relevance and a comparison of completeness across measures. Most individual items (99.1%) were relevant, lending credibility to the proposed framework. However, no measure provided a complete assessment of the HSI construct. This study used a novel methodology to develop a definition and conceptual framework, both of which reflect sound theoretical perspectives and represent the consensus-view of experts. The current results will guide the development of stronger measures with improved construct validity and will support interventions aimed at improving help-seeking.
Collapse
Affiliation(s)
- Margaret M White
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Australia.
| | - Bonnie A Clough
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Australia
| | - Leanne M Casey
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Australia
| |
Collapse
|
8
|
McEvoy P, Williamson T, Kada R, Frazer D, Dhliwayo C, Gask L. Improving access to mental health care in an Orthodox Jewish community: a critical reflection upon the accommodation of otherness. BMC Health Serv Res 2017; 17:557. [PMID: 28806946 PMCID: PMC5557521 DOI: 10.1186/s12913-017-2509-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 08/04/2017] [Indexed: 12/12/2022] Open
Abstract
Background The English National Health Service (NHS) has significantly extended the supply of evidence based psychological interventions in primary care for people experiencing common mental health problems. Yet despite the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably short of the levels of access that may be necessary to offset the health inequalities created by their different exposure to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an Orthodox Jewish community in the North West of England. Methods A combination of qualitative and quantitative data were drawn upon including naturally occurring data, observational notes, e-mail correspondence, routinely collected demographic data and clinical outcomes measures, as well as written feedback and recorded discussions with 12 key informants. Results Improvements in access to mental health care for some people from the Orthodox Jewish community were achieved through the collaborative efforts of a distributed leadership team. The members of this leadership team were a self-selecting group of stakeholders which had a combination of local knowledge, cultural understanding, power to negotiate on behalf of their respective constituencies and expertise in mental health care. Through a process of dialogic engagement the team was able to work with the community to develop a bespoke service that accommodated its wish to maintain a distinct sense of cultural otherness. Conclusions This critical reflection illustrates how dialogic engagement can further the mechanisms of candidacy, concordance and recursivity that are associated with improvements in access to care in under-served sections of the population, whilst simultaneously recognising the limits of constructive dialogue. Dialogue can change the dynamic of community engagement. However, the full alignment of the goals of differing constituencies may not always be possible, due the complex interaction between the multiple positions and understandings of stakeholders that are involved and the need to respect the other’-s’ autonomy. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2509-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Phil McEvoy
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom.
| | - Tracey Williamson
- University of Salford, School of Nursing, Midwifery, Social Work & Social Sciences, Mary Seacole Building, Frederick Road Campus, Salford, M6 6PU, United Kingdom
| | - Raphael Kada
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom
| | - Debra Frazer
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom
| | - Chardworth Dhliwayo
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom
| | - Linda Gask
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom
| |
Collapse
|
9
|
Storrs MJ, Ramov HM, Lalloo R. An Investigation into Patient Non-Attendance and Use of a Short-Message Reminder System at a University Dental Clinic. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.1.tb06055.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mark J. Storrs
- Menzies Health Institute of Queensland and Lecturer in General Dental Practice; School of Dentistry and Oral Health; Griffith University; Queensland Australia
| | | | - Ratilal Lalloo
- School of Dentistry; University of Queensland; Queensland Australia
- Australian Research Centre for Population Oral Health; University of Adelaide; South Australia Australia
| |
Collapse
|
10
|
Delgadillo J, Moreea O, Murphy E, Ali S, Swift JK. Can Low-Cost Strategies Improve Attendance Rates in Brief Psychological Therapy? Double-Blind Randomized Controlled Trial. J Clin Psychol 2015; 71:1139-52. [PMID: 26425941 DOI: 10.1002/jclp.22228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess if telephone text message appointment reminders and orientation leaflets can increase the proportion of patients who attend brief interventions after being assessed as suitable for guided self-help following cognitive behavioral therapy principles. METHOD Attendance was operationally defined as having accessed at least 1 therapy appointment. A secondary outcome was the proportion of attenders who completed or dropped out of therapy. After initial assessment, 254 patients with depression and anxiety disorders were randomly assigned to 1 of 3 groups: (a) usual waitlist control, (b) leaflet, (c) leaflet plus text message. Differences in the proportions of patients who started and completed therapy across groups were assessed using chi-square and logistic regression analyses. RESULTS Overall, 63% of patients in this sample attended therapy. Between-group differences were not significant for attendance, x(2) (2) = 3.94, p = .14, or completion rates, x(2) (2) = 2.98, p = .23. These results were not confounded by demographic or clinical characteristics. CONCLUSIONS Low-cost strategies appear to make no significant difference to therapy attendance and completion rates.
Collapse
|
11
|
Biddle ML, Adler NR, Heath M, Streat S, Wardrop M, Watson JP. Nurse-led clinic: effective and efficient delivery of assessment and review of patients with hepatitis B and C. Intern Med J 2015; 44:581-5. [PMID: 24612294 DOI: 10.1111/imj.12400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/15/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hepatology and gastroenterology services are increasingly utilising the skills and experience of nurse practitioners and nurse specialists to help meet the increasing demand for healthcare. A new nurse-led assessment clinic has been established in the liver clinic at Geelong Hospital to utilise the expertise of nurses to assess and triage new patients and streamline their pathway through the healthcare system. AIM The aim of this study is to assess quantitatively the first 2 years of operation of the nurse assessment clinic at Geelong Hospital, and to assess advantages and disadvantages of the nurse-led clinic. METHODS Data were extracted retrospectively from clinical records of new patients at the liver clinic. Quarterly 1-month periods were recorded over 2 years. Patients were categorised according to the path through which they saw a physician, including missed and rescheduled appointments. The number of appointments, the waiting time from referral to appointments and the number of 'did-not-attend' occasions were analysed before and after the institution of the nurse-led assessment clinic. The Mann-Whitney rank sum test of ordinal data was used to generate median wait times. RESULTS There was shown to be a statistically significant longer waiting time for physician appointment if seen by the nurse first. The difference in waiting time was 10 days. However, there was also a reduction in the number of missed appointments at the subsequent physician clinic. Other advantages have also been identified, including effective triage of patients and organisation of appropriate investigations from the initial nurse assessment.
Collapse
Affiliation(s)
- M L Biddle
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | | | | | | | | | | |
Collapse
|
12
|
Alsawy S, Mansell W, Carey TA, McEvoy P, Tai SJ. Science and Practice of Transdiagnostic CBT: A Perceptual Control Theory (PCT) Approach. Int J Cogn Ther 2014. [DOI: 10.1521/ijct.2014.7.4.334] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
13
|
McLean S, Gee M, Booth A, Salway S, Nancarrow S, Cobb M, Bhanbhro S. Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02340] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundMissed appointments are an avoidable cost and a resource inefficiency that impact on the health of the patient and treatment outcomes. Health-care services are increasingly utilising reminder systems to counter these negative effects.ObjectivesThis project explores the differential effect of reminder systems for different segments of the population for improving attendance, cancellation and rescheduling of appointments.DesignThree inter-related reviews of quantitative and qualitative evidence relating to theoretical explanations for appointment behaviour (review 1), the effectiveness of different approaches to reminding patients to attend health service appointments (review 2) and factors likely to influence non-attendance (review 3).Data sourcesDatabase searches were conducted on Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, The Cochrane Library, EMBASE (via NHS Evidence from 1 January 2000 to January/February 2012), Health Management Information Consortium database, Institute of Electrical and Electronics EngineersXplore, The King’s Fund Library Catalogue, Maternity and Infant Care, MEDLINE, Physiotherapy Evidence Database, PsycINFO, SPORTDiscus and Web of Science from 1 January 2000 to January/February 2012. Supplementary screening of references of included studies was conducted to identify additional potentially relevant studies. Conceptual papers were identified for review 1, randomised controlled trials (RCTs) and systematic reviews for review 2 and a range of quantitative and qualitative research designs for review 3.MethodsWe conducted three inter-related reviews of quantitative and qualitative evidence, involving a review of conceptual frameworks of reminder systems and adherence behaviours, a review of the reminder effectiveness literature and a review informed by realist principles to explain the contexts and mechanisms that explain reminder effectiveness. A preliminary conceptual framework was developed to show how reminder systems work, for whom they work and in which circumstances. Six themes emerged that potentially influence the effectiveness of the reminder or whether or not patients would attend their appointment, namely the reminder–patient interaction, reminder accessibility, health-care settings, wider social issues, cancellation and rebookings, and distal/proxy attributes. Standardised review methods were used to investigate the effectiveness of reminders to promote attendance, cancellation or rebooking across all outpatient settings. Finally, a review informed by realist principles was undertaken, using the conceptual framework to explain the context and mechanisms that influence how reminders support attendance, cancellation and rebooking.ResultsA total of 466 papers relating to 463 studies were identified for reviews 2 and 3. Findings from 31 RCTs and 11 separate systematic reviews (review 2 only) revealed that reminder systems are consistently effective at reducing non-attendance at appointments, regardless of health-care setting or patient subgroups. Simple reminders that provide details of timing and location of appointments are effective for increasing attendance at appointments. Reminders that provide additional information over and above the date, time and location of the appointment (‘reminder plus’) may be more effective than simple reminders at reducing non-attendance and may be particularly useful for first appointments and screening appointments; simple reminders may be appropriate thereafter for most patients the majority of the time. There was strong evidence that the timing of reminders, between 1 and 7 days prior to the appointment, has no effect on attendance; substantial numbers of patients do not receive their reminder; reminders promote cancellation of appointments; inadequate structural factors prevent patients from cancelling appointments; and few studies investigated factors that influence the effectiveness of reminder systems for population subgroups.LimitationsGenerally speaking, the systematic review method seeks to provide a precise answer to a tightly focused question, for which there is a high degree of homogeneity within the studies. A wide range of population types, intervention, comparison and outcomes is included within the RCTs we identified. However, use of this wider approach offers greater analytical capability in terms of understanding contextual and mechanistic factors that would not have been evident in a more narrowly focused review and increases confidence that the findings will have relevance in a wide range of service settings.ConclusionsSimple reminders or ‘reminder plus’ should be sent to all patients in the absence of any clear contraindication. Other reminder alternatives may be relevant for key groups of patients: those from a deprived background, ethnic minorities, substance abusers and those with comorbidities and/or illnesses. We are developing a practice guideline that may help managers to further tailor their reminder systems for their service and client groups. We recommend future research activities in three main areas. First, more studies should routinely consider the potential for differential effects of reminder systems between patient groups in order to identify any inequalities and remedies. Second, ‘reminder plus’ systems appear promising, but there is a need for further research to understand how they influence attendance behaviour. Third, further research is required to identify strategies to ‘optimise’ reminder systems and compare performance with current approaches.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Sionnadh McLean
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Melanie Gee
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sarah Salway
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Susan Nancarrow
- School of Health and Human Sciences, Southern Cross University, East Lismore, NSW, Australia
| | - Mark Cobb
- Sheffield Teaching Hospitals, Sheffield, UK
| | - Sadiq Bhanbhro
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| |
Collapse
|
14
|
The impact of additional initial face-to-face sessions on engagement within an Improving Access to Psychological Therapies service. COGNITIVE BEHAVIOUR THERAPIST 2014. [DOI: 10.1017/s1754470x13000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractDespite substantial investment, Improving Access to Psychological Therapies (IAPT) services in some areas continue to find that demand exceeds provision, leading to waiting lists for therapy. Routine engagement in services is low, with almost half of clients disengaging with the service before or after the initial contact. An audit was carried out to evaluate the impact of introducing a face-to-face initial session within the high-intensity step of an IAPT service. The service structure and pathway of one regional IAPT service is described. A longitudinal observational design was used. All clients discharged from the service within two calendar months – before and after the introduction of an initial face-to-face session were identified. Electronic records were reviewed for each client. Introduction of an initial face-to-face session was associated with an increase in clients attending at least one therapy session and clients completing a course of therapy. Inclusion of an initial face-to-face engagement session may take up additional time, but is likely to be worthwhile in regards to associated benefits in terms of client engagement.
Collapse
|