Appointment Adherence Research Articles

Leveraging machine learning to enhance appointment adherence at a novel post-discharge care transition clinic.

This study applies predictive analytics to identify patients at risk of missing appointments at a novel post-discharge clinic (PDC) in a large academic health system. Recognizing the critical role of appointment adherence in the success of new clinical ventures, this research aims to inform future targeted interventions to increase appointment adherence. We analyzed electronic health records (EHRs) capturing a wide array of demographic, socio-economic, and clinical variables from 2168 patients with scheduled appointments at the PDC from September 2022 to August 2023. Logistic regression, decision trees, and eXtreme Gradient Boosting (XGBoost) algorithms were employed to construct predictive models for appointment adherence. The XGBoost machine learning model outperformed logistic regression and decision trees with an area under the curve (AUC) of 72% vs 65% and 67%, respectively, in predicting missed appointments, despite limited availability of historical data. Key predictors included patient age, number of days between appointment scheduling and occurrence, insurance status, marital status, and mental health and cardiac disease conditions. Findings underscore the potential of machine learning predictive analytics to significantly enhance patient engagement and operational efficiency in emerging healthcare settings. Optimizing predictive models can help balance the early identification of patients at risk of non-adherence with the efficient allocation of resources. The study highlights the potential value of employing machine learning techniques to inform interventions aimed at improving appointment adherence in a post-discharge transition clinic environment.

Access and adherence to cancer care through the Veteran Affairs Close to Me cancer care service.

111 Background: Diagnosing and treating more than 56,000 Veterans annually, the Veterans Affairs (VA) National Oncology Program (NOP) is one of the nation’s largest integrated providers of oncology services. Within VA, oncology care and parenteral therapies are primarily offered at VA Medical Centers (VAMCs) in urban areas, often inaccessible to rural patients. Issues with travel distance, parking, time, and caregiver support can prevent patients from adhering to treatment appointments as evidenced by historical annual No-Show rates for VAMC infusion clinics that range from 1.1-6.7%. To mitigate potential barriers to access, NOP launched the Close to Me (CTM) cancer care service. The service deploys Registered Nurses (RNs) to local VA Community Based Outpatient Clinics (CBOCs) to administer cancer treatments. VA has opened 23 CTM clinics across 5 geographical regions since October 2021. Methods: The CTM service was implemented at VAMCs with NOP providing direct project management, safety assessment and resources such as a comprehensive implementation toolkit, standard operating procedures, care coordination tools, a tiered risk drug matrix and a standardized Healthcare Failure Mode and Effect Analysis risk evaluation. RNs followed a standardized workflow to assess patient eligibility and verify treatment clearances. Access to care was reported by numbers of unique patients and treatment visits. Patient appointment adherence was monitored by no-show rates documented in the electronic health record. Infusion reactions and medical emergencies were reported by RNs. Travel miles saved was calculated by subtracting the difference in miles round trip from the patient’s home to main VAMC and from home to CBOC, then multiplied by number of treatment visits to CBOC. Results: From October 2021 through April 2024, 23 new CTM clinics opened across 5 regions. 515 unique patients were enrolled for a total of 1,916 patient visits. Treatment appointment no-show rate was 1% across all CTM clinics. The most commonly administered medication classes include gonadotropin-releasing hormone agonist (30%), immune globulin (14.5%), immune checkpoint inhibitors (9.3%) and bisphosphonates (8.3%). Zero infusion reactions or medical emergencies were recorded across 1,430 treatments administered. A total of 204,000 travel miles were saved by patients enrolled in this program. Conclusions: The CTM cancer care service safely optimizes current VA CBOC infrastructure to increase access points to oncology treatment for patients across various geographical regions. CTM reduced travel burden for patients and increased ability to adhere to treatment appointments as evidenced by the service’s low no-show rate. These consistent results across CTM services at VAMCs nationwide have cemented CTM as a safe and effective treatment delivery model to expand access. CTM will be scaled to an additional 30 regions by end of 2025.

Transition of care from pediatric to adult nephrology post-renal transplant: a review.

Pediatric renal transplant recipients (RTRs) face heightened risks when they transition from a childhood nephrologist to an adult-centered one. The transition of care usually occurs when an individual is between ages 18 and 21 years, although some change providers earlier or later depending on varying circumstances. Turbulence during this shift can significantly impact daily life and, in severe cases, lead to graft loss. Several modern studies have explored the transition from pediatric to adult-centered nephrology care post-renal transplant. In this review, we first provide an overview of the differences between pediatric and adult renal transplant, highlighting unique challenges faced by pediatric patients such as donor-recipient size disparity, growth impairment, and need for additional immunizations. We then emphasize the criticality of a well-planned transition process, identifying factors that can hinder a smooth transition-such as medical and medication nonadherence, lack of health literacy, patient psychosocial challenges, and systemic shortcomings in coordination between care teams. Furthermore, this review outlines existing protocols and risk assessment tools, in addition to highlighting recent advancements aimed at facilitating smoother transitions such as the RISE protocol, readiness assessment, and the use of multidisciplinary teams. Proper implementation of coordinated, evidence-based transition protocols can improve patient outcomes, promote medication and appointment adherence, and reduce graft rejection rates. Efforts from multidisciplinary teams utilizing technology, risk stratification tools, and open communication between providers and patients are key to optimizing the transition process for pediatric RTRs as they transfer to adult-centered care.

Abstract C177: Increasing cervical cancer screening among women living with HIV (WLWH) in Jamaica

Abstract Background: Cervical cancer (CCA) is the third most common cancer and the third leading cause of cancer deaths among women in Jamaica. Although human papilloma virus (HPV), the primary risk factor for CCA, has a prevalence of 54% among sexually active Jamaican women, HPV vaccination uptake is low, and CCA is often diagnosed at advanced stages due to inadequate screening. Women comprise 50% of persons living with HIV in Jamaica and are about six times more likely to develop cervical cancer than women without HIV. However, despite national guidelines requiring annual screenings, a national audit found that fewer than one-third of eligible WLWH underwent a Pap smear in the past year. Objective: We aimed to address gaps in CCA screening among WLWH attending four large HIV treatment sites in Jamaica through programmatic and operational support integrated into HIV care. Method: Working through the UCSF Jamaica Country Programme, funded by PEPFAR, clinical advisors completed site reviews to identify gaps in the CCA screening process. Critical gaps identified at the four sites included insufficient supplies (speculums, slides, cytology brushes, fixative, Pap smear jackets, and bed rolls), limited provider knowledge, delays in sample processing, and the delayed return of results from the national public health lab. From January 2023 to May 2024, our team provided technical assistance and resources for sample collection, private laboratory testing, delivery of samples, and collection and review of results. Results: Cervical cancer modules were integrated into an ongoing clinical management training series that reached 33 clinicians across multiple sessions. With supportive supervision, the sites strengthened patient notification and sample transportation, that facilitated appointment adherence, timely sample delivery, and prompt collection of results. Clinical advisors further supported site teams to identify abnormal results and ensure timely and appropriate follow-up diagnostic tests and treatment referrals. This intervention supported 656 eligible WLWH to complete Pap smears, with 614 timely results returned to the sites by May 2024. Conclusion: Targeted programmatic interventions can increase CCA screening by improving the availability of Pap supplies, clinic workflow, and operational efficiency within HIV care clinics thereby reaching a population at high risk for CCA. Technical and financial support from donors can be expanded to explore clinic-based models for improving and integrating HPV screening and vaccine uptake among vulnerable WLWH. The impact of these interventions can be tested through quality improvement and implementation science frameworks. Citation Format: Sharlene T Beckford Jarrett, Sasha-Kaye Blackwood, Kimlin Tam Ashing, Kamelia Bryan, Tyrone O Ellis, Jeffrey Edwards, Willi McFarland, Nicola Skyers. Increasing cervical cancer screening among women living with HIV (WLWH) in Jamaica [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C177.

A clinical audit exploring the relationship between HbA1c control and appointment adherence among young adult diabetes clinic patients

A clinical audit exploring the relationship between HbA1c control and appointment adherence among young adult diabetes clinic patients

A descriptive study of the connections between social risk and healthcare utilization with supportive oncology care

Objective This study utilized social risk data in the electronic heath record collected as part of routine clinical practice and examined relationships with supportive oncology care contacts and healthcare utilization. Methods A total of 2,807 cancer patients were screened for four social determinants of health (SDOH) domains (financial resource strain, housing instability, food insecurity, and transportation need) and categorized to low or high risk SDOH groups. The number of patient contacts with supportive oncology was compared amongst the groups. The data were analyzed for demographic and outcome differences including emergency department visits, inpatient admissions, and appointment adherence. Results Heightened social risk was associated with more total contacts with supportive oncology care. Patients with high SDOH risk had more contacts across all outcomes examined including emergency department visits (M = 13), inpatient admissions (M = 14), and missed appointments (M = 11). Conclusions Patients with both greater social risks and acute care utilization are associated with more psychosocial interventions in supportive oncology follow-up. These findings highlight the need for comprehensive action to respond to social risk factors identified in SDOH screening.

Effectiveness of Personalised Phone Calls and Short Message Service Reminders in Improving Patient Attendance at a Radiology Department.

Patients missing scheduled hospital appointments posesignificant challenges, including resource waste and delayed patient care. This study evaluated the effectiveness of personalised reminder systems (phone calls andshortmessageservice (SMS)) in improving patient attendance rates at a radiology department. The study was conducted at a hospital facility in Saudi Arabia. The intervention involved reminding 493 patients of their radiology appointments using their preferred method (phone call or SMS). Demographic, clinical, and other factors were considered in analysing the impact of these reminders on appointment attendance. Attendance rates before the intervention were further compared with attendance rates after the intervention to assess the effectiveness of the studied strategies. Patient reminders affected overall patient attendance, with a 5% improvement compared to the attendance rates before the intervention. Phone call reminders were found to be more effective than SMS, particularly among older patients (41-60 years). The attendance rate for patients receiving phone call reminders ranged from 35% to 85%, whereas those receiving SMS reminders had a 15-65% attendance range. The study indicated marital status and distance as key factors associated with attendance. Chi-square analysis also highlighted significant differences in attendance rates before and after the intervention, particularly among female patients, single and divorced individuals, and those with at least secondary education. Patients living more than 35 km from the hospital and those referred from other hospitals were more likely to miss appointments, irrespective of the intervention. Personalised phone call reminders seem to be more effective than SMS in reducing missed appointments, especially among older patients. This study highlighted the importance of considering patient demographics and preferences in designing reminder systems to enhance healthcare appointment adherence.

Effectiveness of text message reminders on paediatric appointment adherence: a systematic review and meta-analysis.

Attending health appointments is important for the paediatric population, as it allows for earlier detection of health issues and subsequent necessary treatments. It also ensures timely immunisations while also allowing patients or their parents to raise health concerns. Hence, it is crucial to take steps to ensure that such medical appointments are attended.To evaluate the effectiveness of text message reminders (TMRs) in improving paediatric patients' adherence to their appointments.A systematic review and meta-analysis were conducted. The search spanned across eight online databases from their inception dates to January 2024. The random-effects model was utilised to conduct the meta-analysis, where risk ratio was used as the effect measure. Subgroup analyses were conducted for age, number of TMRs sent, and type of appointments attended.In total, 13 studies were included. Compared to standard care (involving non-text message reminders or no reminders), TMRs were significantly more effective in improving appointment attendance among the paediatric population. Significant subgroup differences were found in the type of appointments attended, where TMRs were more effective for medical appointments compared to vaccination appointments. No differences in adherence to appointments were found across age groups or the number of TMRs sent. Conclusion: Sending TMRs can be a potentially cost-effective way to improve the attendance rate of paediatric medical appointments, given the ease of implementation and the extensive mobile phone usage globally. Future studies should compare TMRs to other modes of automated reminders such as telephone messages or emails, to identify the most optimal method of delivery. Trial registration: PROSPERO (CRD42023464893).

A - 66 Factors Impacting Appointment No-Shows and Cancellations in Neuropsychology: Predictors for Improving Access to Care for a Diverse Patient Population

Abstract Objective Access to care can be impacted adversely by appointment adherence. We aimed to identify predictors of no-shows and cancellations for neuropsychological services offered by a healthcare system serving diverse communities. Method Demographics and appointment status were documented from a sample of 537 consecutive patients scheduled for neuropsychological evaluation at an outpatient psychiatry clinic. Patients included 220 males and 317 females with an average formal education of 11.01 years (SD = 3.87) and age of 55.64 years (SD = 16.2). Chi-square analyses were used to evaluate the association between appointment status and gender, race/ethnicity, payor, availability of a collateral, and MyChart access. Multivariate analysis of variance was used to assess the relationship between age, education, proxy income, and prior no-show rate with appointment status. Results The overall rate of no-shows or late cancellations was 20%, and some patients no-showed multiple times. No-shows and late cancellations were associated with historical no-show rates and older age (F = 14.60, p < 0.0001), while race/ethnicity and MyChart activation had slight impacts (χ2 = 5.572, p = 0.062 and χ2 = 3.69, p = 0.055, respectively). Being a monolingual Spanish speaker was associated negatively with MyChart activation, but positively with collateral availability (p < 0.05). Conclusions No-show rates, which impact access to care, are high and associated with prior history of no-shows. Other factors, such as MyChart activation and culturally-associated barriers may also impact access. Implementing interventions addressing prior no-show rates and enhancing MyChart access could significantly increase show rates; such improvements could increase patient access to care, reduce the system’s financial burden, and decrease wait times for other patients.

Access to Care among Hispanic/Latin American Patients in Neuropsychology: Addressing Potential Barriers to Appointment Adherence

Abstract Objective We will review barriers impacting access to care among Hispanic/Latin American patients, focusing on factors contributing to no-shows and possible interventions. Method We implemented an appointment management system to improve attendance using native Spanish speakers when indicated. We then recorded demographic data and attendance from 211 consecutive Hispanic/Latin American patients (123 females/88 males; mean age = 55 years, SD = 17.3; mean years formal education = 8.7, SD = 4.5). These were from a study of 537 patients in which we conducted MANOVA assessing the relationship between attendance and age, education, proxy income, and prior no-show rate, and Chi-Squares assessing associations between appointment status and gender, payor, race/ethnicity, MyChart Activation, and availability of collaterals. Among Hispanic/Latin American patients, we assessed associations between appointment status and language, MyChart activation, and availability of collaterals. Results Our system improved attendance, though no-shows remained high (17% among Latin American/Hispanic patients) with significant associations between attendance and language (χ2 = 9.884, p = 0.007), MyChart access and language (χ2 = 11.315 p = 0.004), and availability of collaterals and language (χ2 = 8.785, p = 0.012). Being monolingual Spanish speaking was associated positively with collateral availability (p < 0.05), while the relationships between language and attendance and between language and MyChart activation were complex. In the larger sample, older age, higher prior no-show rates, and no MyChart activation were associated with poorer appointment attendance; education and availability of collaterals were not. Conclusion There are potentially modifiable targets to improve attendance and access to care. We are now developing a health-fair model to teach patients the importance of attendance, assisting them with MyChart, transportation, and other resources.

Factors Associated With Patient Failure To Attend Dental Appointments: A Retrospective Analysis.

Nonattendance at scheduled dental appointments has a significant impact on healthcare systems worldwide. This study examines the factors associated with missed appointments at the Dental Center in the Department of Oral and Dental Health in Riyadh, Saudi Arabia, through a retrospective secondary data analysis. Existing medical records from January 1, 2024, to May 1, 2024 were analyzed to identify patterns or factors contributing to nonattendance. Data were collected using a standardized sheet and analyzed with statistical methods, including correlation analysis, ANOVA, and chi-square tests, to determine significant associations and factors affecting nonattendance. The results indicated that the majority of nonattendees were single (56.2%), with a higher proportion of females (60.7%) compared to males (39.3%). Only 3.8% of those who missed their appointments were over 55 years old. Tuesdays had the highest incidence of nonattendance (331 cases). No significant association was found between age groups and the time (F = 0.224, p = 0.925) or date (F = 0.840, p = 0.500) of appointments. Patients were less likely to attend morning appointments compared to evening ones. The high rate of missed appointments reduces the effectiveness and efficiency of the Dental Center's resources. The identified patterns and factors can guide managers and policymakers in developing strategies to reduce missed appointments and improve overall appointment adherence.

Assessment of Medication Compliance and Follow-Up Clinic Attendance Among Patients With Cardiovascular Diseases in the Jazan Region.

Cardiovascular diseases are common causes of mortality in Saudi Arabia and the world. This study aims to assess medication compliance and regularity of follow-up for cardiovascular patients in the Jazan region. An analytical cross-sectional approach was used to target all registered cardiovascular patients attending the cardio clinic in a Jazan region hospital. Data were collected using an interview questionnaire developed by the researchers with the help of experts. The questionnaire included the patients' sociodemographic data, clinical characteristics, disease-related data, drugs, and appointments. The study included 259 patients diagnosed with cardiac disease. About 53.7% of the patients were males. All the cases had the disease for one year or more. About 56% of the patients hadno difficulty remembering their medications, while 44% had problems remembering to take them. More than half of the patients had good medication adherence, and 79.6% had good appointment adherence. Only 20.4% of patients had a poor adherence rate. The adherence rate for the patients' medication and appointments was satisfactory due to high patient awareness. On the other hand, poor adherence was related more to non-Saudi patients.

Enhancing Continuity of Physiotherapy Care: Investigating the Impact of Missed Follow-up Appointments in Outpatient Settings

Background: Physiotherapy is essential in managing chronic diseases in musculoskeletal, neurological and cardiovascular domains. These conditions have high morbidity rates and hence need therapeutic interventions that enhance the quality of life. However, poor adherence to review appointments diminishes treatment effectiveness and healthcare productivity. Evidence from developed countries reveals varying missed appointment (MA) rates, thereby calling for targeted treatments embedded in contextual factors. Methods: This was a retrospective study using clinic data to identify MA rates and associated variables that included age, gender, and residential origins. The effect of each variable on appointment adherence was investigated. An intervention plan was designed to reduce MA through appointment reminders and patient education. Incentives were also foreseen. Descriptive statistics, Pearson’s correlation and cost-benefit analysis was conducted using SPSS version 23. Results: The rate of MA was 22% initially, significantly reducing to 12% after the intervention (p<0.001). The demographic variables significantly relating to appointment adherence were age group and residential location (p<0.001, 0.012) respectively. Seasonality and referral sources played their role in attendance patterns, which align with earlier studies on healthcare use determinants. Conclusion: This study provides deep insights from physiotherapy appointment adherence in Pakistan and depicts successful measures for reducing MAs and improving treatment delivery. The findings represent the values of patient-centred treatments, which result in a better functional outcome for patients, with a smooth running of clinic operations. Keywords: Appointments, Follow-up, Physiotherapy, Records.

Improvement in Adherance to Anesthesia Preoperative Appointment With Telemedicine: A Retrospective Analysis.

Amidst the coronavirus disease 2019 (COVID-19) pandemic, the sudden demand for virtual medical visits drove theexpansion of telemedicine across all medical specialties. Current literature demonstrates limited knowledge of the impact of telehealth on appointment adherence, particularly in preoperative anesthesia evaluations. This study aims to describe the impact of telemedicine-based anesthesia evaluation and its effects on appointment completion. Methods: This was a retrospective, non-randomized, cohort study of adult patients at the University of California, Los Angeles, United States, who received preoperative anesthesia evaluations by telemedicine or in-person in an academic medical center. From January to September 2021, we evaluated telemedicine and in-person appointment completion in patients scheduled for surgery. The primary outcome was the incidence of appointment completion. The secondary outcomes included appointment no-shows and cancellations. Results: Of 1332 patients included in this study, 956 patients received telehealth visits while 376 patients received in-person preoperative anesthesia evaluations. Compared to the in-person group, the telemedicine group had more appointment completions (81.38% vs 76.60%), fewer cancellations (12.55% vs 19.41%), and no statistical difference in appointment no-shows (6.07% vs 3.99%). Compared to the in-person group, patients who received telemedicine evaluations were younger (55.81 ± 18.38 vs 65.97 ± 15.19), less likely Native American and Alaska Native (0.31% vs 1.60%), more likely of Hispanic or Latino ethnicity (16.63% vs 12.23%), required less interpreter services (4.18% vs 9.31%), had more private insurance coverage (53.45% vs 37.50%) and less Medicare coverage (37.03% vs 50.53%). This study demonstrates that telemedicine can improve preoperative anesthesia appointment completion and decrease appointment cancellations. We also demonstrate potential shortcomings of telemedicine in serving patients who are older, require interpreter services, or are non-privately insured.These inequities highlight potential avenues to increase equity and access to telemedicine.

Musculoskeletal shoulder pain: Home exercise frequency and adherence to appointments are not mediators of outcome

ObjectiveTo investigate whether appointment adherence and frequency of home exercises mediates the association of baseline i) pain self-efficacy (PSE) or ii) patient expectation of recovery, with outcome at 6 months. DesignMulticentre longitudinal cohort study. MethodsSix-month outcome data (SPADI, QuickDASH) were provided by 810 of 1030 recruited participants. Daily frequency of home exercises over 6 weeks, were expressed as the proportion of days exercises were completed. Measures of adherence included proportion of appointments attended and completing a course of physiotherapy. Mediation analyses were conducted using Baron and Kennys’ four-step method, and for continuous variables, testing the indirect effect using a non-parametric version of Sobel’s test. ResultsAppointment adherence, completing a course of physiotherapy and frequency of home exercise did not mediate the relationship between PSE or patient expectation with 6 months SPADI or QuickDASH. Higher PSE was significantly associated with appointment adherence and completing a course of physiotherapy. Patient expectation was significantly associated with frequency of home exercise. However, none of the hypothesised mediators had a significant effect on outcome. ConclusionAppointment adherence and higher frequency of home exercise do not appear to be the mechanisms by which high PSE or expectation of recovery predict a good outcome. This study was not designed to address the effectiveness of a home exercise programme for which no conclusions should be drawn. However, our results do support the need for a greater emphasis on the assessment and incorporation of techniques to facilitate high pain self-efficacy and expectation of recovery.

Medical Appointment Adherence and Challenges Encountered by HIV Infected Children at Kenyatta National Hospital, Kenya

Purpose: The goal of this study was to determine the adherence and challenges to scheduled medical appointment on HIV care services among HIV positive children aged 18 months to nine years undergoing treatment at Kenyatta National Hospital, Kenya at six months interval
 Methodology: The study design was prospective cohort study design consisting of 221 caregivers and their HIV infected children. Consecutive sampling method was used, in which potential participants were sought out on a daily basis until we had contacted all the eligible individuals and enroled them.This research was undertaken from March, 2017 to November, 2018. The study participants each was followed for period of one year. Pretested questionnaire was used for collecting data together with review of standardized clinical notes on challenges and adherence to scheduled medical appointments. Data was analyzed using statistical package for the Social Sciences (SPSS) Version 20. The descriptive statistics were done and data was presented in frequency tables. Ethical approval no P688/09/2016) was obtained.
 Findings: It was observed that adherence to scheduled medical appointment among children infected with HIV ranged from 77% to 81.9% at 6 and 12 months respectively. This study found an average of 20% of children infected with HIV are at high risk of adverse outcomes related to non-adherence to planned medical appointments. The observed difference on adherence was associated with financial constrain, perceived stigma and discrimination, long distance and long waiting period in the medical HIV clinic.
 Unique Contribution to Theory, Practice and Policy: Targeted intervention aimed at addressing measures to reduce children missing attendance of scheduled medical appointment is vital. The health care providers may address measures to reduce children missing attendance of scheduled medical appointment by reducing waiting time in the clinic and reducing the number of scheduled medical appointments. This study adds to the pool of knowledge that stigma and discrimination, long waiting time in the clinic and the number of scheduled medical appointments has influence on adherence to appointments. The attendance of scheduled medical appointment should be enhanced in the policies by Ministry of health and HIV health care providers focusing on reducing waiting time, mitigating stigma and discrimination.

Telephone-based telepsychiatry consultations: a qualitative exploration of psychiatrists’ experiences in Oman

ObjectivesThe utilisation of tele-mental health services has the potential to address challenges in mental health services within the Eastern Mediterranean Region. However, the adoption of tele-mental health in Oman remains...

Exploring factors influencing outpatient radiology attendance based on Health Belief Model (HBM): A qualitative study

IntroductionNon-attendance for radiology outpatient appointments is a global issue and is associated with adverse clinical outcomes and operational inefficiencies. This paper aims to understand the underlying factors influencing outpatient radiology attendances based on the Health Belief Model (HBM). MethodsPurposive sampling was used to recruit patients (n=30) for in-depth semi-structured telephone interviews. Inclusion criteria comprised participants who were above 21 years old and fluent in English, while participants reliant on third-party assistance (e.g., nursing homes and prison services), to attend the appointment were excluded. The interviews were recorded and transcribed verbatim. The COREQ (Consolidated Criteria for Reporting Qualitative Research) was utilised to guide the reporting of this study. The data analysis involved a hybrid thematic analysis approach using NVivo. ResultsSix key themes associated with appointment adherence in radiology were identified. These themes included: 1) prioritising health and acceptance of current medical conditions; 2) the impact of perceived severity on non-attendance; 3) perceived benefits of attending appointments; 4) perceived barriers to attendance; 5) influential prompts; and 6) confidence in attendance. ConclusionThis is the first study of its kind to utilise the HBM to examine factors influencing attendance adherence among radiology outpatients in Singapore. Costs, prompts, and the perceived severity of the condition play pivotal roles in shaping the health-seeking behaviours of these outpatients while professionalism of healthcare staff and barriers to attendance present opportunities for providers to address patients' lack of interest towards their appointments. Implications for practiceFindings of this study will contribute to the development of personalised, targeted interventions for improving patient engagement and attendance in radiology settings.

Hemapheresis Clinic Scheduling Quality Improvement Project

Abstract Introduction/Objective Outpatient (OP) Red blood cell exchange (RCE) therapy is used to treat patients with severe manifestations of sickle cell disease. Like any blood transfusion, a patient must have an active type and screen, drawn 24 to 72 hours prior to scheduled RCE procedure. UIH Hemapheresis clinic performs several types of apheresis procedures treating sickle cell disease, kidney transplant rejection and autoimmune disorders. Outpatient clinic staff perceived that most RCE procedures are scheduled disproportionately between Wednesday through Friday, which creates an unbalanced schedule that is lighter on Monday and Tuesday, and heavier Wednesday through Friday. The study's objective was to determine if there is a significant difference between the number of outpatient procedures scheduled on the different days of the week. If significant differences are identified, processes may be improved to schedule a more balanced OP clinic week. Potential benefits may include a more balanced patient to nursing staff ratios which can improve patient care and more efficient RBC utilization which can ease workload across multiple cross-functional departments such as nursing staff, reference labs and in-house blood bank staff. Methods/Case Report The UIH Epic Hemapheresis Clinic schedule was searched to identify how many total OP procedures, including RCE, were scheduled each day of the week between 01AUG2021 – 31JUL2022. Only OP procedures occurring in complete five-day weeks were included. Weekends and weeks having clinic closures for holidays were excluded Results (if a Case Study enter NA) Our study show that the lowest number of OP RCE (mean 1.4) and total number of OP procedures (mean 2.6) were on Monday. Wednesday is the busiest day with overall averaging 3.5 total procedures (Standard Deviation: 1.56). However, Friday is the most variable, with the largest SD for both RBCX (SD 1.4) and Total number of procedures (SD 1.7). Conclusion Contributing factors to low procedure volume on Monday are likely multifactorial. Some patients may prefer not to come to the hospital on Saturday for type and screen, while some may forget they need labs. Transportation issues are another factor. One intervention the clinic has implemented is automatic appointment call reminders. Staff encourage patients or caregivers to sign up for the EPIC MyChart app which also notifies patients of upcoming appointments. Future studies need to be conducted to address other bottlenecks within the scheduling workflow and to determine ways to optimize patient appointment adherence.

Impact of a Pharmacist-Managed Telemedicine Pharmacotherapy Clinic in the Era of COVID-19

Purpose: Telemedicine has been essential during the coronavirus disease 2019 (COVID-19) pandemic. In March 2020, pharmacist-led chronic disease state management services at our family care centers and primary care clinics were converted to telemedicine. This study aimed to determine the impact of expanding telemedicine services on appointment adherence, clinical outcomes, and financial reimbursement. Methods: This was a single-center, retrospective, quasi-experimental study of the impact of expanding telemedicine services on adult patients with diabetes, hypertension, and/or hyperlipidemia. The study included patients scheduled with a pharmacist at a hospital-based (HB) or physician-based (PB) clinic. The primary outcome was the difference in the mean no-show rate. The secondary outcomes were differences in mean change in HbA1c, LDL, blood pressure, and reimbursement. Mean differences between pre- and post-telemedicine groups of each clinic were measured for all outcomes. Results: The mean difference (SE) in the no-show rate in the HB clinic was -12.09% (4.862; P = .014), compared to 2.88% (3.656; P = .431) in the PB clinic. The mean difference (SE) in the change in HbA1c in the HB clinic was .00% (.338; P = .992), compared to .01% (.239; P = .945) in the PB clinic. The mean difference (SE) in reimbursement in the HB clinic was $1.93 (4.209; P = .647), compared to $20.46 (3.210; P < .0001) in the PB clinic. Conclusion: Expansion of pharmacy telemedicine services provided evidence for improved appointment adherence in the HB clinic and increased reimbursement in the PB clinic. No change in healthcare outcomes was observed.