Increased Interval From Initial Evaluation to Initial Voice Therapy Session is Associated With Missed Voice Therapy Appointments

Abstract

Voice therapy (VT) is an essential component to a successful treatment of laryngological disorders and thus patient outcomes depend on patient compliance with VT. As volume of VT patients' ebb and flow, there is often variation in wait times for initial VT sessions. There is a paucity research evaluating VT latency and missed appointments. It is important to find associations between latency and patient compliance to assist with increasing the quality of patient care in all voice and swallowing clinics and decreasing missed appointments for VT following. Should a clinical setting be able to make changes to better care for the patients, it may show a substantial change in missed appointments and patient outcomes. To determine what factors contribute to missed initial VT session and specifically whether patients who have a time interval of >4 weeks from their initial interdisciplinary evaluation to their initial VT session are more likely to not attend. Retrospective analysis of a database, at a tertiary academic voice and swallowing center. A prospective voice and swallowing database was evaluated for new voice patient evaluations starting from January 1, 2014 to December 31, 2017. Patients with a primary diagnosis of dysphonia or dyspnea and scheduled for VT after the initial patient evaluation in an interdisciplinary laryngology clinic were included. Three hundred and eighteen patients (mean age = 5.27, standard deviation 16.0) met the inclusion criteria. Patients were 73% (n = 231) female, and 81% White/Caucasian. Univariate analysis shows that insurance type, profession, body mass index, interval to VT appointment, Reflux Severity Index (RSI), and Eating Assessment Tool-10 scores were associated with missed appointment rates. Multivariate logistic regression model demonstrated interval to VT, RSI, race, and profession were significant factors in missed appointments. Patients with an interval >4 weeks, were more likely to miss their appointment, as compared to patients <4 weeks (odds ratio 2.07 95% confidence interval 1.18-3.60). The data presented suggests that patients who have their first VT appointment greater than 4-weeks from the time of their initial interdisciplinary evaluation have an increased risk of missed appointment. Race, RSI, and professional voice use also appear to play a role in missed appointment rates.