1
|
Sinha S, Nudelman N, Feustal PJ, Caton-Darby M, Rothschild MI, Wladis EJ. Factors associated with appointment 'no-shows' at two tertiary level outpatient oculoplastic clinics. Orbit 2023; 42:523-528. [PMID: 36437639 DOI: 10.1080/01676830.2022.2148259] [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: 09/03/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Appointment no-shows in clinics can adversely impact patients and physicians alike. This study aimed to determine the rate and potential causes of missed appointments in oculoplastic clinics and compare a private practice and hospital-based academic setting. METHODS A retrospective review of patients who booked appointments for oculoplastic consultation, between August 2019 and January 2020 at two oculoplastic clinics was performed. Demographic and patient-specific characteristics of patients who failed to attend their appointment were identified. Data were analysed to determine and compare the no-show rates in both clinics and logistic regression was performed to determine factors associated with them. RESULTS The rate of missed appointments was 3% and 17% at the oculoplastic clinics of Lions Eye Institute (LEI, private practice) and Albany Medical Center (AMC, academic hospital-based office), respectively. Patients at the AMC clinic were more likely to be male, younger, have a lower household income, not carry private insurance, and suffer from trauma. Logistic regression analysis showed lower patient age to significantly increase the likelihood of no-shows in both clinics (p = .01 for LEI, p = .003 for AMC), and lead appointment time greater than 90 days to be a significant risk factor for no-shows at LEI (p = .01). CONCLUSIONS The no-show rate for oculoplastic appointments is 3% and 17% at LEI and AMC clinics, respectively. Our analysis shows that younger patients are more likely to miss appointments at both clinics, and an appointment lead time greater than 90 days is a significant risk factor for no-shows at LEI.
Collapse
Affiliation(s)
- Shruti Sinha
- Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Slingerlands, New York, USA
| | - Nicole Nudelman
- Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Slingerlands, New York, USA
| | - Paul J Feustal
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, New York, USA
| | - Mireille Caton-Darby
- Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Slingerlands, New York, USA
| | - Michael I Rothschild
- Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Slingerlands, New York, USA
| | - Edward J Wladis
- Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Slingerlands, New York, USA
| |
Collapse
|
2
|
COVID-19 Pandemic Effects on Clinic Schedule Patterns. J Ambul Care Manage 2022; 45:343-345. [PMID: 36006392 DOI: 10.1097/jac.0000000000000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
3
|
Doolan BJ, Saikal SL, Scaria A, Gupta M. Patient factors associated with dermatology outpatient non-attendance: An analysis of racial and ethnic diversity. Clin Dermatol 2022; 40:405-410. [PMID: 34983001 DOI: 10.1016/j.clindermatol.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Non-attendance to dermatology outpatient appointments is a risk factor for poorer patient outcomes. The culturally and linguistically diverse (CALD) communities in Australia have been identified as at risk of poorer health outcomes, but there is a paucity of data assessing patient factors that may increase outpatient non-attendance. To investigate this, we performed a retrospective cross-sectional study of dermatology appointments from patients attending a tertiary, referral public hospital located in one of Australia's most racially and ethnically diverse communities. Patients within the 18-45 years age bracket were 61% more likely to not attend compared to older age groups. Those born in Oceania, Middle East Asia, and surprisingly Australia were more likely to miss an appointment, whilst those born in East and Southeast Asia were more likely to attend. Those who spoke Arabic at home were more likely to not attend, whilst those who spoke Vietnamese at home were more likely to attend. This study sheds further light on health disparities in non-attendance and emphasizes the importance of not collectively amalgamating all groups of the CALD community.
Collapse
Affiliation(s)
- Brent J Doolan
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.
| | - Samra L Saikal
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia; The University of Newcastle, Sydney, New South Wales, Australia
| | - Anish Scaria
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Western Sydney University, New South Wales, Australia
| |
Collapse
|
4
|
Bhavsar NA, Doerfler SM, Giczewska A, Alhanti B, Lutz A, Thigpen CA, George SZ. Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions. PLoS One 2021; 16:e0251336. [PMID: 34048440 PMCID: PMC8162651 DOI: 10.1371/journal.pone.0251336] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/23/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Chronic pain affects 50 million Americans and is often treated with non-pharmacologic approaches like physical therapy. Developing a no-show prediction model for individuals seeking physical therapy care for musculoskeletal conditions has several benefits including enhancement of workforce efficiency without growing the existing provider pool, delivering guideline adherent care, and identifying those that may benefit from telehealth. The objective of this paper was to quantify the national prevalence of no-shows for patients seeking physical therapy care and to identify individual and organizational factors predicting whether a patient will be a no-show when seeking physical therapy care. DESIGN Retrospective cohort study. SETTING Commercial provider of physical therapy within the United States with 828 clinics across 26 states. PARTICIPANTS Adolescent and adult patients (age cutoffs: 14-117 years) seeking non-pharmacological treatment for musculoskeletal conditions from January 1, 2016, to December 31, 2017 (n = 542,685). Exclusion criteria were a primary complaint not considered an MSK condition or improbable values for height, weight, or body mass index values. The study included 444,995 individuals. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of no-shows for musculoskeletal conditions and predictors of patient no-show. RESULTS In our population, 73% missed at least 1 appointment for a given physical therapy care episode. Our model had moderate discrimination for no-shows (c-statistic:0.72, all appointments; 0.73, first 7 appointments) and was well calibrated, with predicted and observed no-shows in good agreement. Variables predicting higher no-show rates included insurance type; smoking-status; higher BMI; and more prior cancellations, time between visit and scheduling date, and between current and previous visit. CONCLUSIONS The high prevalence of no-shows when seeking care for musculoskeletal conditions from physical therapists highlights an inefficiency that, unaddressed, could limit delivery of guideline-adherent care that advocates for earlier use of non-pharmacological treatments for musculoskeletal conditions and result in missed opportunities for using telehealth to deliver physical therapy.
Collapse
Affiliation(s)
- Nrupen A. Bhavsar
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United Stated of America
| | - Shannon M. Doerfler
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
| | - Anna Giczewska
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
| | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
| | - Adam Lutz
- ATI Physical Therapy, Greenville, SC, United Stated of America
- Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United Stated of America
| | - Charles A. Thigpen
- ATI Physical Therapy, Greenville, SC, United Stated of America
- Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United Stated of America
- Center for Effectiveness Research in Orthopaedics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United Stated of America
| | - Steven Z. George
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United Stated of America
| |
Collapse
|
5
|
Briggs MS, Ulses C, VanEtten L, Mansfield C, Ganim A, Hand BN, Quatman-Yates CC. Predictive Factors for Patients' Failure to Show for Initial Outpatient Physical Therapist Evaluation. Phys Ther 2021; 101:6124132. [PMID: 33528021 DOI: 10.1093/ptj/pzab047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/19/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study was to examine primary factors that may predict patients' failure to show at initial physical therapist evaluation in an orthopedic and sports outpatient setting. METHODS A retrospective analysis of patients' demographic data for physical therapist evaluations between January 2013 and April 2015 was performed. A binary logistic regression model was used to evaluate the odds of a no-show at evaluation. Demographic variables of age, employment status, days waited for the appointment, payer source, and distance traveled to the clinic were analyzed. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0. RESULTS A total of 6971 patients were included in the final analysis, with 10% (n = 698) of the scheduled patients having a no-show event for their initial evaluation. The following factors increased the odds of patients having a no-show event: days to appointment (OR = 1.058; 95% CI = 1.042-1.074), unemployment status (OR = 1.96; 95% CI = 1.41-2.73), unknown employment status (OR = 3.22; 95% CI = 1.12-8.69), Medicaid insurance (OR = 4.87; 95% CI = 3.43-6.93), Medicare insurance (OR = 2.22; 95% CI = 1.10-4.49), unknown payer source (OR = 262.84; 95% CI = 188.72-366.08), and distance traveled 8 or more kilometers (OR = 1.31; 95% CI = 1.01-1.70). Female sex (OR = 0.73; 95% CI = 0.57-0.95) and age 40 years or older (OR = 0.44; 95% CI = 0.33-0.60) decreased the odds of a no-show event. CONCLUSIONS Results from this study indicate there may be some demographic factors that are predictive of patients failing to attend their first physical therapist visit. IMPACT Understanding the predictive factors and identifying potential opportunities for improvements in scheduling processes might help decrease the number of patients failing to show for their initial physical therapy appointment, with the ultimate goal of positively influencing patient outcomes.
Collapse
Affiliation(s)
- Matthew S Briggs
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christine Ulses
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lucas VanEtten
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cody Mansfield
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Anthony Ganim
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brittany N Hand
- School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Catherine C Quatman-Yates
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
6
|
Hester T, Thomas R, Cederna J, Peterson AM, Brown J, Johnson TM, Cha KB. Increasing Access to Specialized Dermatology Care: A Retrospective Study Investigating Clinical Operation and Impact of a University-Affiliated Free Clinic. Dermatol Ther (Heidelb) 2020; 11:105-115. [PMID: 33175327 PMCID: PMC7858729 DOI: 10.1007/s13555-020-00462-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Our objective was to study the impact and clinical operation of an integrated model for free specialized dermatology care via collaboration between an academic institution and a nonprofit outpatient clinic through an analysis of patient demographics and care provided. Methods Hope@UMHS is a partnership between the University of Michigan Health System (UMHS) and Hope Clinic (HC) which provides free specialty consultations to uninsured residents of Southeast Michigan. A retrospective chart review was completed for patients referred to the UMHS Dermatology clinic as part of the HOPE@UMHS collaboration from April 2012 through February 2020. Results Of the 294 referred patients, 264 were managed in 30 clinic sessions over 8 years, staffed by 92 unique volunteers. Patients most commonly presented with atopic dermatitis (10.5%), seborrheic dermatitis (7.9%), and actinic keratosis (7.4%). The majority of patients (68.2%) were prescribed at least one new medication. Nine skin cancers, including one melanoma, were diagnosed and treated. There were 102 procedures performed. Eighty-seven percent of patients received conclusive evaluation and treatment at the time of their consultation. Conclusion Our experience illustrates that providing free, comprehensive dermatology care in a university hospital by partnering with a nonprofit clinic is both feasible and beneficial to the greater community.
Collapse
Affiliation(s)
- Thomas Hester
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Reinie Thomas
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Timothy M Johnson
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
- Ganger Dermatology, Ann Arbor, MI, USA
| | - Kelly B Cha
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
7
|
Elhasid R, Nirel R, Avigad S, Avrahami G, Abramov A, Attias D, Arad N, Ballin A, Ben-Arush M, Bielorai B, Burstein Y, Elitzur S, Gabriel H, Hameiri-Grossman M, Kapelushnik J, Sthoeger D, Toren A, Wientraub M, Yaniv I, Izraeli S, Stark B. Poorer outcome of childhood acute lymphoblastic leukemia in the Bedouin population: A report from the Berlin-Frankfurt-Muenster-based Israeli national protocols. Pediatr Blood Cancer 2020; 67:e28024. [PMID: 31595664 DOI: 10.1002/pbc.28024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/10/2019] [Accepted: 09/04/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Therapy outcomes for childhood acute lymphoblastic leukemia (ALL) had substantially improved in the last decades, but variability across racial and ethnic groups was identified in some clinical studies. In this study, we aimed to investigate whether such a difference in outcome is found in the diverse ethnicities in Israel as well. METHODS A retrospective study was conducted among 1154 patients (855 Jews, 195 Muslims, 52 Bedouins, 26 Druze, and 26 others) aged 1 to 21 years, who were diagnosed with ALL between 1989 and 2011 and were treated according to the same Berlin-Frankfurt-Muenster-based Israel National Study protocols. RESULTS Bedouins had a higher incidence of t(1;19) (16% vs 3% for non-Bedouins) and a lower incidence of high-hyperdiploidy (10% vs 25% for non-Bedouins) (P = 0.01). Five-year event-free survival (EFS) and overall survival (OS) were poorer for the Bedouins (60.3% ± 7.2% and 63.1% ± 7.2%, respectively) compared with the Jews, Muslims, and Druze (80.4% ± 1.4%, 77.3% ± 3.2%, and 84% ± 7.3%, respectively, for EFS [P = 0.02], and 86.3% ± 1.2%, 82.3% ± 2.9%, and 88.3% ± 6.4%, respectively, for OS [P = 0.002]). Adherence to intensive chemotherapy was similar between the Muslims and the Bedouins. CONCLUSIONS Our findings suggest that the Bedouins, a highly inbred ethnic Arab people, may be considered a higher risk group that may need more intensive chemotherapy and/or supportive care in order to improve their outcome.
Collapse
Affiliation(s)
- Ronit Elhasid
- Department of Pediatric Hemato-Oncology, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Nirel
- Department of Statistics, Hebrew University, Jerusalem, Israel
| | - Smadar Avigad
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Avrahami
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aya Abramov
- Department of Pediatric Hematology/Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Dina Attias
- Department of Pediatric Hematology/Oncology, Bnei-Zion Medical Center and Faculty of Medicine, Technion, Haifa, Israel
| | - Nira Arad
- Department of Pediatric Hematology/Oncology, Rambam Medical Center, and The Bruce Rappaport Faculty of Medicine, Technion-Israel, Institute of Technology, Haifa, Israel
| | - Ami Ballin
- Department of Pediatric Hematology/Oncology, Edith Wolfson Medical Center, Holon, Israel
| | - Myriam Ben-Arush
- Department of Pediatric Hematology/Oncology, Rambam Medical Center, and The Bruce Rappaport Faculty of Medicine, Technion-Israel, Institute of Technology, Haifa, Israel
| | - Bella Bielorai
- Department of Pediatric Hematology/Oncology Chaim Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Burstein
- Department of Pediatric Hemato-Oncology, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarah Elitzur
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Herzel Gabriel
- Department of Pediatric Hematology/Oncology, Ha-Emek Medical Center, Afula, Israel
| | - Michal Hameiri-Grossman
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Kapelushnik
- Department of Pediatric Hematology/Oncology, Soroka Medical Center, Beer Sheva, Israel
| | - Dalia Sthoeger
- Department of Pediatric Hematology/Oncology, Kaplan Medical Center, Rehovot, Israel
| | - Amos Toren
- Department of Pediatric Hematology/Oncology Chaim Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Wientraub
- Department of Pediatric Hematology/Oncology, Hadassah University Hospital, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Isaac Yaniv
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Izraeli
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Batia Stark
- Division of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Mieloszyk RJ, Rosenbaum JI, Hall CS, Hippe DS, Gunn ML, Bhargava P. Environmental Factors Predictive of No-Show Visits in Radiology: Observations of Three Million Outpatient Imaging Visits Over 16 Years. J Am Coll Radiol 2019; 16:554-559. [PMID: 30947887 DOI: 10.1016/j.jacr.2018.12.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the impact of environmental and socioeconomic factors on outpatient cancellations and "no-show visits" (NSVs) in radiology. MATERIALS AND METHODS We conducted a retrospective analysis by collecting environmental factor data related to outpatient radiology visits occurring between 2000 and 2015 at our multihospital academic institution. Appointment attendance records were joined with daily weather observations from the National Oceanic and Atmospheric Administration and estimated median income from the US Census American Community Survey. A multivariate logistic regression model was built to examine relationships between NSV rate and median income, commute distance, maximum daily temperature, and daily snowfall. RESULTS There were 270,574 (8.0%) cancellations and 87,407 (2.6%) NSVs among 3,379,947 scheduled outpatient radiology appointments and 575,206 unique patients from 2000 to 2015. Overall cancellation rates decreased from 14% to 8%, and NSV rates decreased from 6% to 1% as median income increased from $20,000 to $120,000 per year. In a multivariate model, the odds of NSV decreased 10.7% per $10,000 increase in median income (95% confidence interval [CI]: 10.3%-11.1%) and 2.0% per 10°F increase in maximum daily temperature (95% CI: 1.3%-1.6%). The odds of NSV increased 1.4% per 10-mile increase in commute distance (95% CI: 1.3%-1.6%) and 4.5% per 1-inch increase in daily snowfall (95% CI: 3.6%-5.3%). Commute distance was more strongly associated with NSV for those in the two lower tertiles of income than the highest tertile (P < .001). CONCLUSION Environmental factors are strongly associated with patients' attendance at scheduled outpatient radiology examinations. Modeling of appointment failure risk based on environmental features can help increase the attendance of outpatient radiology appointments.
Collapse
Affiliation(s)
| | | | | | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington
| | - Martin L Gunn
- Department of Radiology, University of Washington, Seattle, Washington
| | - Puneet Bhargava
- Department of Radiology, University of Washington, Seattle, Washington.
| |
Collapse
|
9
|
Tsai WC, Lee WC, Chiang SC, Chen YC, Chen TJ. Factors of missed appointments at an academic medical center in Taiwan. J Chin Med Assoc 2019; 82:436-442. [PMID: 30907780 DOI: 10.1097/jcma.0000000000000068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Missed appointments mean appointments neither attended nor canceled by patients. Missed appointments belong to one of the important subjects of hospital management because they would incur the inactivity of medical professionals and devices, occupy the health resources for other patients, and thus impair the quality of healthcare services. The aim of this study was to explore the factors of missed appointments at the outpatient department of an academic medical center in Taiwan. METHODS This was a cross-sectional study based on registration records of an academic medical center in Northern Taiwan in 2015. Fifteen variables of patients, appointments, and weathers were taken into analysis. Logistic regression was used to calculate the adjusted odds ratio of each variable. For nonfirst visits, we further built a logistic regression model with the five most influential variables and the personal attendance pattern of the previous three appointments. RESULTS Of 2 132 577 eligible appointments in 2015, the overall no-show rate was 16.9%. The influential factors included the following: (1) patient characteristics: younger than 40 years, ≤6 visits, and a no-show rate between 50% and 75% in the previous year; (2) appointment characteristics: Saturdays, evenings, on the last third of the waiting list, only one appointment on the same day, online appointments, appointment-to-visit intervals (wait time) in 7 to 14 days, appointments to obstetrics/gynecology or pediatrics, first-time appointments, and the interval between the appointed visit and the previous visit in <7 days; and (3) weather characteristics: warm weathers and heavy rains. For nonfirst appointments, the influences in decreasing order were heavy rain, shorter interval between the appointed visit and the previous visit to the same department, higher no-show rate in the previous year, total absence in the personal attendance pattern of the previous three appointments, longer wait time, and children. CONCLUSION The factors of missed appointments were multifaceted. Further measures could be undertaken accordingly to enhance healthcare efficiency.
Collapse
Affiliation(s)
- Wen-Chien Tsai
- Superintendent Office, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wui-Chiang Lee
- Department of Medical Affairs and Planning, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shu-Chiung Chiang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Financial Engineering and Actuarial Mathematics, Soochow University, Taipei, Taiwan, ROC
| | - Yu-Chun Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
10
|
Evaluation of Missed Clinic Visits at an Academic Multi-Provider Urology Clinic. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
11
|
Impact of Delayed Time to Advanced Imaging on Missed Appointments Across Different Demographic and Socioeconomic Factors. J Am Coll Radiol 2018; 15:713-720. [PMID: 29503152 DOI: 10.1016/j.jacr.2018.01.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/11/2018] [Accepted: 01/21/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this study was to investigate the impact of wait days (WDs) on missed outpatient MRI appointments across different demographic and socioeconomic factors. METHODS An institutional review board-approved retrospective study was conducted among adult patients scheduled for outpatient MRI during a 12-month period. Scheduling data and demographic information were obtained. Imaging missed appointments were defined as missed scheduled imaging encounters. WDs were defined as the number of days from study order to appointment. Multivariate logistic regression was applied to assess the contribution of race and socioeconomic factors to missed appointments. Linear regression was performed to assess the relationship between missed appointment rates and WDs stratified by race, income, and patient insurance groups with analysis of covariance statistics. RESULTS A total of 42,727 patients met the inclusion criteria. Mean WDs were 7.95 days. Multivariate regression showed increased odds ratio for missed appointments for patients with increased WDs (7-21 days: odds ratio [OR], 1.39; >21 days: OR, 1.77), African American patients (OR, 1.71), Hispanic patients (OR, 1.30), patients with noncommercial insurance (OR, 2.00-2.55), and those with imaging performed at the main hospital campus (OR, 1.51). Missed appointment rate linearly increased with WDs, with analysis of covariance revealing underrepresented minorities and Medicaid insurance as significant effect modifiers. CONCLUSIONS Increased WDs for advanced imaging significantly increases the likelihood of missed appointments. This effect is most pronounced among underrepresented minorities and patients with lower socioeconomic status. Efforts to reduce WDs may improve equity in access to and utilization of advanced diagnostic imaging for all patients.
Collapse
|
12
|
Dantas LF, Fleck JL, Cyrino Oliveira FL, Hamacher S. No-shows in appointment scheduling - a systematic literature review. Health Policy 2018; 122:412-421. [PMID: 29482948 DOI: 10.1016/j.healthpol.2018.02.002] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 12/20/2017] [Accepted: 02/07/2018] [Indexed: 12/29/2022]
Abstract
No-show appointments significantly impact the functioning of healthcare institutions, and much research has been performed to uncover and analyze the factors that influence no-show behavior. In spite of the growing body of literature on this issue, no synthesis of the state-of-the-art is presently available and no systematic literature review (SLR) exists that encompasses all medical specialties. This paper provides a SLR of no-shows in appointment scheduling in which the characteristics of existing studies are analyzed, results regarding which factors have a higher impact on missed appointment rates are synthetized, and comparisons with previous findings are performed. A total of 727 articles and review papers were retrieved from the Scopus database (which includes MEDLINE), 105 of which were selected for identification and analysis. The results indicate that the average no-show rate is of the order of 23%, being highest in the African continent (43.0%) and lowest in Oceania (13.2%). Our analysis also identified patient characteristics that were more frequently associated with no-show behavior: adults of younger age; lower socioeconomic status; place of residence is distant from the clinic; no private insurance. Furthermore, the most commonly reported significant determinants of no-show were high lead time and prior no-show history.
Collapse
Affiliation(s)
- Leila F Dantas
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil.
| | - Julia L Fleck
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil.
| | - Fernando L Cyrino Oliveira
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil.
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil.
| |
Collapse
|
13
|
Minshall I, Neligan A. A review of people who did not attend an epilepsy clinic and their clinical outcomes. Seizure 2017. [DOI: 10.1016/j.seizure.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
14
|
Alaeddini A, Hong SH. A Multi-way Multi-task Learning Approach for Multinomial Logistic Regression*. An Application in Joint Prediction of Appointment Miss-opportunities across Multiple Clinics. Methods Inf Med 2017; 56:294-307. [PMID: 28590498 DOI: 10.3414/me16-01-0112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/15/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Whether they have been engineered for it or not, most healthcare systems experience a variety of unexpected events such as appointment miss-opportunities that can have significant impact on their revenue, cost and resource utilization. In this paper, a multi-way multi-task learning model based on multinomial logistic regression is proposed to jointly predict the occurrence of different types of miss-opportunities at multiple clinics. METHODS An extension of L1 / L2 regularization is proposed to enable transfer of information among various types of miss-opportunities as well as different clinics. A proximal algorithm is developed to transform the convex but non-smooth likelihood function of the multi-way multi-task learning model into a convex and smooth optimization problem solvable using gradient descent algorithm. RESULTS A dataset of real attendance records of patients at four different clinics of a VA medical center is used to verify the performance of the proposed multi-task learning approach. Additionally, a simulation study, investigating more general data situations is provided to highlight the specific aspects of the proposed approach. Various individual and integrated multinomial logistic regression models with/without LASSO penalty along with a number of other common classification algorithms are fitted and compared against the proposed multi-way multi-task learning approach. Fivefold cross validation is used to estimate comparing models parameters and their predictive accuracy. The multi-way multi-task learning framework enables the proposed approach to achieve a considerable rate of parameter shrinkage and superior prediction accuracy across various types of miss-opportunities and clinics. CONCLUSIONS The proposed approach provides an integrated structure to effectively transfer knowledge among different miss-opportunities and clinics to reduce model size, increase estimation efficacy, and more importantly improve predictions results. The proposed framework can be effectively applied to medical centers with multiple clinics, especially those suffering from information scarcity on some type of disruptions and/or clinics.
Collapse
Affiliation(s)
- Adel Alaeddini
- Adel Alaeddini, Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX, USA, E-mail:
| | | |
Collapse
|
15
|
Ratmansky M, Hai N, Schlossberg T, Mimouni-Bloch A, Schweiger A. Does pain take holidays? Non-attendance rates at a hospital-based pain clinic are elevated during the Jewish high-holidays. Isr J Health Policy Res 2017; 6:11. [PMID: 28373903 PMCID: PMC5374672 DOI: 10.1186/s13584-017-0132-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/11/2017] [Indexed: 12/17/2022] Open
Abstract
Background Patient non-attendance is an expensive and persistent problem worldwide with rates between 5–39% reported in the literature. The objective of the study was to assess whether there is a higher incidence of non-attendance in a hospital-based pain clinic during the period of the Jewish High Holidays (Rosh-Hashanah to Sukkot) and whether this is further compounded by other factors, such as demographic characteristics and previous visits to the clinic. Methods Records were taken from the Lowenstein Rehabilitation Hospital appointment scheduling system. Data was gathered from two time-periods: High-Holidays and Control for each year, over a total of 6 years 2008–2013. Non-attendance was analyzed by period, by age, by gender and by previous visits to the clinic. Results In the entire population studied (666 distinct records), the non-attendance rate was higher during the High-Holidays as compared to the Control period (32 vs. 24.1%; p = 0.030). Non-attendance rates were significantly higher during the Holidays among repeating patients (28.6 vs. 14.8%; p = 0.002) and among women (34.6 vs. 20.7%; p = 0.004). Discussion Our data suggest that non-attendance is elevated during the High-Holidays in specific groups of patients, namely, repeating patients and women. Despite no direct inquiry into the reasons for non-attendance, we speculate that the elevated well-being and familial support during the holidays contribute to the patients’ ability to cope with persistent pain and possibly directly reduce the amount of pain, leading to patients missing their pain clinic appointments. Conclusion Our results, provided they can be corroborated by larger-scale studies, can assist in scheduling policy adjustments such as avoidance of appointments during the High-holidays for specific patient populations and more rigorous reminder efforts during these times of the year that may lead to reduction in overall non-attendance rates in the pain clinic. Further, our data provide an impetus for further studies of non-attendance patterns among pain clinic patients, in order to acquire a better understanding of the reasons for non-attendance and develop strategies to reduce it and thus contribute to the continuous improvement of the Israeli health systems as well as others worldwide. Electronic supplementary material The online version of this article (doi:10.1186/s13584-017-0132-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Motti Ratmansky
- Pain Unit, Loewenstein Rehabilitation Hospital, 278 Ahuza Street, 43100 Raanana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nitzan Hai
- The Academic College of Tel Aviv, Tel Aviv, Israel
| | - Tzion Schlossberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Leumit health fund, Jerusalem, Israel
| | - Aviva Mimouni-Bloch
- Pain Unit, Loewenstein Rehabilitation Hospital, 278 Ahuza Street, 43100 Raanana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | |
Collapse
|
16
|
Cancelled Primary Care Appointments: A Prospective Cohort Study of Diabetic Patients. J Med Syst 2017; 41:53. [PMID: 28214994 DOI: 10.1007/s10916-017-0700-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/05/2017] [Indexed: 10/20/2022]
Abstract
Patients scheduled for primary care appointments often cancel or no show. For diabetic patients, nonattendance can affect continuity of care and result in higher emergency department (ED) and hospital use. Nonattendance also impacts appointment scheduling, patient access, and clinic work load. While no show has received significant attention, little research has addressed the prevalence and impact of appointment cancellation. Data on 46,710 appointments for 7586 adult diabetic patients was used to conduct a prospective cohort study examining primary care appointment behavior. The independent variable was the status of the INDEX appointment, which was attended, cancelled, or no showed. Dependent variables included the dates of (1) the last attended appointment, (2) scheduling the NEXT appointment, (3) the next attended follow-up appointment, and (4) ED visits and hospitalizations within six months of the INDEX. Cancellation was more prevalent than no show (17.7% vs 12.2%). Of those who cancelled and scheduled a next appointment, 28.8% experienced over 30 days delay between the INDEX and NEXT appointment dates, and 59.9% delayed rescheduling until on or after the cancelled appointment date. Delay in rescheduling was associated with an 18.6% increase in days between attended appointments and a 26.0% increase in ED visits. For diabetic patients, cancellation with late rescheduling is a prevalent and unhealthy behavior. Although more work is necessary to address the health, intervention, and cost issues, this work suggests that cancellation, like no show, may be problematic for many clinics and patients.
Collapse
|
17
|
Treister-Goltzman Y, Peleg R. What is Known About Health and Morbidity in the Pediatric Population of Muslim Bedouins in Southern Israel: A Descriptive Review of the Literature from the Past Two Decades. J Immigr Minor Health 2016; 17:940-6. [PMID: 24585250 DOI: 10.1007/s10903-014-0001-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Bedouins comprise one of the ethnic groups in Israeli society. They are Muslims, most of who live in the Negev desert region of southern Israel and live by their unique traditions and customs. At the present they are going through a period of "society in transition", a unique condition that has ramifications for health and morbidity. In recent years the number of publications on the health of Bedouins in the Negev has increased. Recognition of unique socio-economic features, characteristics of health and diseases can help the medical team treat various health problems in this population as well as other populations with similar characteristics. In the present paper we survey and discuss publications on the health of Bedouin children over the past 20 years.
Collapse
Affiliation(s)
- Yulia Treister-Goltzman
- The Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 653, 84105, Beer-Sheva, Israel,
| | | |
Collapse
|
18
|
Kheirkhah P, Feng Q, Travis LM, Tavakoli-Tabasi S, Sharafkhaneh A. Prevalence, predictors and economic consequences of no-shows. BMC Health Serv Res 2016; 16:13. [PMID: 26769153 PMCID: PMC4714455 DOI: 10.1186/s12913-015-1243-z] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Patients not attending to clinic appointments (no-show) significantly affects delivery, cost of care and resource planning. We aimed to evaluate the prevalence, predictors and economic consequences of patient no-shows. Method This is a retrospective cohort study using administrative databases for fiscal years 1997–2008. We searched administrative databases for no-show frequency and cost at a large medical center. In addition, we estimated no-show rates and costs in another 10 regional hospitals. We studied no-show rates in primary care and various subspecialty settings over a 12-year period, the monthly and seasonal trends of no-shows, the effects of implementing a reminder system and the economic effects of missed appointments. Results The mean no-show rate was 18.8 % (2.4 %) in 10 main clinics with highest occurring in subspecialist clinics. No-show rate in the women clinic was higher and the no-show rate in geriatric clinic was lower compared to general primary care clinic (PCP). The no-show rate remained at a high level despite its reduction by a centralized phone reminder (from 16.3 % down to 15.8 %). The average cost of no-show per patient was $196 in 2008. Conclusions Our data indicates that no-show imposed a major burden on this health care system. Further, implementation of a reminder system only modestly reduced the no-show rate.
Collapse
Affiliation(s)
- Parviz Kheirkhah
- Office of Performance Improvement, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qianmei Feng
- Industrial Engineering Department, University of Houston, Houston, TX, USA
| | | | - Shahriar Tavakoli-Tabasi
- Baylor College of Medicine, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Amir Sharafkhaneh
- Baylor College of Medicine, 2002 Holcombe Blvd., Houston, TX, 77030, USA. .,Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.
| |
Collapse
|
19
|
Kheirkhah P, Feng Q, Travis LM, Tavakoli-Tabasi S, Sharafkhaneh A. Prevalence, predictors and economic consequences of no-shows. BMC Health Serv Res 2016. [PMID: 26769153 DOI: 10.1186/s12913‐015‐1243‐z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients not attending to clinic appointments (no-show) significantly affects delivery, cost of care and resource planning. We aimed to evaluate the prevalence, predictors and economic consequences of patient no-shows. METHOD This is a retrospective cohort study using administrative databases for fiscal years 1997-2008. We searched administrative databases for no-show frequency and cost at a large medical center. In addition, we estimated no-show rates and costs in another 10 regional hospitals. We studied no-show rates in primary care and various subspecialty settings over a 12-year period, the monthly and seasonal trends of no-shows, the effects of implementing a reminder system and the economic effects of missed appointments. RESULTS The mean no-show rate was 18.8% (2.4%) in 10 main clinics with highest occurring in subspecialist clinics. No-show rate in the women clinic was higher and the no-show rate in geriatric clinic was lower compared to general primary care clinic (PCP). The no-show rate remained at a high level despite its reduction by a centralized phone reminder (from 16.3% down to 15.8%). The average cost of no-show per patient was $196 in 2008. CONCLUSIONS Our data indicates that no-show imposed a major burden on this health care system. Further, implementation of a reminder system only modestly reduced the no-show rate.
Collapse
Affiliation(s)
- Parviz Kheirkhah
- Office of Performance Improvement, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qianmei Feng
- Industrial Engineering Department, University of Houston, Houston, TX, USA
| | | | - Shahriar Tavakoli-Tabasi
- Baylor College of Medicine, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Amir Sharafkhaneh
- Baylor College of Medicine, 2002 Holcombe Blvd., Houston, TX, 77030, USA. .,Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.
| |
Collapse
|
20
|
Peng Y, Erdem E, Shi J, Masek C, Woodbridge P. Large-scale assessment of missed opportunity risks in a complex hospital setting. Inform Health Soc Care 2014; 41:112-27. [PMID: 25325215 DOI: 10.3109/17538157.2014.965303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In this research, we apply a large-scale logistic regression analysis to assess the patient missed opportunity risks at a complex VA (US Department of Veterans Affairs) hospital in three categories, namely, no-show alone, no-show combined with late patient cancellation and no-show combined with late patient and clinic cancellations. The analysis includes unique explanatory variables related to VA patients for predicting missed opportunity risks. Furthermore, we develop two aggregated weather indices by combining many weather measures and include them as explanatory variables. The results indicate that most of the explanatory variables considered are significant factors for predicting the missed opportunity risks. Patients with afternoon appointment, higher percentage service connected, and insurance, married patients, shorter lead time and appointments with longer appointment length are consistently related to lower risks of missed opportunity. Furthermore, the VA patient-related factors and the two proposed weather indices are useful predictors for the risks of no-show and patient cancellation. More importantly, this research presents an effective procedure for VA hospitals and clinics to analyze the missed opportunity risks within the complex VA information technology system, and help them to develop proper interventions to mitigate the adverse effects caused by the missed opportunities.
Collapse
Affiliation(s)
- Yidong Peng
- a Healthcare Engineering Group, North Dakota State University , Fargo , ND , USA and
| | - Ergin Erdem
- a Healthcare Engineering Group, North Dakota State University , Fargo , ND , USA and
| | - Jing Shi
- a Healthcare Engineering Group, North Dakota State University , Fargo , ND , USA and
| | - Christopher Masek
- b MidWest Mountain Veterans Engineering Resource Center , Albuquerque , NM , USA
| | - Peter Woodbridge
- b MidWest Mountain Veterans Engineering Resource Center , Albuquerque , NM , USA
| |
Collapse
|
21
|
Levi I, Feuchtwanger M, Rabinovich A, Grotto I. Clinical and epidemiologic characteristics of non Hodgkin's lymphoma in Bedouins in the south of Israel. SPRINGERPLUS 2014; 2:672. [PMID: 24386618 PMCID: PMC3874137 DOI: 10.1186/2193-1801-2-672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022]
Abstract
The presentation of Non Hodgkin’s Lymphoma (NHL) may vary in relation to ethnicity or environmental effects. The objective of our study was to characterize NHL among the Negev Bedouin population, compared to the Jewish population. Retrospective data were collected for 45 Bedouin and 45 Jewish patients who were treated at Soroka University Medical Center between 1990 and 2007. Upon diagnosis, rates of aggressive NHL types, involvement of extra-lymphatic organs, as well as mean LDH were higher among Bedouin. Treatment response was poorer among the Bedouin: overall survival and disease-free survival were higher among Jews (mean of 145 and 168 months, respectively, compared with 70 and 45 months, respectively, among Bedouin; p < 0.01 for both). In summary, disease aggressiveness and poor response to treatment among the Negev Bedouin may shed some light on the pathogenicity of NHL and may indicate a need for more aggressive treatment in different ethnic groups.
Collapse
Affiliation(s)
- Itai Levi
- Hematology Institute, Soroka University Medical Center, Beer-Sheva, Israel ; Department of Hematology, Soroka University Medical Center, PO Box 151, Beer-Sheva, Israel
| | - Michal Feuchtwanger
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anat Rabinovich
- Hematology Institute, Soroka University Medical Center, Beer-Sheva, Israel
| | - Itamar Grotto
- Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
22
|
Guedes R, Leite I, Baptista A. Dermatology missed appointments: an analysis of outpatient non-attendance in a general hospital's population. Int J Dermatol 2013; 53:39-42. [PMID: 23879642 DOI: 10.1111/j.1365-4632.2012.05710.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-attendance of scheduled appointments is a serious issue in dermatology hospital practice with implications in patient care. Herein we aim to characterize the population of non-attendees of dermatology appointments at a general hospital. MATERIAL AND METHODS A prospective study was carried out of the reschedule requests received from January to December 2009 at a dermatology outpatient department of a general hospital. Variables such as gender, age, type of consultation, justification for non-attendance, timing between missed appointments and the reschedule request as well as rates of other missed appointments were analyzed. RESULTS Throughout the study period, 265 patients filed a written request to reschedule a missed appointment, of whom 165 were female and 100 were male. The age distribution displayed two peaks, one in the second and the other in the sixth decade. Regarding the type of consultation, there was a clear predominance of missed follow-up consultations. Confusion and illness were the most frequent excuses for non-attendance. CONCLUSION We propose to identify patients at risk of missed appointments and suggest interventions to overcome this pitfall and improve patient outcomes.
Collapse
Affiliation(s)
- Rita Guedes
- Dermatology Department Centro Hospitalar de Vila Nova de Gaia-Espinho, Portugal
| | | | | |
Collapse
|
23
|
Nasseri E, Bertrand J, Brassard D, Fortier-Riberdy G, Marcil I. Physician survey regarding patient nonattendance at follow-up appointments at a university-affiliated medical dermatology clinic. J Cutan Med Surg 2012; 16:92-6. [PMID: 22513060 DOI: 10.2310/7750.2011.11004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patient nonattendance is a frequent occurrence in dermatology clinics, and our responsibility regarding the follow-up of these patients remains nebulous. OBJECTIVE This study sought to evaluate the beliefs and practices of physicians at a university-affiliated medical dermatology clinic regarding patient nonattendance at follow-up appointments and to provide an algorithm to deal appropriately with absentee patients based on various Canadian medical association guidelines. METHODS A questionnaire was distributed to the 17 dermatologists practicing at the Centre Hospitalier de l'Université de Montréal medical dermatology clinic. We contacted provincial and national medical associations regarding directives for patient follow-up. RESULTS There is a lack of consensus among dermatologists at the Centre Hospitalier de l'Université de Montréal regarding responsibility toward patients who miss their follow-up appointments. However, the majority of survey respondents consider that patient follow-up must be adjusted on a case-by-case basis and that diagnoses at risk for high morbidity and mortality require particular attention, which is in line with various Canadian medical association guidelines. CONCLUSION Dermatologists should have a structured approach to dealing with patients who miss their follow-up appointments to ensure the appropriate care of all patients.
Collapse
Affiliation(s)
- Eiman Nasseri
- Department of Dermatology, Center Hospitalier de l'Université de Montréal, Montreal, QC.
| | | | | | | | | |
Collapse
|
24
|
Feitsma WN, Popping R, Jansen DEMC. No-show at a forensic psychiatric outpatient clinic: risk factors and reasons. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2012; 56:96-112. [PMID: 21187299 DOI: 10.1177/0306624x10389435] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Nonattendance for and late cancellations of scheduled appointments, that is no-show, is a well-known phenomenon in psychiatric outpatient clinics. Research on the topic of no-show for initial and consecutive appointments in the field of forensic psychiatry is scarce. This study therefore aims to determine the prevalence and causes of no-show and to explore reasons for nonattendance. The study was carried out in an outpatient clinic in northern Netherlands. Telephone interviews were administered to 27 no-show clients, 84 follow-up no-show clients, and 41 attendees of 18 years and older. A no-show rate of 24.9% and a follow-up no-show rate of 9.8% was found. The majority of appointments missed were in the beginning phase of clinic contact. No-show clients were younger than their attending counterparts and more often dropped out from clinic contact. Also, less family social support was experienced by nonattendees. Reasons for nonattendance were having forgotten about appointment and work commitments.
Collapse
|
25
|
Anon JB. Hereditary angioedema: a clinical review for the otolaryngologist. EAR, NOSE & THROAT JOURNAL 2011; 90:32-9. [PMID: 21229509 DOI: 10.1177/014556131109000822] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hereditary angioedema (HAE) is a relatively rare genetic disorder that is usually characterized by either low levels of C1 esterase inhibitor (C1-INH) or the presence of dysfunctional C1-INH. It can present with relatively mild and self-limiting symptoms, but it is also potentially fatal; the most common cause of death is asphyxiation secondary to edema of the upper airway. The diagnosis of HAE, especially in the emergency situation, is not straightforward. HAE must be distinguished from several other types of angioedema that require different management approaches. Management approaches include trigger avoidance and pharmacologic therapy; the latter has traditionally involved the administration of attenuated androgens and antifibrinolytics. Recently, a new class of agent-C1-INH-has been introduced in the United States. This article provides an update on the pathophysiology, clinical picture, diagnosis, prophylaxis, and acute treatment of HAE. We must keep HAE in mind as a possible diagnosis whenever we are faced with a case of unexplained angioedema if we are to take advantage of the effective and more specific therapies that are becoming available.
Collapse
Affiliation(s)
- Jack B Anon
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| |
Collapse
|
26
|
Chow KM, Szeto CC, Kwan BCH, Pang WF, Leung CB, Li PKT. Characteristics and Outcomes of Chronic Kidney Disease Patients Who Default on Appointments at a Low Clearance Clinic. Int J Organ Transplant Med 2011. [DOI: 10.1016/s1561-5413(11)60005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
27
|
Carlsen K, Carlsen K, Serup J. Non-attendance rate in a Danish University Clinic of Dermatology. J Eur Acad Dermatol Venereol 2011; 25:1269-74. [DOI: 10.1111/j.1468-3083.2010.03962.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Non-attendance in Endocrinology and Metabolism Patients. J Formos Med Assoc 2010; 109:895-900. [DOI: 10.1016/s0929-6646(10)60136-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 10/07/2009] [Accepted: 12/24/2009] [Indexed: 11/19/2022] Open
|
29
|
Hajjaj FM, Salek MS, Basra MKA, Finlay AY. Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice. J R Soc Med 2010; 103:178-87. [PMID: 20436026 PMCID: PMC2862069 DOI: 10.1258/jrsm.2010.100104] [Citation(s) in RCA: 186] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine.
Collapse
Affiliation(s)
- F M Hajjaj
- Department of Dermatology and Wound Healing, School of Medicine, Cardiff University, UK.
| | | | | | | |
Collapse
|