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Izquierdo R, Rava M, Moreno-García E, Blanco JR, Asensi V, Cervero M, Curran A, Rubio R, Iribarren JA, Jarrín I. HIV medical care interruption among people living with HIV in Spain, 2004-2020. AIDS 2023; 37:1277-1284. [PMID: 36939068 DOI: 10.1097/qad.0000000000003552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE We estimated the incidence rate of HIV medical care interruption (MCI) and its evolution over a 16-year-period, and identified associated risk factors among HIV-positive individuals from the Cohort of the Spanish AIDS Research Network in 2004-2020. DESIGN We included antiretroviral-naive individuals aged at least 18 years at enrolment, recruited between January 1, 2004, and August 30, 2019, and followed-up until November 30, 2020. METHODS Individuals with any time interval of at least 15 months between two visits were defined as having a MCI. We calculated the incidence rate (IR) of having at least one MCI and used multivariable Poisson regression models to identify associated risk factors. RESULTS Of 15 274 individuals, 5481 (35.9%) had at least one MCI. Of those, 2536 (46.3%) returned to HIV care after MCI and 3753 (68.5%) were lost to follow-up at the end of the study period. The incidence rate (IR) of MCI was 7.2/100 person-years (py) [95% confidence interval (CI): 7.0-7.4]. The annual IR gradually decreased from 20.5/100 py (95% CI: 16.4-25.6) in 2004 to 4.9/100 py (95% CI: 4.4-5.5) in 2014, a slight increase was observed between 2015 and 2018, reaching 9.3/100 py (95% CI: 8.6-10.2) in 2019. Risk factors for MCI included younger age, lower educational level, having contracted HIV infection through injecting drug use or heterosexual intercourse, having been born outside of Spain, and CD4 + cell count >200 cell/μl, viral load <100 000 and co-infection with hepatitis C virus at enrolment. CONCLUSIONS Around a third of individuals had at least one MCI during the follow-up. Identified predictors of MCI can help health workers to target and support most vulnerable individuals.
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Affiliation(s)
- Rebeca Izquierdo
- National Center for Epidemiology, Instituto de Salud Carlos III
- Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid
| | - Marta Rava
- National Center for Epidemiology, Instituto de Salud Carlos III
- Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid
| | | | | | - Víctor Asensi
- Infectious Diseases - HIV Unit, Internal Medicine, Hospital Universitario Central de Asturias, Oviedo University School of Medicine, Translational Research in Infective Pathology Lab, ISPA-FINBA
| | - Miguel Cervero
- Internal Medicine Department, Hospital Universitario Severo Ochoa, Leganés
| | - Adrian Curran
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona
| | - Rafael Rubio
- HIV Unit, Internal Medicine Department, Biomedical Research Institute Imas12, Hospital Universitario 12 de Octubre. Medicine Department. Universidad Complutense de Madrid, Madrid
| | - José Antonio Iribarren
- Department of Infectious Diseases, Donostia University Hospital, IIS Biodonostia, San Sebastián, Spain
| | - Inmaculada Jarrín
- National Center for Epidemiology, Instituto de Salud Carlos III
- Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid
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Adinkrah EK, Cobb S, Bazargan M. Delayed Medical Care of Underserved Middle-Aged and Older African Americans with Chronic Disease during COVID-19 Pandemic. Healthcare (Basel) 2023; 11:595. [PMID: 36833128 PMCID: PMC9956154 DOI: 10.3390/healthcare11040595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Background: While African American middle-aged and older adults with chronic disease are particularly vulnerable during the COVID-19 pandemic, it is unknown which subgroups of this population may delay seeking care. The aim of this study was to examine demographic, socioeconomic, COVID-19-related, and health-related factors that correlate with delayed care in African American middle-aged and older adults with chronic disease. Methods: In this cross-sectional study, 150 African American middle-aged and older adults who had at least one chronic disease were recruited from faith-based organizations. We measured the following exploratory variables: demographic factors (age and gender), socioeconomic status (education), marital status, number of chronic diseases, depressive symptoms, financial strain, health literacy, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 knowledge, and COVID-19 perceived threat. The outcome was delay in chronic disease care. Results: According to the Poisson log-linear regression, higher level of education, higher number of chronic diseases, and depressive symptoms were associated with a higher level of delayed care. Age, gender, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 perceived threat, COVID-19 knowledge, financial strain, marital status, and health literacy were not correlated with delayed care. Discussion: Given that higher healthcare needs in terms of multiple chronic medical diseases and depressive symptomatology but not COVID-19-related constructs (i.e., vaccination history, diagnosis history, and perceived threat) were associated with delayed care, there is a need for programs and interventions that assist African American middle-aged and older adults with chronic disease to seek the care that they need. More research is needed to understand why educational attainment is associated with more delayed care of chronic disease in African American middle-aged and older adults with chronic illness.
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Affiliation(s)
- Edward K. Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), 1731 E. 120th St., Los Angeles, CA 90059, USA
| | - Sharon Cobb
- Mervyn M. Dymally School of Nursing (MMDSON), CDU, Los Angeles, CA 90059, USA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), 1731 E. 120th St., Los Angeles, CA 90059, USA
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90059, USA
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Izudi J, Okoboi S, Lwevola P, Kadengye D, Bajunirwe F. Effect of disclosure of HIV status on patient representation and adherence to clinic visits in eastern Uganda: A propensity-score matched analysis. PLoS One 2021; 16:e0258745. [PMID: 34665842 PMCID: PMC8525739 DOI: 10.1371/journal.pone.0258745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Disclosure of human immunodeficiency virus (HIV) status improves adherence to antiretroviral therapy (ART) and increases the chance of virological suppression and retention in care. However, information on the effect of disclosure of HIV status on adherence to clinic visits and patient representation is limited. We evaluated the effects of disclosure of HIV status on adherence to clinic visits and patient representation among people living with HIV in eastern Uganda. METHODS In this quasi-randomized study, we performed a propensity-score-matched analysis on observational data collected between October 2018 and September 2019 from a large ART clinic in eastern Uganda. We matched participants with disclosed HIV status to those with undisclosed HIV status based on similar propensity scores in a 1:1 ratio using the nearest neighbor caliper matching technique. The primary outcomes were patient representation (the tendency for patients to have other people pick-up their medications) and adherence to clinic visits. We fitted a logistic regression to estimate the effects of disclosure of HIV status, reported using the odds ratio (OR) and 95% confidence interval (CI). RESULTS Of 957 participants, 500 were matched. In propensity-score matched analysis, disclosure of HIV status significantly impacts adherence to clinic visits (OR = 1.63; 95% CI, 1.13-2.36) and reduced patient representation (OR = O.49; 95% CI, 0.32-0.76). Sensitivity analysis showed robustness to unmeasured confounders (Gamma value = 2.2, p = 0.04). CONCLUSIONS Disclosure of HIV status is associated with increased adherence to clinic visits and lower representation to collect medicines at the clinic. Disclosure of HIV status should be encouraged to enhance continuity of care among people living with HIV.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
- Infectious Diseases Institute, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen Okoboi
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
- Infectious Diseases Institute, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul Lwevola
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Damazo Kadengye
- African Population and Health Research Center (APHRC), APHRC Campus, Nairobi, Kenya
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Low level of tuberculosis preventive therapy incompletion among people living with Human Immunodeficiency Virus in eastern Uganda: A retrospective data review. J Clin Tuberc Other Mycobact Dis 2021; 25:100269. [PMID: 34504952 PMCID: PMC8414169 DOI: 10.1016/j.jctube.2021.100269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction In most developing countries, tuberculosis (TB) is the leading cause of mortality among people living with the Human Immunodeficiency Virus (PLHIV). Uganda implements TB preventive therapy (TPT) using Isoniazid but data are limited about TPT incompletion. We, therefore, assessed the magnitude of TPT incompletion and the associated factors among PLHIV in a large rural referral health facility in rural eastern Uganda. Methods and materials We conducted a retrospective data review for PLHIV initiated on TPT between October 2018 and September 2019. The outcome variable was TPT incompletion defined as the failure to finish 6 consecutive months of Isoniazid or failure to finish 9 months of Isoniazid without stopping for more than 2 months at a time. We descriptively summarized numerical data using frequencies and percentages and compared differences in the outcome with independent variables using the Chi-square or fisher’s exact, and the Student’s t-tests. We used a generalized linear model to assess factors independently associated with TPT incompletion, reported using adjusted odds ratio (aOR) and 95% confidence interval (CI). Results We enrolled 959 participants with a mean age of 41.1 ± 13.8 years, 561 (58.5%) were females, 663 (69.1%) married, 538 (56.1) travelled 5–10 km from their place of residence to the ART clinic, 293 (30.6%) had disclosed HIV status, 362 (37.7%) had been on ART for 5–9 years, and 923 (96.2%) were on first-line ART regimen. We found 26 (2.7%) participants had incomplete TPT. Non-adherence to ART clinic visits (aOR, 2.81; 95% CI, 1.09–7.73), history of switch in ART regimen (aOR, 9.33; 95% CI, 1.19–52.39), patient representation (aOR, 4.70; 95% CI, 1.35–13.99), and one unit increase in ongoing counselling session (aOR, 0.67; 95% CI, 0.46–0.91) were associated with TPT incompletion. Conclusion We found low rates of TPT incompletion among PLHIV in rural eastern Uganda. Non-adherence to ART clinic visits, patient representation, and history of switch in ART regimen is associated with a higher likelihood of TPT incompletion while ongoing counselling is associated with a reduction in TPT incompletion. The health system should address non-adherence to ART clinic visits and patient representation, through ongoing psychosocial support.
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Jiamsakul A, Boyd M, Choi JY, Edmiston N, Kumarasamy N, Hutchinson J, Law M. Trends in Follow-Up Visits Among People Living With HIV: Results From the TREAT Asia and Australian HIV Observational Databases. J Acquir Immune Defic Syndr 2021; 88:70-78. [PMID: 33990493 PMCID: PMC8373656 DOI: 10.1097/qai.0000000000002725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Less frequent follow-up visits may reduce the burden on people living with HIV (PLHIV) and health care facilities. We aimed to assess trends in follow-up visits and survival outcomes among PLHIV in Asia and Australasia. SETTINGS PLHIV enrolled in TREAT Asia HIV Observational Database (TAHOD) or Australian HIV Observational Database (AHOD) from 2008 to 2017 were included. METHODS Follow-up visits included laboratory testing and clinic visit dates. Visit rates and survival were analyzed using repeated measure Poisson regression and competing risk regression, respectively. Additional analyses were limited to stable PLHIV with viral load <1000 copies/mL and self-reported adherence ≥95%. RESULTS We included 7707 PLHIV from TAHOD and 3289 PLHIV from AHOD. Visit rates were 4.33 per person-years (/PYS) in TAHOD and 3.68/PYS in AHOD. Both TAHOD and AHOD showed decreasing visit rates in later calendar years compared with that in years 2008-2009 (P < 0.001 for both cohorts). Compared with PLHIV with 2 visits, those with ≥4 visits had poorer survival: TAHOD ≥4 visits, subhazard ratio (SHR) = 1.88, 95% confidence interval (CI): 1.16 to 3.03, P = 0.010; AHOD ≥4 visits, SHR = 1.80, 95% CI: 1.10 to 2.97, P = 0.020; whereas those with ≤1 visit showed no differences in mortality. The association remained evident among stable PLHIV: TAHOD ≥4 visits, SHR = 5.79, 95% CI: 1.84 to 18.24, P = 0.003; AHOD ≥4 visits, SHR = 2.15, 95% CI: 1.20 to 3.85, P = 0.010, compared with 2 visits. CONCLUSIONS Both TAHOD and AHOD visit rates have declined. Less frequent visits did not affect survival outcomes; however, poorer health possibly leads to increased follow-up and higher mortality. Reducing visit frequency may be achievable among PLHIV with no other medical complications.
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Affiliation(s)
| | - Mark Boyd
- School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Natalie Edmiston
- Faculty of Medicine and Health, University of Sydney, NSW, Australia
- HIV/Sexual Health Services North Coast Public Health, Mid North Coast Local health District, NSW, Australia
- Rural Research, Western Sydney University, NSW, Australia
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), The Voluntary Health Services (VHS), Chennai, India
| | | | - Matthew Law
- The Kirby Institute, UNSW Sydney, NSW, Australia
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Choo J, Yang HM, Park S, Park M, Park YM, Lim DS. Appointment Adherence to a City-Wide Cardiovascular Disease Prevention Program: Its Predictors and Outcomes. Asia Pac J Public Health 2021; 33:555-563. [PMID: 34041933 DOI: 10.1177/10105395211012912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study identified predictors of appointment adherence and examined its impacts on improvements in metabolic risk factors in a free city-wide cardiovascular disease prevention program in Seoul, South Korea. Data of 8251 citizens with metabolic syndrome were used. Appointment adherers were defined as having 70% or higher adherence rates, that is, 3 or more visits. Of the 8251 citizens, 17.6% were appointment adherers. Appointment adherers were significantly more likely to be older, low-income earners, nonsmokers, and nonobese than appointment nonadherers. Moreover, appointment adherers, compared with nonadherers, showed significant improvements in waist circumference, systolic blood pressure, and high-density lipoprotein cholesterol, but not in fasting glucose and triglycerides. Designing strategies for increasing appointment adherence to a free city-wide cardiovascular disease prevention program is essential to improve health outcomes, especially targeting population groups with young age, high-income, current smoking, or obesity.
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Affiliation(s)
- Jina Choo
- College of Nursing, Korea University, Seoul, South Korea.,Transdisciplinary Major in Learning Health Systems, Graduate School, Korea University, Seoul, South Korea
| | - Hwa-Mi Yang
- College of Nursing, Korea University, Seoul, South Korea
| | - Sooyeon Park
- College of Nursing, Korea University, Seoul, South Korea
| | - MiSuk Park
- Metabolic Syndrome Management Center of Seoul Metropolitan Government, Seoul, South Korea
| | - Yoo Mi Park
- Citizens' Health Bureau, Seoul Metropolitan Government, Seoul, South Korea
| | - Do-Sun Lim
- Metabolic Syndrome Management Center of Seoul Metropolitan Government, Seoul, South Korea.,Department of Cardiology, School of Medicine, Korea University, Seoul, South Korea
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7
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McLaughlin MJ, Modrcin AC, Hickman TP, Hoffman M. Determining the impact of a clinic coordinator on patient access and clinic efficiency in a pediatric multidisciplinary spina bifida clinic using medical informatics. J Pediatr Rehabil Med 2021; 14:661-666. [PMID: 34806629 DOI: 10.3233/prm-200790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The objective of this study was to analyze the effects on patient access by decreasing missed appointments after hiring a clinic coordinator using medical informatics. METHODS A single-center retrospective analysis of the rates of missed appointments before and after hiring a clinic coordinator in a multidisciplinary spinal differences clinic were analyzed using a commercially available business software system (SAP® Business Objects). The total number of clinic visits was collected for each month to determine the access available for patients. RESULTS The median number of missed appointments per clinic by month before employing the clinic coordinator was higher than in the two years following implementation (p < 0.0005). No differences were seen in the number of available appointment slots per month indicating no new clinics were needed to improve patient access (p = 0.551). Projected billing amounts prior to hiring the clinic coordinator indicated that $91,520 was lost in the 2 years prior to hiring this coordinator compared to $30,160 lost during the 2 years following the creation of this position (p = 0.0009). CONCLUSION Hiring a clinic coordinator decreased the rate of missed appointments and was a cost-efficient intervention to improve patient access and provide effective patient care in a multidisciplinary setting.
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Affiliation(s)
- Matthew J McLaughlin
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pediatrics, Children's Mercy - Kansas City, Kansas City, MO, USA
| | - Ann C Modrcin
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pediatrics, Children's Mercy - Kansas City, Kansas City, MO, USA
| | - Timothy P Hickman
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Mark Hoffman
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pediatrics, Children's Mercy - Kansas City, Kansas City, MO, USA
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Callejo-Black P, Biederman D, Douglas C, Silberberg M. Eviction as a Disruptive Factor in Health Care Utilization: Impact on Hospital Readmissions and No-show Rates. J Health Care Poor Underserved 2021; 32:386-396. [PMID: 33678703 DOI: 10.1353/hpu.2021.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Residential eviction is a component of housing instability that negatively affects physical and mental health, but the effect of eviction on health care utilization, specifically hospital readmissions and outpatient no-show rates, is not known. METHODS We conducted a retrospective review of health care utilization of individuals evicted from public housing between January 2013 and December 2017, investigating hospital readmissions and no-show rates one year before and after eviction. RESULTS 131 individuals who had been evicted had one year of data pre-and post-eviction. The majority were African American (97.7%) and female (80.9%). There was no significant change in 30-, 60-, and 90-day hospital readmissions (p>.05). No-show rate decreased from 27.57 per person per year to 20.13 (p=.05). CONCLUSIONS For our study population, health care utilization was not disrupted. The decreased no-show rate represents an opportunity for health systems to engage with patients on social factors affecting their health post-eviction.
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Giunta DH, Alonso Serena M, Luna D, Peroni ML, Sanchez Thomas D, Binder F, Blugerman GA, Fuentes N, Elizondo CM, Gonzalez Bernaldo de Quirós F. Association between non‐attendance to outpatient clinics and emergency department consultations, hospitalizations and mortality in a Health Maintenance Organization. Int J Health Plann Manage 2020; 35:1140-1156. [DOI: 10.1002/hpm.3021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/07/2020] [Accepted: 06/05/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Diego Hernán Giunta
- Internal Medicine Research Unit Hospital Italiano de Buenos Aires CABA Argentina
- Research Department Hospital Italiano de Buenos Aires CABA Argentina
| | - Marina Alonso Serena
- Internal Medicine Research Unit Hospital Italiano de Buenos Aires CABA Argentina
| | - Daniel Luna
- Health Informatics Department Hospital Italiano de Buenos Aires CABA Argentina
| | - Maria Leticia Peroni
- Internal Medicine Research Unit Hospital Italiano de Buenos Aires CABA Argentina
| | - Diego Sanchez Thomas
- Internal Medicine Research Unit Hospital Italiano de Buenos Aires CABA Argentina
| | - Fernando Binder
- Internal Medicine Research Unit Hospital Italiano de Buenos Aires CABA Argentina
| | | | - Nora Fuentes
- Internal Medicine Research Unit Hospital Italiano de Buenos Aires CABA Argentina
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Chung S, Martinez MC, Frosch DL, Jones VG, Chan AS. Patient-Centric Scheduling With the Implementation of Health Information Technology to Improve the Patient Experience and Access to Care: Retrospective Case-Control Analysis. J Med Internet Res 2020; 22:e16451. [PMID: 32519970 PMCID: PMC7315363 DOI: 10.2196/16451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/09/2020] [Accepted: 03/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background Cancellations and rescheduling of doctor’s appointments are common. An automated rescheduling system has the potential to facilitate the rescheduling process so that newly opened slots are promptly filled by patients who need and can take the slot. Building on an existing online patient portal, a large health care system adopted an automated rescheduling system, Fast Pass, that sends out an earlier appointment offer to patients via email or SMS text messaging and allows patients to reschedule their appointment through the online portal. Objective We examined the uptake of Fast Pass at its early stage of implementation. We assessed program features and patient and visit characteristics associated with higher levels of Fast Pass utilization and the association between Fast Pass use and no-show and cancellation rates. Methods This study was a retrospective analysis of Fast Pass offers sent between July and December 2018. Multivariable logistic regression was used to assess the independent contribution of program, patient, and visit characteristics on the likelihood of accepting an offer. We then assessed the appointment outcome (completion, cancellation, or no-show) of Fast Pass offered appointments compared to appointments with the same patient and visit characteristics, but without an offer. Results Of 177,311 Fast Pass offers sent, 14,717 (8.3%) were accepted. Overall, there was a 1.3 percentage point (38%) reduction in no-show rates among Fast Pass accepted appointments compared to other appointments with matching characteristics (P<.001). The offers were more likely to be accepted if they were sent in the evening (versus early morning), the first (versus repeated) offer for the same appointment, for a slot 1-31 days ahead (versus same-day), for later in a day (versus before 10am), for a primary care (versus specialty) visit, sent via SMS text messaging (versus email only), for an appointment made through the online patient portal (versus via phone call or in-person), or for younger adults aged 18-49 years (versus those aged 65 years or older; all at P<.001). Factors negatively associated with offer acceptance were a higher number of comorbidities (P=.02) and visits scheduled for chronic conditions (versus acute conditions only; P=.002). Conclusions An automated rescheduling system can improve patients’ access by reducing wait times for an appointment, with an added benefit of reducing no-shows by serving as a reminder of an upcoming appointment. Future modifications, such as increasing the adoption of SMS text messaging offers and targeting older adults or patients with complex conditions, may make the system more patient-centered and help promote wider utilization.
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Affiliation(s)
- Sukyung Chung
- Quantitative Sciences Unit, School of Medicine, Stanford University, Palo Alto, CA, United States.,Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Meghan C Martinez
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Veena G Jones
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States.,Palo Alto Medical Foundation, Palo Alto, CA, United States.,Sutter Health, Sacramento, CA, United States
| | - Albert S Chan
- Palo Alto Medical Foundation, Palo Alto, CA, United States.,Sutter Health, Sacramento, CA, United States.,Center for Biomedical Information Research, Stanford University, Palo Alto, CA, United States
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Zebina M, Melot B, Binachon B, Ouissa R, Lamaury I, Hoen B. Impact of an SMS reminder service on outpatient clinic attendance rates by patients with HIV followed-up at Pointe-à-Pitre University Hospital. Patient Prefer Adherence 2019; 13:215-221. [PMID: 30774317 PMCID: PMC6354684 DOI: 10.2147/ppa.s182186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE By the end of 2014, 23% of people living with HIV (PWHIV) who had had a scheduled appointment at our outpatient clinic had not attended. We implemented an SMS reminder service and assessed its impact on medical consultation-attendance rate. METHODS The intervention was directed at all PWHIV with a scheduled appointment between March and April 2015 at our infectious diseases department. Two days before the scheduled visit, an appointment reminder SMS was sent to every other patient at random. On the visit day, a questionnaire was used to determine patient perceptions regarding the SMS. RESULTS A total of 224 patients (126 males, 98 females, mean age 52 years, 94% taking anti-retroviral therapy) were selected to take part in the study. The medical consultation-attendance rate was 76% in the SMS reminder read group (87 patients) and 72% in the SMS reminder not sent or not read group (137 patients, P=0.6). Among the 66 SMS reminder read patients who attended their consultation and answered the questionnaire, 51% reported that the SMS had contributed to their attendance. CONCLUSION Sending an SMS reminder had no significant impact on clinic attendance rates. This may have been due in part to the sociocultural characteristics of our patients. Further research should investigate other tools to improve attendance rates.
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Affiliation(s)
- Marine Zebina
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
| | - Bénédicte Melot
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
| | - Blandine Binachon
- INSERM, Center for Clinical Investigation, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Rachida Ouissa
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
| | - Isabelle Lamaury
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
| | - Bruno Hoen
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
- INSERM, Center for Clinical Investigation, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France
- EA 4537, Faculty of Medicine Hyacinthe Bastaraud, University of the French West Indies and French Guiana, Pointe-à-Pitre, France
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Edmiston N, Petoumenos K, Smith DJ. Multimorbidity, not human immunodeficiency virus (HIV) markers predicts unplanned admission among people with HIV in regional New South Wales. Intern Med J 2018; 48:706-713. [PMID: 29316115 DOI: 10.1111/imj.13733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/03/2017] [Accepted: 12/11/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multimorbidity and unplanned admissions are common among people with human immunodeficiency virus (PWH). AIMS To determine factors predictive of unplanned admission among PWH in regional New South Wales and compare care coordination between people with and without unplanned admissions. METHODS A prospective cohort study of PWH attending a regional human immunodeficiency virus (HIV) service was conducted. Baseline HIV-specific results and multimorbidity markers including Cumulative Illness Rating Scale (CIRS) were assessed as predictors of time to first unplanned admission using Cox regression analysis. Care coordination markers were compared between people with and without unplanned admission, using χ2 statistic for proportions and t-test for means. RESULTS A cohort of 181 PWH was followed for a maximum of 5 years. During a total of 739 person-years of follow up, 39 (20.6%) patients reached the endpoint of unplanned admission. In multivariate analysis, the baseline CIRS score was predictive of unplanned admission (P < 0.001). Age, HIV-specific markers and missed visits were not predictive of unplanned admission. For patients with an unplanned admission, discharge summaries were documented for 22/39 (56.4%). Of 180 PWH with a visit after baseline, 131 (72.8%) had a letter to a general practitioner and 79 (43.7%) had two or more prescribers. Having two or more prescribers was more common in people with an unplanned admission than in those without (64.1% vs 38.0%, P = 0.004). CONCLUSION Unplanned admission among PWH is predicted by multimorbidity. Care for PWH should include coordinated management of other health conditions in order to reduce their severity and prevent unplanned admissions.
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Affiliation(s)
- Natalie Edmiston
- North Coast Sexual Health Services, Lismore, New South Wales, Australia
| | - Kathy Petoumenos
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - David J Smith
- North Coast Sexual Health Services, Lismore, New South Wales, Australia
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Mitzel LD, Vanable PA, Carey MP. HIV-Related Stigmatization and Medication Adherence: Indirect Effects of Disclosure Concerns and Depression. STIGMA AND HEALTH 2018; 4:282-292. [PMID: 31681850 DOI: 10.1037/sah0000144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Stigmatization due to HIV status may interfere with disease management among persons living with HIV (PLWHA) by heightening serostatus disclosure concerns and vulnerability to depressive symptoms. Purpose In this cross-sectional study, indirect effects of disclosure concerns and depressive symptoms were examined for the association of stigma to treatment adherence (medication and clinic appointment adherence) in an outpatient sample of PLWHA. Method Participants (N = 179; 47% White, 41% African-American; 35% MSM) completed measures of stigma-related experiences, concerns about disclosing HIV status, depression, and medication adherence; clinic appointment attendance was obtained from chart data. Results Stigma had an indirect effect on medication adherence (but not clinic attendance) via disclosure concerns. Stigma had indirect effects on both medication adherence and clinic attendance via depressive symptoms. In path analyses including both disclosure concerns and depressive symptoms, combined indirect effects emerged for both medication adherence and clinic attendance. There was a significant indirect pathway from stigma to disclosure concerns to depression to clinic attendance, whereas the positioning of the mediators was swapped for the significant indirect pathway from stigma to medication adherence. Conclusions These analyses provide evidence that stigmatizing experiences negatively affect treatment adherence through the indirect effects of disclosure concerns and depressive symptoms. Disclosure concerns and depressive symptoms are two mechanisms worthy of further research to enhance understanding of the association between stigma and treatment adherence difficulties.
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Affiliation(s)
- Luke D Mitzel
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Peter A Vanable
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island
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14
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Banerjee R, Suarez A, Kier M, Honeywell S, Feng W, Mitra N, Grande D, Myers J. If You Book It, Will They Come? Attendance at Postdischarge Follow-Up Visits Scheduled by Inpatient Providers. J Hosp Med 2017; 12:618-625. [PMID: 28786427 DOI: 10.12788/jhm.2777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Postdischarge follow-up visits (PDFVs) are widely recommended to improve inpatient-outpatient transitions of care. OBJECTIVE To measure PDFV attendance rates. DESIGN Observational cohort study. SETTING Medical units at an academic quaternary-care hospital and its affiliated outpatient clinics. PATIENTS Adult patients hospitalized between April 2014 and March 2015 for whom at least 1 PDFV with our health system was scheduled. Exclusion criteria included nonprovider visits, visits cancelled before discharge, nonaccepted health insurance, and visits scheduled for deceased patients. MEASUREMENTS The study outcome was the incidence of PDFVs resulting in no-shows or same-day cancellations (NS/SDCs). RESULTS Of all hospitalizations, 6136 (52%) with 9258 PDFVs were analyzed. Twenty-five percent of PDFVs were NS/SDCs, 23% were cancelled before the visit, and 52% were attended as scheduled. In multivariable regression models, NS/SDC risk factors included black race (odds ratio [OR] 1.94, 95% confidence interval [CI], 1.63-2.32), longer lengths of stay (hospitalizations ≥15 days: OR 1.51, 95% CI, 1.22- 1.88), and discharge to facility (OR 2.10, 95% CI, 1.70-2.60). Conversely, NS/SDC visits were less likely with advancing age (age ≥65 years: OR 0.39, 95% CI, 0.31-0.49) and driving distance (highest quartile: OR 0.65, 95% CI, 0.52-0.81). Primary care visits had higher NS/SDC rates (OR 2.62, 95% CI, 2.03-3.38) than oncologic visits. The time interval between discharge and PDFV was not associated with NS/SDC rates. CONCLUSIONS PDFVs were scheduled for more than half of hospitalizations, but 25% resulted in NS/SDCs. New strategies are needed to improve PDFV attendance.
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Affiliation(s)
- Rahul Banerjee
- Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alex Suarez
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melanie Kier
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steve Honeywell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Weiwei Feng
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Grande
- Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer Myers
- Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Mendel A, Chow S. Impact of health portal enrolment with email reminders at an academic rheumatology clinic. BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:bmjquality_uu214811.w5926. [PMID: 28321302 PMCID: PMC5348589 DOI: 10.1136/bmjquality.u214811.w5926] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/23/2016] [Indexed: 11/12/2022]
Abstract
Missed appointments reduce the quality, safety and efficiency of healthcare delivery. ‘No-Shows’ (NS) have been identified as a problem within the rheumatology clinic at Sunnybrook Health Sciences Center in Toronto, Ontario. NS were studied through a prospective chart review and telephone interviews. Over 6 months, 110 NS took place (rate 2.5-6.8%). From interviews, 85% of NS were attributed to forgetting, being unaware of the appointment, having the wrong date, or another miscommunication. Fifty-seven percent of patients were interested in an appointment reminder, including electronic reminders (46%). Patients were encouraged to enroll in the hospital's electronic patient portal, MyChart, and email reminders were implemented at one clinic for portal users. A detailed follow-up card was also given to patients. Process measures included portal enrolment, email reminder receipt, and call volumes. Outcome measures were NS and patient and staff satisfaction. During the intervention, 120/274 (44%) surveyed patients had MyChart accounts. Of these, 73 (61%) received the e-mail reminder and 72 (99%) found the e-mail helpful. Twenty-two patients knew about their appointment from the e-mail reminder alone. Improvement in attendance was seen after 3.5 months, but it was not sustained thereafter. Prior to this intervention there was no appointment reminder system at this clinic, and the email reminder demonstrated high patient satisfaction. Low portal enrolment, technical difficulties, and the inability of the intervention to reach new patients were possible reasons why the intervention was unsuccessful at reducing NS.
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Affiliation(s)
- Arielle Mendel
- Division of rheumatology, Sunnybrook Health Sciences Center, Canada
| | - Shirley Chow
- Division of rheumatology, Sunnybrook Health Sciences Center, Canada
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16
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Abstract
PURPOSE Between 23% and 34% of outpatient appointments are missed annually. Patients who frequently miss medical appointments have poorer health outcomes and are less likely to use preventive health care services. Missed appointments result in unnecessary costs and organizational inefficiencies. Appointment reminders may help reduce missed appointments; particular types may be more effective than other types. We used a survey with a discrete choice experiment (DCE) to learn why individuals miss appointments and to assess appointment reminder preferences. METHODS We enrolled a national sample of adults from an online survey panel to complete demographic and appointment habit questions as well as a 16-task DCE designed in Sawtooth Software's Discover tool. We assessed preferences for four reminder attributes - initial reminder type, arrival of initial reminder, reminder content, and number of reminders. We derived utilities and importance scores. RESULTS We surveyed 251 adults nationally, with a mean age of 43 (range 18-83) years: 51% female, 84% White, and 8% African American. Twenty-three percent of individuals missed one or more appointments in the past 12 months. Two primary reasons given for missing an appointment include transportation problems (28%) and forgetfulness (26%). Participants indicated the initial reminder type (21%) was the most important attribute, followed by the number of reminders (10%). Overall, individuals indicated a preference for a single reminder, arriving via email, phone call, or text message, delivered less than 2 weeks prior to an appointment. Preferences for reminder content were less clear. CONCLUSION The number of missed appointments and reasons for missing appointments are consistent with prior research. Patient-centered appointment reminders may improve appointment attendance by addressing some of the reasons individuals report missing appointments and by meeting patients' needs. Future research is necessary to determine if preferred reminders used in practice will result in improved appointment attendance in clinical settings.
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Affiliation(s)
- Trisha M Crutchfield
- University of North Carolina Center for Health Promotion and Disease Prevention
- University of North Carolina Lineberger Comprehensive Cancer Center
- Cecil G. Sheps Center for Health Services Research
- Correspondence: Trisha M Crutchfield, University of North Carolina Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Boulevard, Campus Box 7426, Chapel Hill, NC 27599-7426, USA, Tel +1 919 590 9532, Email
| | - Christine E Kistler
- University of North Carolina Lineberger Comprehensive Cancer Center
- Cecil G. Sheps Center for Health Services Research
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Nordentoft PB, Engell-Sørensen T, Jespersen S, Correia FG, Medina C, da Silva Té D, Østergaard L, Laursen AL, Wejse C, Hønge BL. Assessing factors for loss to follow-up of HIV infected patients in Guinea-Bissau. Infection 2016; 45:187-197. [PMID: 27743308 DOI: 10.1007/s15010-016-0949-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/25/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE The objective of this study was to ascertain vital status of patients considered lost to follow-up at an HIV clinic in Guinea-Bissau, and describe reasons for loss to follow-up (LTFU). METHODS This study was a cross-sectional sample of a prospective cohort, carried out between May 15, 2013, and January 31, 2014. Patients lost to follow-up, who lived within the area of the Bandim Health Project, a demographic surveillance site (DSS), were eligible for inclusion. Active follow-up was attempted by telephone and tracing by a field assistant. Semi-structured interviews were done face to face or by phone by a field assistant and patients were asked why they had not shown up for the scheduled appointment. Patients were included by date of HIV testing and risk factors for LTFU were assessed using Cox proportional hazard model. RESULTS Among 561 patients (69.5 % HIV-1, 18.0 % HIV-2 and 12.6 % HIV-1/2) living within the DSS, 292 patients had been lost to follow-up and were, therefore, eligible for active follow-up. Vital status was ascertained in 65.9 % of eligible patients and 42.7 % were alive, while 23.2 % had died. Information on reasons for LTFU existed for 103 patients. Major reasons were moving (29.1 %), travelling (17.5 %), and transferring to other clinics (11.7 %). CONCLUSION A large proportion of the patients at the clinic were lost to follow-up. The main reason for this was found to be the geographic mobility of the population in Guinea-Bissau.
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Affiliation(s)
- Pernille Bejer Nordentoft
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Thomas Engell-Sørensen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Sanne Jespersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | | | - Candida Medina
- National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau
| | | | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Alex Lund Laursen
- Department of Infectious Diseases, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Christian Wejse
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau. .,Department of Infectious Diseases, Aarhus University Hospital, 8200, Aarhus N, Denmark. .,GloHAU, Center for Global Health, School of Public Health, Aarhus University, 8000, Aarhus C, Denmark.
| | - Bo Langhoff Hønge
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, 8200, Aarhus N, Denmark.,Department of Clinical Immunology, Aarhus University Hospital, 8200, Aarhus N, Denmark
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18
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Chan LG, Carvalhal A. Journeying with HIV patients across the health care spectrum - an examination of a seamless model of HIV Psychiatry of a large urban general hospital. Gen Hosp Psychiatry 2015; 37:538-41. [PMID: 26277772 DOI: 10.1016/j.genhosppsych.2015.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe a model of HIV psychiatry used in an urban hospital in Toronto and examine it against current literature. METHOD Using a narrative method, we elaborate on how this model delivers care across many different settings and the integral roles that the HIV psychiatrist plays in each of these settings. This is articulated against a backdrop of existing literature regarding models of HIV care. RESULTS This model is an example of an integrated model as opposed to a traditional consultation-liaison model and is able to deliver seamless care while remaining focused on patient-centric care. CONCLUSION An HIV psychiatrist delivers seamless and patient-centric care by journeying with patients across the healthcare spectrum and playing different roles in different care settings.
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Affiliation(s)
- Lai Gwen Chan
- Department of Psychological Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
| | - Adriana Carvalhal
- Medical Psychiatry Consultation Service, St Michael's Hospital; Department of Psychiatry, University of Toronto, Associated Scientist, Li Ka Shing, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
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19
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Hwang AS, Atlas SJ, Cronin P, Ashburner JM, Shah SJ, He W, Hong CS. Appointment "no-shows" are an independent predictor of subsequent quality of care and resource utilization outcomes. J Gen Intern Med 2015; 30:1426-33. [PMID: 25776581 PMCID: PMC4579240 DOI: 10.1007/s11606-015-3252-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Identifying individuals at high risk for suboptimal outcomes is an important goal of healthcare delivery systems. Appointment no-shows may be an important risk predictor. OBJECTIVES To test the hypothesis that patients with a high propensity to "no-show" for appointments will have worse clinical and acute care utilization outcomes compared to patients with a lower propensity. DESIGN We calculated the no-show propensity factor (NSPF) for patients of a large academic primary care network using 5 years of outpatient appointment data. NSPF corrects for patients with fewer appointments to avoid over-weighting of no-show visits in such patients. We divided patients into three NSPF risk groups and evaluated the association between NSPF and clinical and acute care utilization outcomes after adjusting for baseline patient characteristics. PARTICIPANTS A total of 140,947 patients who visited a network practice from January 1, 2007, through December 31, 2009, and were either connected to a primary care physician or to a primary care practice, based on a previously validated algorithm. MAIN MEASURES Outcomes of interest were incomplete colorectal, cervical, and breast cancer screening, and above-goal hemoglobin A1c (HbA1c) and low-density lipoprotein (LDL) levels at 1-year follow-up, and hospitalizations and emergency department visits in the subsequent 3 years. KEY RESULTS Compared to patients in the low NSPF group, patients in the high NSPF group (n=14,081) were significantly more likely to have incomplete preventive cancer screening (aOR 2.41 [2.19-.66] for colorectal, aOR 1.85 [1.65-.08] for cervical, aOR 2.93 [2.62-3.28] for breast cancer), above-goal chronic disease control measures (aOR 2.64 [2.22-3.14] for HbA1c, aOR 1.39 [1.15-1.67] for LDL], and increased rates of acute care utilization (aRR 1.37 [1.31-1.44] for hospitalization, aRR 1.39 [1.35-1.43] for emergency department visits). CONCLUSIONS NSPF is an independent predictor of suboptimal primary care outcomes and acute care utilization. NSPF may play an important role in helping healthcare systems identify high-risk patients.
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Affiliation(s)
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick Cronin
- Lab of Computer Science, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey M Ashburner
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sachin J Shah
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Wei He
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Clemens S Hong
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
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20
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Zinski A, Westfall AO, Gardner LI, Giordano TP, Wilson TE, Drainoni ML, Keruly JC, Rodriguez AE, Malitz F, Batey DS, Mugavero MJ. The Contribution of Missed Clinic Visits to Disparities in HIV Viral Load Outcomes. Am J Public Health 2015; 105:2068-75. [PMID: 26270301 DOI: 10.2105/ajph.2015.302695] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored the contribution of missed primary HIV care visits ("no-show") to observed disparities in virological failure (VF) among Black persons and persons with injection drug use (IDU) history. METHODS We used patient-level data from 6 academic clinics, before the Centers for Disease Control and Prevention and Health Resources and Services Administration Retention in Care intervention. We employed staged multivariable logistic regression and multivariable models stratified by no-show visit frequency to evaluate the association of sociodemographic factors with VF. We used multiple imputations to assign missing viral load values. RESULTS Among 10 053 patients (mean age = 46 years; 35% female; 64% Black; 15% with IDU history), 31% experienced VF. Although Black patients and patients with IDU history were significantly more likely to experience VF in initial analyses, race and IDU parameter estimates were attenuated after sequential addition of no-show frequency. In stratified models, race and IDU were not statistically significantly associated with VF at any no-show level. CONCLUSIONS Because missed clinic visits contributed to observed differences in viral load outcomes among Black and IDU patients, achieving an improved understanding of differential visit attendance is imperative to reducing disparities in HIV.
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Affiliation(s)
- Anne Zinski
- Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD
| | - Andrew O Westfall
- Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD
| | - Lytt I Gardner
- Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD
| | - Thomas P Giordano
- Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD
| | - Tracey E Wilson
- Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD
| | - Mari-Lynn Drainoni
- Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD
| | - Jeanne C Keruly
- Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD
| | - Allan E Rodriguez
- Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD
| | - Faye Malitz
- Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD
| | - D Scott Batey
- Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD
| | - Michael J Mugavero
- Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD
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Diaz A, Ten A, Marcos H, Gutiérrez G, González-García J, Moreno S, Barrios AM, Arponen S, Portillo Á, Serrano R, García MT, Pérez JL, Toledo J, Royo MC, González G, Izquierdo A, Viloria LJ, López I, Elizalde L, Martínez E, Castrillejo D, Aranguren R, Redondo C, Diez M. [Factors determining irregular attendance to follow-up visits among human immunodeficiency virus patients: results of the hospital survey of patients infected with human immunodeficiency virus]. Enferm Infecc Microbiol Clin 2014; 33:324-30. [PMID: 25444044 DOI: 10.1016/j.eimc.2014.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/06/2014] [Accepted: 07/22/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION To describe the occurrence of non-regular attendance to follow-up visits among HIV patients and to analyze the determining factors. METHODS One-day survey carried out annually (2002-2012) in public hospitals. Epidemiological, clinical and behavioral data are collected in all HIV-infected inpatients and outpatients receiving HIV-related care on the day of the survey. "Non-regular attendance to a follow-up visit" was defined as sporadic attendance to the medical appointments, according to the judgment of the attending physician. Descriptive and bivariate analyses were performed, and factors associated to non-regular attendance to follow-up visits were estimated using logistic regression. RESULTS A total of 7,304 subjects were included, of whom 13.7% did not attend medical appointments regularly. Factors directly associated with non-regular attendance were: age between 25-49 years; birth in Sub-Saharan Africa or Latin-America; low educational level; being homeless or in prison; living alone or in closed institutions; being unemployed or retired; being an intravenous drug user; not using a condom at last sexual encounter, and injecting drugs in the last 30 days. Conversely, HIV diagnosis within the last year and being men who have sex with men were factors inversely associated with non-regular attendance to follow-up visits. CONCLUSION In spite of health care beings free of charge for everyone in Spain, social factors can act as barriers to regular attendance to medical appointments, which, in turn, can endanger treatment effectiveness in some population groups. This should be taken into account when planning HIV policies in Spain.
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Affiliation(s)
- Asuncion Diaz
- Área de Vigilancia del VIH y comportamientos de riesgo, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España; CIBER Epidemiología y Salud Pública (CIBERESP), Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, Madrid, España.
| | - Alicia Ten
- Plan sida, Servicio de Promoción y Protección de Salud, Subdirección General de Promoción de la Salud y Prevención, DG salud pública, Conselleria de Sanidad de Valencia, Valencia, España
| | - Henar Marcos
- Servicio de Vigilancia Epidemiológica y Enfermedades Transmisibles, DG de Salud Pública, Consejería de Sanidad de Castilla y León, Valladolid, España
| | - Gonzalo Gutiérrez
- Servicio de Epidemiología, DG de Salud Pública, Consejería de Sanidad de Castilla-La Mancha, Toledo, España
| | | | - Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Ana María Barrios
- Servicio de Medicina Interna, Hospital de Fuenlabrada, Madrid, España
| | - Sari Arponen
- Servicio de Medicina Interna, Hospital Universitario de Torrejón, Madrid, España
| | - Álvaro Portillo
- Servicio de Medicina Interna, Hospital Infanta Elena, Madrid, España
| | - Regino Serrano
- Servicio de Medicina Interna, Hospital Universitario del Henares, Madrid, España
| | | | - José Luis Pérez
- Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Madrid, España
| | - Javier Toledo
- Coordinación de VIH/sida, Servicio de Promoción de la Salud y Prevención de la Enfermedad, DG de Salud Pública de Aragón, Zaragoza, España
| | - Maria Carmen Royo
- Servicio de Evaluación de la Salud y Programas, DG de Salud Pública, Consejería de Sanidad, Asturias, Oviedo, España
| | - Gustavo González
- Oficina de Coordinación VIH de Extremadura, Servicio de Participación Comunitaria en Salud, DG de Salud Pública, Servicio Extremeño de Salud, Mérida, Extremadura, España
| | - Ana Izquierdo
- Servicio de Epidemiología y Promoción de la Salud, DG de Salud Pública, Servicio Canario de la Salud, Santa Cruz de Tenerife, Canarias, España
| | - Luis Javier Viloria
- Sección de Vigilancia Epidemiológica, DG de Salud Pública, Santander, Cantabria, España
| | - Irene López
- Servicio de Prevención y Epidemiología del Plan sobre sida, Consejería de Sanidad y Consumo, Ceuta, España
| | - Lázaro Elizalde
- Sección de Promoción de Salud, Instituto de Salud Pública y Laboral, Pamplona, Navarra, España
| | - Eva Martínez
- Sección de Vigilancia Epidemiológica y Control de Enfermedades Transmisibles, DG de Salud Pública y Consumo, Logroño, La Rioja, España
| | - Daniel Castrillejo
- Servicio de Epidemiología, DG de Sanidad y Consumo, Consejería de Bienestar Social y Sanidad, Melilla, España
| | - Rosa Aranguren
- Coordinación Autonómica de Drogas y de la Estrategia de Sida, DG de Salut Pública i Consum, Conselleria de Salut, Família i Bienestar Social, Palma, Baleares, España
| | - Caridad Redondo
- Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Mercedes Diez
- Área de Vigilancia del VIH y comportamientos de riesgo, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España; CIBER Epidemiología y Salud Pública (CIBERESP), Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, Madrid, España; Plan Nacional sobre el Sida, SG de Promoción de la Salud y Epidemiología, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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Nwabuo CC, Dy SM, Weeks K, Young JH. Factors associated with appointment non-adherence among African-Americans with severe, poorly controlled hypertension. PLoS One 2014; 9:e103090. [PMID: 25121589 PMCID: PMC4133195 DOI: 10.1371/journal.pone.0103090] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/26/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Missed appointments are associated with an increased risk of hospitalization and mortality. Despite its widespread prevalence, little data exists regarding factors related to appointment non-adherence among hypertensive African-Americans. OBJECTIVE To investigate factors associated with appointment non-adherence among African-Americans with severe, poorly controlled hypertension. DESIGN AND PARTICIPANTS A cross-sectional survey of 185 African-Americans admitted to an urban medical center in Maryland, with severe, poorly controlled hypertension from 1999-2004. Categorical and continuous variables were compared using chi-square and t-tests. Adjusted multivariable logistic regression was used to assess correlates of appointment non-adherence. MAIN OUTCOME MEASURES Appointment non-adherence was the primary outcome and was defined as patient-report of missing greater than 3 appointments out of 10 during their lifetime. RESULTS Twenty percent of participants (n = 37) reported missing more than 30% of their appointments. Patient characteristics independently associated with a higher odds of appointment non-adherence included not finishing high school (Odds ratio [OR] = 3.23 95% confidence interval [CI] (1.33-7.69), hypertension knowledge ([OR] = 1.20 95% CI: 1.01-1.42), lack of insurance ([OR] = 6.02 95% CI: 1.83-19.88), insurance with no medication coverage ([OR] = 5.08 95% CI: 1.05-24.63), cost of discharge medications ([OR] = 1.20 95% CI: 1.01-1.42), belief that anti-hypertensive medications do not work ([OR] = 3.67 95% CI: 1.16-11.7), experience of side effects ([OR] = 3.63 95% CI: 1.24-10.62), medication non-adherence ([OR] = 11.31 95% CI: 3.87-33.10). Substance abuse was not associated with appointment non-adherence ([OR] = 1.05 95% CI: 0.43-2.57). CONCLUSIONS Appointment non-adherence among African-Americans with poorly controlled hypertension was associated with many markers of inadequate access to healthcare, knowledge, attitudes and beliefs.
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Affiliation(s)
- Chike C. Nwabuo
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States of America
| | - Sydney Morss Dy
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States of America
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, MD, United States of America
| | - Kristina Weeks
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States of America
| | - J. Hunter Young
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States of America
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States of America
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Continued declining incidence and improved survival of progressive multifocal leukoencephalopathy in HIV/AIDS patients in the current era. Eur J Clin Microbiol Infect Dis 2013; 33:179-87. [PMID: 23948752 DOI: 10.1007/s10096-013-1941-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
Abstract
To evaluate the situation and perspectives of progressive multifocal leukoencephalopathy (PML) in human immunodeficiency virus (HIV)-infected patients, we investigated changes in the incidence, causes, and long-term outcome of this disease in 72 acquired immunodeficiency syndrome (AIDS) patients who were diagnosed with PML from 1996 to 2011. Patients were classified according to the date of diagnosis in the first (1996-2000, n = 35), second (2001-2006, n = 26), and recent or third highly active antiretroviral therapy (HAART) period (2007-2011, n = 11). Overall, the incidence of PML decreased from 14.8 cases/1,000 patients/year in 1996 to 2.6 in 2005 and 0.8 in 2011, and nearly two-thirds of recent cases (64 %) were observed in HIV patients not attending clinical visits. The baseline median CD4+ count was higher in recently PML-diagnosed patients (77 vs. 86 vs. 101 cells/mm(3); p < 0.01), and this fact was associated with a cerebrospinal fluid (CSF) inflammatory profile (from 11 to 31 to 55 %, p = 0.007) and with a significantly longer survival (attributable death, 54 vs. 35 vs. 36 %, respectively, p < 0.01). Thus, the overall 1-year and 3-year survival rates were 55 and 50 %, respectively, increasing to 79 % at 1 year for patients with CD4+ count above 100 cells/mm(3) at diagnosis. In a Cox regression analysis, an older age (hazard ratio, HR 0.76), a baseline CD4+ count above 100 cells/mm(3) (HR 0.33), and a CSF inflammatory profile (HR 0.12) were significantly associated with a longer survival. The clinical presentation and outcome of PML in AIDS patients continue to change dramatically. Now, a declining incidence and long-term survival is observed.
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Horberg MA, Hurley LB, Silverberg MJ, Klein DB, Quesenberry CP, Mugavero MJ. Missed office visits and risk of mortality among HIV-infected subjects in a large healthcare system in the United States. AIDS Patient Care STDS 2013; 27:442-9. [PMID: 23869466 PMCID: PMC3739947 DOI: 10.1089/apc.2013.0073] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Linkage and retention in care soon after HIV diagnosis improves clinical outcomes. Conversely, missed visits after diagnosis are associated with increased mortality in the public care setting. We analyzed mortality among newly diagnosed HIV patients ≥18 years old in a large private care setting between 01/01/1997 and 12/31/2009, comparing patients who missed visits in their first year following diagnosis (index period) with those who did not. Patients who died during the index period were excluded. Hazard ratios (HR) for association of missed visits and mortality were obtained by Cox proportional hazards regression, adjusting for patient demographics, CD4+ counts, and AIDS-defining conditions (CDC, 1993) at diagnosis. We also evaluated risk factors of missed visits by multivariable logistic regression. 2811 patients were included, of whom 65% had ≥1 missed visit, and 226 patients died during follow-up. Patients with ≥1 missed visit had a 71% increased mortality risk (HR=1.71, p=0.001) with 12% increased rate per missed visit (HR=1.12, p<0.001). Factors associated with missed visits were younger age (OR=1.69 compared to 60+ years), Black and Latino race/ethnicity (OR=1.54, 1.48 respectively, compared to Caucasians), injection drug use (OR=2.50 compared to men who have sex with men), and lower CD4+ (OR=1.43 for CD4+ 100-199 cells/μL, OR=1.39 for 50-99 cells/μL, and OR=1.63 for CD4+ <50 cells/μL, compared with CD4+ >500 cells/μL). In an insured patient population, missed visits in the first year of HIV care are common and associated with increased mortality. Early retention in HIV care is critical to improving outcomes.
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Affiliation(s)
- Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Rockville, MD 20852, USA.
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Abstract
Background: Missed primary care appointments lead to poor disease control and later presentation to care. No-show rates are higher in clinics caring for underserved populations and may contribute to poorer health outcomes in this group. The objective of this study was to determine who were the patients not showing to primary care appointments and their reasons to no-show. Methods: A retrospective study was conducted at a community health center serving a predominantly Latino, immigrant, low-income population. Adult patients >18 years old who did not show to primary care appointments during a 5-month period were called by a bilingual (English and Spanish) patient service coordinator. The patients’ reported reason for missing the appointment was documented. Two-sided t test of proportions was used to compare demographic characteristics of the patients that showed to their appointments to patients that did not. Results: Of 7508 scheduled appointments, 5604 were included in the analysis and 927 (16.5%) no-showed. There were 735 (79%) calls made to the patients who missed their appointments and 273 (37%) were reached. The 2 most common reasons for missing an appointment were forgetting (n = 97, 35.5%) and miscommunication (n = 86, 31.5%). When compared with patients who came to their appointments, patients who no-showed were younger ( P < .0001), more likely to be black ( P = .0423) or Hispanic ( P = .0001), and to have Medicaid ( P < .0001). Conclusions: No-show rates interfere with quality primary care. Interventions designed to target reasons for no-show are needed to help reduce the no-show rate, improve access and decrease health disparities in underserved patient populations.
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Affiliation(s)
- Emma Kaplan-Lewis
- Massachusetts General Hospital Department of Medicine, Boston, MA, USA
| | - Sanja Percac-Lima
- Massachusetts General Hospital Department of Medicine, Boston, MA, USA
- Massachusetts General Hospital Chelsea HealthCare Center, Chelsea, MA, USA
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