Does pain take holidays? Non-attendance rates at a hospital-based pain clinic are elevated during the Jewish high-holidays

Evaluation of the Use of Telehealth Video Visits for Veterans With Chronic Pain

BACKGROUND

Telehealth video visits are essential for delivering timely care while mitigating exposure during the COVID-19 pandemic. Telehealth video visits have the potential to improve missed appointments, reduce costs associated with Veterans Affairs (VA) travel reimbursement, and lead to positive patient and provider satisfaction.

AIMS

This evidence-based improvement project sought to evaluate whether telehealth visits reduce the occurrence of missed appointments, determine cost savings associated with the VA travel reimbursement and assess patient and provider satisfaction with telehealth video visits.

DESIGN

Evidence-based improvement project.

SETTING

A retrospective chart review was conducted on military veterans with chronic pain who completed a telehealth video visit in the VA San Diego (VASD) pain clinic.

METHODS

Missed appointment rates were compared from before (April 1, 2019-October 1, 2019) to after (April 1, 2020-October 1, 2020) implementation of the telehealth video visits. Estimated travel reimbursement for qualified patients was calculated per VA policy. Electronic satisfaction surveys were administered to patients and nurse practitioners to assess satisfaction with telehealth video visits.

RESULTS

There was an 82.5% reduction in missed appointments from pre to post implementation of telehealth video visits. There was an estimated cost savings in travel reimbursements of $3,308.30. Overall, 93.62% of patients (n = 42) were satisfied with their video visits and there was a high degree of satisfaction in implementing video visits among the nurse practitioners (n = 3).

CONCLUSIONS

The use of telehealth video visits during the COVID-19 pandemic reduced missed appointments, exhibited cost savings in VA travel reimbursement, and led to positive patient and provider satisfaction.

Prevalence and factors associated with missed hospital appointments: a retrospective review of multiple clinics at Royal Hospital, Sultanate of Oman

OBJECTIVES

Missed hospital appointments pose a major challenge for healthcare systems. There is a lack of information about drivers of missed hospital appointments in non-Western countries and extent of variability between different types of clinics. The aim was to evaluate the rate and predictors of missed hospital appointments and variability in drivers between multiple outpatient clinics.

SETTING

Outpatient clinics in the Royal hospital (tertiary referral hospital in Oman) between 2014 and 2018.

PARTICIPANTS

All patients with a scheduled outpatient clinic appointment (N=7 69 118).

STUDY DESIGN

Retrospective cross-sectional analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

A missed appointment was defined as a patient who did not show up for the scheduled hospital appointment without notifying or asking for the appointment to be cancelled or rescheduled. The outcomes were the rate and predictors of missed hospital appointments overall and variations by clinic. Conditional logistic regression compared patients who attended and those who missed their appointment.

RESULTS

The overall rate of missed hospital appointments was 22.3%, which varied between clinics (14.0% for Oncology and 30.3% for Urology). Important predictors were age, sex, service costs, patient's residence distance from hospital, waiting time and appointment day and season. Substantive variability between clinics in ORs for a missed appointment was present for predictors such as service costs and waiting time. Patients aged 81-90 in the Diabetes and Endocrine clinic had an adjusted OR of 0.53 for missed appointments (95% CI 0.37 to 0.74) while those in Obstetrics and Gynaecology had OR of 1.70 (95% CI 1.11 to 2.59). Adjusted ORs for longer waiting times (>120 days) were 2.22 (95% CI 2.10 to 2.34) in Urology but 1.26 (95% CI 1.18 to 1.36) in Oncology.

CONCLUSION

Predictors of a missed appointment varied between clinics in their effects. Interventions to reduce the rate of missed appointments should consider these factors and be tailored to clinic.