Appointment Adherence Research Articles

Exploring Factors Associated With Missed Dental Appointments: A Machine Learning Analysis of Electronic Dental Records.

This study aimed to employ machine learning techniques to explore the factors that could be associated with missed dental appointments. This cross-sectional study analyzed a total of 14,066 electronic dental records. Dental appointment adherence was categorized as attended or missed. Descriptive statistics and machine learning techniques, including conditional inference regression trees (CTree) and random forests (RFs), were employed for the analyses. About 31% of dental appointments were missed. Among the study population, appointments scheduled on Monday of the first week in the school year had the highest percentage of missed appointments, reaching up to 60%. Similarly, appointments scheduled on weeks 9, 10, 15-19, on Mondays, and with female dental students had slightly above 40% of missed appointments. The random forest analysis identified the week of the dental appointment, age, clinical day, and dental education level of students as the most influential variables in predicting dental appointment adherence. The most significant factors associated with a higher proportion of missed dental appointments were scheduled during specific weeks, on Mondays, with younger patients (<50 years), and with female dental students. Therefore, identifying these factors may assist healthcare providers and dental institutions in planning strategies to improve appointment attendance.

Does the Quality of Behavior Change Counseling in Routine HIV Care Vary According to Topic and Demand?

HIV clinicians face increasing time constraints. Our objective was to describe the prevalence and quality of behavior change counseling within routine HIV visits and to explore whether clinicians may provide lower quality counseling when facing increased counseling demands. We audio-recorded and transcribed encounters between 205 patients and 12 clinicians at an urban HIV primary care clinic. We identified and coded episodes of behavior change counseling to determine clinicians' consistency with motivational interviewing (MI) and used multi-level regression to evaluate counseling quality changes with each additional topic. Clinician counseling for at least one behavior was indicated in 92% of visits (mean 2.5/visit). Behavioral topics included antiretroviral medication adherence (80%, n = 163), appointment adherence (54%, n = 110), drug use (46%, n = 95), tobacco use (45%, n = 93), unsafe sex (43%, n = 89), weight management (39%, n = 80), and alcohol use (35%, n = 71). Clinician counseling was most MI-consistent when discussing drug and tobacco use and least consistent for medication and appointment adherence, unsafe sex, and alcohol use. In multilevel analyses, clinician counseling was significantly less MI-consistent (β = -0.14, 95% CI -0.29 to -0.001) with each additional behavior change counseling need. This suggests that HIV ambulatory care be restructured to allocate increased time for patients with greater need for behavior change.

Assessing Self-Care Practises of People Living With HIV/AIDS Attending the Antiretroviral Clinic of the University of Abuja Teaching Hospital, Nigeria

In pursuance of the Global and National Goals of achieving HIV-AIDS epidemic control, it’s imperative to explore the Promotion of self-care management among people living with HIV/AIDS. Self-care management involves adhering to treatment regimens, good dietary patterns, increased physical exercise, social support, and health-seeking behaviours. The study reviewed five core pillars of self-care management: physical, psychological, emotional, spiritual, and workplace/professional. A cross-sectional descriptive, analytical study with a quantitative approach was conducted at the Antiretroviral Clinic of the University of Abuja Teaching Hospital from October to December 2020. Using random sampling, 372 people living with AIDS participated in the study. Trained research assistants collected data through a structured questionnaire administered at the antiretroviral clinic. The data was analysed using SPSS version 25.0, employing frequencies, computations, percentages, averages, means, standard deviation, and correlations, with a confidence interval of 95%. The study’s findings indicate that the weighted matrix scores (WMS) for various aspects of self-care were significantly above average, suggesting that PLHIV attending the antiretroviral clinic at the University of Abuja Teaching Hospital exhibit good self-care practices. However, psychological and workplace self-care requires some strengthening. The study revealed differences between self-reported appointment adherence and the calculated average appointment gap (3 visits). Associations were found between the average appointment gap and viral load among participants. The study did not establish any significant association between Total Matrixed self-care scores, adherence (appointment gap), or viral load suppression. The COVID epidemic and the nationwide ENDSARS protest in Nigeria during the study period were significant confounders and limitations. Keywords: Antiretroviral drugs, appointment adherence, HIV/AIDS, psychological health, self-care management.

Dental Appointment Adherence Patterns in the College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences: Insights From Electronic Dental Records.

Background The purpose of this study was to determine the pattern of dental appointment adherence in the College of Dentistry (COD), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS). Methodology The electronic dental record SALUD (Two-Ten Health, Dublin, Ireland;n = 15,193) was used in this cross-sectional study.The primary outcome measure was adherence to dental appointments, categorized as attended, canceled by the patient, canceled by the school, or missed.Other variables of interest were demographic and appointment-related factors. Descriptive statistics were used to describe patterns of dental appointments.In addition, the proportion of check-in time for dental appointments among those who attended was calculated.For requested dental appointments among dental specialties, we calculated the percentage of booked, canceled, and rejected appointment requests for each specialty and compared the proportions across specialties. Results The proportion of attended dental appointments was 70.92% (10,775), with 9.14% (1,388) of appointments being missed and 16.70% (2,537) being canceled.Approximately 54% (5,765) of dental appointments were checked in on time.Approximately 77% (10,115) of dental appointment requests were scheduled. Pedodontics and orthodontics had the most scheduled appointments, while restorative dentistry had the most appointment requests. Conclusions The utilization of data from electronic dental records revealed a low rate of missed dental appointments. Identifying those who were late or skipped appointments was critical to determining the possible causes.

Factors Associated with No-Show Rates in a Pediatric Audiology Clinic.

To evaluate factors associated with no-show rates in a pediatric audiology clinic. Retrospective review. Tertiary referral center. All pediatric patients younger than 18 years whose parents/guardians scheduled an appointment at a tertiary Audiology Clinic between June 1, 2015, and July 1, 2017. Data included whether the patient came to their appointment, patient age, sex, race, insurance type, appointment type, location, season of appointment, and day of the week of the appointment. Of the 7,784 pediatric appointments scheduled with audiology, the overall no-show rate was 24.3% (n = 1893). Lower age was significantly associated with no-shows ( p = 0.0003). Black/African American children were more likely to no-show compared with White/Caucasians ( p = 0.0001). Compared with self-pay/military/other insurance, those with Medicaid were more likely to no-show ( p = 0.0001). The highest rate of no-shows occurred during summer (27%). On multivariate analysis, younger age, Black/African American race, and Medicaid insurance were associated with increased no-show rates. A variety of factors influence no-show rates in a pediatric audiology setting. No-shows can affect treatment quality and affect overall hearing outcomes. Further investigation is necessary to assess barriers to appointment adherence and to develop interventions to improve adherence and care.

Identifying Risk Factors for Appointment No-Shows in a Pediatric Orthopaedic Surgery Clinic

Background: Appointment nonadherence in pediatric orthopaedic clinics negatively affects patient outcomes. While previous studies have examined risk factors for missed appointments, there is a lack of such research in pediatric orthopaedics. This study tests the hypothesis that pediatric orthopaedic patients with greater socioeconomic risk are more likely to miss appointments. Our objective is to identify risk factors contributing to missed appointments.Methods: A retrospective chart review was conducted of all visits in an outpatient pediatric orthopaedic clinic and affiliated Midwest level 1 academic hospital in 2019. Possible covariates with appointment attendance collected included sociodemographic information such as age, gender (male/female), race/ethnicity (non-Hispanic White, Black, Hispanic/Latinx, Other), and insurance (Commercial, Medicaid, Medicaid HMO, Other). The main study outcome was appointment status, defined as either “No-Show” or “Attended/Completed.” Using census data, the Area Deprivation Index (ADI) was determined for a matched case (“No-Show”) control sample to quantify socioeconomic risk. Factors associated with appointment nonadherence were analyzed with a logistic regression model.Results: Out of 10,078 total encounters included in the study, there was a no-show rate of 6.61%. Significant predictors of no-show included race (p<0.001), insurance type (p<0.001), and lag days between appointment scheduling and completion (p<0.001). In a matched case-control sub-study, ADI was positively associated with increased odds of no-show (p<0.001), making this model unique from other studies.Conclusions: This data informs pediatric orthopaedic providers of risk factors for appointment nonadherence in order to individualize patient care plans based on specific socioeconomic needs. Efforts to improve appointment adherence may reduce the rate of poor health outcomes and health disparities in underserved areas. Next steps include qualitative assessments to articulate the experience of families who miss appointments to develop a greater standard for more accessible patient-centered care.Level of Evidence: Retrospective chart review (Level III) Key Concepts•There appears to be a link between pediatric orthopaedic appointment adherence and socioeconomic factors.•The Area Deprivation Index is a useful tool to quantify socioeconomic risk in the clinical setting.•Further research is needed to understand the specific reasons patients miss appointments.

Service Utilization for Parent Management of Early Childhood Behavior Problems in a Private Outpatient Behavioral Clinic: The Impact of Out-of-Pocket Cost, Travel Distance, and Initial Treatment Progress.

Poorly-managed early childhood disruptive behavior disorders (DBDs) have costly psychological and societal burdens. While parent management training (PMT) is recommended to effectively manage DBDs, appointment adherence is poor. Past studies on influential factors of PMT appointment adherence focused on parental factors. Less well studied are social drivers relative to early treatment gains. This study investigated how financial and time cost relative to early gains influence PMT appointment adherence for early childhood DBDs in a clinic of a large behavioral health pediatric hospital from 2016 to 2018. Using information obtained from the clinic's data repository, claims records, public census and geospatial data, we assessed how owed unpaid charges, travel distance from home to clinic, and initial behavioral progress influences total and consistent attendance of appointments for commercially- and publicly-insured (Medicaid and Tricare) patients, controlling for demographic, service, and clinical differences. We further assessed how social deprivation interacted with unpaid charges to influence appointment adherence for commercially-insured patients. Commercially-insured patients had poorer appointment adherence with longer travel distances, or having unpaid charges and greater social deprivation; they also attended fewer total appointments with faster behavioral progress. Comparatively, publicly-insured patients were not affected by travel distance and had higher consistent attendance with faster behavioral progress. Longer travel distance and difficulty paying service costs while living in greater social deprivation are barriers to care for commercially-insured patients. Targeted intervention may be needed for this specific subgroup to attend and stay engaged in treatment.

PA06 Impact of clinical pharmacist-led isotretinoin management and acne care education at a multispecialty clinic

Abstract Isotretinoin, an oral retinoid derived from vitamin A, is one of the most effective medications in the treatment of severe acne vulgaris. However, it carries serious risks due to the teratogenic nature of the drug. The iPledge national programme in the USA has been founded to reduce and prevent adverse isotretinoin reactions and complications by ensuring its safe use by patients. Owing to the strict monitoring parameters of isotretinoin, an increased workload is placed on prescribing physicians for accurate and timely iPledge authorization, comprehensive counselling, laboratory testing and many patient follow-up visits. The most commonly reported reasons for delay were iPledge-related, including issues navigating the iPledge website, missed pick-up windows, and missed or delayed doctor appointments or laboratory tests. To remedy the difficulties with isotretinoin monitoring, physicians can look to clinical pharmacists as a valuable asset to their practice. Because clinical pharmacists are well trained in isotretinoin dispensing and iPledge regulation and consultation, they can play a crucial role in the management and education of patients with severe acne vulgaris. This retrospective, longitudinal case study takes place at a multispeciality clinic with internal medicine, rheumatology and dermatology. At this multispecialty clinic, a clinical pharmacist will be integrated into the practice with complete patient appointments and isotretinoin follow-ups under the training and direction of a dermatological specialist. The initial evaluation, diagnosis and prescribing of isotretinoin will be completed by the physician. The clinical pharmacist will follow-up the patients in subsequent visits in conjunction with the physician. The study population is approximately 50 patients with existing diagnoses of severe acne vulgaris. The inclusion criteria will include patients with acne who complete a clinical pharmacist visit for isotretinoin acne treatment from September 2022 to March 2023. At each follow-up clinical pharmacist visit, patients receive management and counselling on medications, a review of laboratory values, iPledge verification, and monitoring of symptoms and quality of life. Primary outcomes are patient symptoms and quality of life, acne grade and severity and side-effects; secondary outcomes are navigation of the iPledge website, number of misses in pick-up windows and doctor appointment adherence. The preliminary results showed significant improvement in primary and secondary outcomes. Patient acne grade decreased, while satisfaction increased; there was also a decreased risk of missed pick-up windows and improved doctor appointment adherence compared with the national standard. In addition, a clinical pharmacist-led iPledge programme can substantially reduce the time required for administrative work on managing isotretinoin while maintaining the same quality of care for patients with severe acne.

Expanding veteran treatment access points through Close To Me (CTM) infusion service.

1519 Background: Diagnosing and treating more than 43,000 Veterans annually, the Veterans Affairs (VA) National Oncology Program (NOP) oversees the largest integrated providers of hematology/oncology services in the US. Within the VA, parenteral therapies are primarily offered at VA Medical Centers (VAMC) in urban areas, often inaccessible to rural patients. Travel distance, parking, time, and caregiver support can prevent patients from adhering to treatment regimens. To resolve these challenges, NOP launched the Close to Me (CTM) infusion service. The service seeks to reduce travel time for patients, improve VA care continuity, and increase access points to patient-centric care by administering treatments utilizing the network of VA Community Based Outpatient Clinics (CBOC). Methods: In the CTM CBOC infusion service select medications are compounded at the main VAMC, then transported via a registered nurse to the surrounding CBOCs for administration. Eligible patients must be established with a VA hematologist/oncologist and tolerated 1 cycle of treatment at the VAMC. Patients are assessed via telehealth prior to each treatment at the CBOC. Patient drive miles saved was calculated by subtracting the mileage between the patient’s home address and the CBOC from the patient’s home address and the VAMC, then multiplied by number of treatment visits at the CBOC. Medication cost avoidance was calculated by subtracting the VA purchase price from the 2023 published Centers for Medicare and Medicaid Services reimbursement rates, then multiplied by number of treatments received at the CBOC. The first CTM CBOC clinics were opened within the Minneapolis VA Health Care System in October 2021, followed by the VA Pittsburgh Healthcare System in June 2022. Results: From October 2021 through December 2022, 373 unique patients were treated within CTM CBOC clinics for a total of 532 patient visits. The CTM infusion service resulted in 43,249 patient drive miles saved and 813,352 in medication cost avoidance. No medical emergencies were reported during CTM CBOC treatments. One medication was discarded without use due to damage during shipping. One compounded product was not used due to change in patient status. One patient was non-adherent with treatment appointments on two occasions resulting in an overall 99.6 % treatment adherence. Conclusions: The CTM infusion service optimizes current VA infrastructure to increase access points to hematology/oncology treatment, reduce travel burden for patients, increase treatment appointment adherence and reduce medication cost expenditures. To facilitate expansion of this successful service, NOP has provided funding and support to 11 additional VAMCs to implement one of the CTM solutions including CBOC, mobile infusion unit or home infusion. A comprehensive implementation toolkit was developed to encourage the independent adoption of this service at appropriate locations across VA.

A community health worker and mobile health app intervention to improve adherence to HIV medication among persons with HIV: the CHAMPS study protocol

BackgroundPersons with HIV (PWH) can now achieve a near-normal life expectancy due to antiretroviral therapy (ART). Despite widespread availability of ART in the United States (US), many of the country’s approximate 1.1 million PWH are not achieving viral suppression due to poor ART adherence. Viral suppression rates are particularly low in Alabama (AL, 62%) and New York City (NYC, 67%). There is mixed evidence on the efficacy of community health workers (CHW) and mHealth interventions for improving ART adherence and viral suppression in PWH thus, we sought to combine these interventions and test the efficacy for improving health outcomes in PWH.MethodsThe CHAMPS study is a two-arm randomized controlled trial among 300 PWH with suboptimal primary care appointment adherence (n = 150 in AL and 150 in NYC) over the course of 12 months. Participants are randomly assigned to CHAMPS (intervention) or a standard-of-care (control) arm. Participants in the intervention arm are given a CleverCap pill bottle that syncs to the WiseApp to track medication adherence, reminds users to take their medication at a set time, and enables communication with CHW. All participants complete baseline, 6-month, and 12-month follow-up visits where surveys are administered and, CD4 and HIV-1 viral load are obtained through blood draw.DiscussionMaintaining ART adherence has significant implications in HIV management and transmission. mHealth technologies have been shown to optimize the provision of health services, produce positive changes in health behavior, and significantly improve health outcomes. CHW interventions also provide personal support to PWH. The combination of these strategies may provide the necessary intensity to increase ART adherence and clinic attendance among PWH at highest risk for low engagement. Delivering care remotely enables CHW to contact, assess, and support numerous participants throughout the day, reducing burden on CHW and potentially improving intervention durability for PWH. The adoption of the WiseApp coupled with community health worker sessions in the CHAMPS study has the potential to improve HIV health outcomes, and will add to the growing knowledge of mHealth and CHW efforts to improve PWH medication adherence and viral suppression.Trial registrationThis trial was registered with Clinicaltrials.gov (NCT04562649) on 9/24/20.

Describing Engagement in the HIV Care Cascade: A Methodological Study.

Engagement in the HIV care cascade is required for people living with HIV (PLWH) to achieve an undetectable viral load. However, varying definitions of engagement exist, contributing to heterogeneity in research regarding how many individuals are actively participating and benefitting from care. A standardized definition is needed to enhance comparability and pooling of data from engagement studies. The objective of this paper was to describe the various definitions for engagement used in HIV clinical trials. Articles were retrieved from CASCADE, a database of 298 clinical trials conducted to improve the HIV care cascade (https://hivcarecascade.com/), curated by income level, vulnerable population, who delivered the intervention, the setting in which it was delivered, the intervention type, and the level of pragmatism of the intervention. Studies with engagement listed as an outcome were selected from this database. 13 studies were eligible, of which five did not provide an explicit definition for engagement. The remaining studies used one or more of the following: appointment adherence (n=6), laboratory testing (n=2), adherence to antiretroviral therapy (n=2), time specification (n=5), intervention adherence (n=5), and quality of interaction (n=1). This paper highlights the existing diversity in definitions for engagement in the HIV care cascade and categorize these definitions into appointment adherence, laboratory testing, adherence to antiretroviral therapy, time specification, intervention adherence, and quality of interaction. We recommend consensus on how to describe and measure engagement.

Physician-Pharmacist Collaborative Drug Therapy Management in Pediatric Hypertension.

Pediatric hypertension affects 2% to 5% of children and adolescents in the United States and is frequently undertreated. The increasing prevalence of pediatric hypertension and worsening physician shortage create difficulties in closing this treatment gap. Physician-pharmacist collaborations have been shown to improve patient outcomes in adult patients. Our aim was to demonstrate a similar benefit for pediatric hypertension. Pediatric patients whose hypertension was managed at a single pediatric cardiology clinic from January 2020 to December 2021 were enrolled in collaborative drug therapy management (CDTM). Patients whose hypertension was managed in the same clinic from January 2018 to December 2019 were used as a comparison group. The primary outcomes were achievement of at-goal blood pressure at 3, 6, and 12 months and time to control of hypertension. Secondary outcomes were appointment adherence and serious adverse events. A total of 151 patients were included in the CDTM group, and 115 patients were included in the traditional care group. Of those, 100 CDTM patients and 78 traditional care patients were assessed for the primary outcome. Fifty-four (54%) CDTM patients and 28 (36%) traditional care patients achieved at-goal blood pressure at 12 months (OR, 2.09; 95% CI, 1.14-3.85). Appointment non-adherence was 9.4% for CDTM and 16% for traditional care (OR, 0.54; 95% CI, 0.35-0.82). Adverse events were similar between groups. CDTM increased rates of at-goal blood pressure without increased adverse events. Physician-pharmacist collaboration may improve treatment of hypertension in pediatric patients.

Inclement Weather and Risk of Missing Scheduled Hemodialysis Appointments among Patients with Kidney Failure.

Nonadherence to hemodialysis appointments could potentially result in health complications that can influence morbidity and mortality. We examined the association between different types of inclement weather and hemodialysis appointment adherence. We analyzed health records of 60,135 patients with kidney failure who received in-center hemodialysis treatment at Fresenius Kidney Care clinics across the Northeastern US counties during 2001-2019. County-level daily meteorological data on rainfall, hurricane and tropical storm events, snowfall, snow depth, and wind speed were extracted using National Oceanic and Atmosphere Agency data sources. A time-stratified case-crossover study design with conditional Poisson regression was used to estimate the effect of inclement weather exposures within the Northeastern US region. We applied a distributed lag nonlinear model framework to evaluate the delayed effect of inclement weather for up to 1 week. We observed positive associations between inclement weather and missed appointment (rainfall, hurricane and tropical storm, snowfall, snow depth, and wind advisory) when compared with noninclement weather days. The risk of missed appointments was most pronounced during the day of inclement weather (lag 0) for rainfall (incidence rate ratio [RR], 1.03 per 10-mm rainfall; 95% confidence interval [CI], 1.02 to 1.03) and snowfall (RR, 1.02; 95% CI, 1.01 to 1.02). Over 7 days (lag 0-6), hurricane and tropical storm exposures were associated with a 55% higher risk of missed appointments (RR, 1.55; 95% CI, 1.22 to 1.98). Similarly, 7-day cumulative exposure to sustained wind advisories was associated with 29% higher risk (RR, 1.29; 95% CI, 1.25 to 1.31), while wind gusts advisories showed a 34% higher risk (RR, 1.34; 95% CI, 1.29 to 1.39) of missed appointment. Inclement weather was associated with higher risk of missed hemodialysis appointments within the Northeastern United States. Furthermore, the association between inclement weather and missed hemodialysis appointments persisted for several days, depending on the inclement weather type.

Mobile phone aided reminder to promote childhood vaccination: a bibliometric analysis

Background: Vaccines have been demonstrated to reduce the incidence of disease. With global and regional guidance, the World Health Organization provides information and assistance to immunization programs worldwide. Despite all of the efforts, some countries’ vaccination rates remain low. When reminder and recall strategies are employed, vaccination rates in youngsters have been proven to improve. Only a few studies have looked into the effect of reminders sent through mobile phones on vaccine uptake. Objectives and methods: This study aims to evaluate how successful mobile phone-assisted reminders are at improving vaccination uptake rates. For this research, Pub Med, Scopus, Science Direct, and Google Scholar were used to look for papers published in the previous ten years that looked at the effectiveness of mobile phone vaccine reminders for children. These databases’ papers were chosen, extracted, and assessed using the inclusion and exclusion criteria. Out of a total of 1016 articles, ten were chosen for review. Results: According to the chosen articles, the majority of the study involved randomized control trials in both rural and urban settings spanning Africa, Asia, America, and Australia. Most of the research used text message/SMS interventions rather than voice call or phone call treatments. The outcome was determined by appointment adherence, vaccine coverage, and regular immunization completion. Regardless of the type of intervention utilized, the study group had higher vaccination coverage and completion rates than the control groups. In terms of vaccine timeliness, the research groups demonstrated an improvement. Extra incentives, manual calendars, and training have all been shown to be more successful. Providing extra incentives, manual calendars, or training is a more successful means of improving outcomes. Conclusion: Immunization coverage, schedule compliance, and vaccine uptake timeliness have all been proven to improve using mobile phone-assisted reminders in the form of text messages, voice messages, or phone calls. When used in conjunction with incentives, calendars, and training, these reminders help to increase success rates.

Improving Adolescent Violent Trauma Outcomes With a Hospital-Based Violence Prevention Initiative.

Violent trauma results in significant morbidity/mortality in Black/Hispanic males aged 15 to 24 years. Hospital- and community-level interventions may improve patient and community outcomes. To determine if a hospital-based violence prevention intervention using community outreach workers was associated with improved violent trauma patient postdischarge follow-up and reinjury rates. This is a retrospective, single-center, cohort study of admitted violent trauma patients to a public hospital in the Bronx, NY. Data were collected from a convenience sample of patients aged 15 to 24 years admitted with International Classification of Diseases, 10th Revision, codes for gunshot wound, stab wound, or physical assault from August 2014 to April 2018. The exposure variable was documentation of intervention team evaluation during admission. The outcome variables included attending >50% scheduled postdischarge follow-up visits, and subsequent violent reinjury (gunshot wound, stab wound, blunt assault) during the study time period. Multivariable regression models were used to determine the association between the exposure and outcome variables. A total of 535 patients were evaluated and were primarily male (92.5%), Black (54%)/Latino (36.4%), with mean age of 19.1 years. Patients in the exposure group had increased odds of attending >50% of scheduled clinic postdischarge follow-up visits (odds ratio, 2.29; 95% confidence interval 1.59-3.29) and decreased odds of subsequent violent reinjury presentation (odds ratio, 0.41; 95% confidence interval 0.22-0.75) 3 months after hospital discharge. A hospital-based violence prevention intervention may be associated with decreased odds of violent reinjury and increased odds of postdischarge scheduled appointment adherence in admitted pediatric violent trauma patients.

Improving adherence and health outcomes in testicular cancer survivors using a mobile health-based intervention: A mixed-methods pilot study.

Testicular cancer (TC) is one of the most common cancers among young men, with survival rates exceeding 97% due to effective treatments. Post-treatment follow-up care is important for long-term survival and monitoring psychosocial symptoms, yet TC survivors (TCS) show poor adherence to post-treatment care. Mobile-health-based interventions show high acceptability in men with cancer. This study will examine the feasibility of using the Zamplo health app to improve adherence to post-treatment care and support psychosocial outcomes in TCS. This mixed-methods, longitudinal, single-arm pilot study will recruit N = 30 patients with a diagnosis of TC who finished treatment within ≤ 6 months and are currently aged ≥18 years old. Adherence to follow-up appointments (e.g. blood work, scans) will be assessed (primary outcome), and measures for fatigue, depression, anxiety, sexual satisfaction and function, social roles satisfaction, general mental and physical health and body image (secondary outcomes) will be completed at four-time points: baseline, 3, 6 and 12 months. One-on-one semi-structured interviews will be conducted post-intervention (month 12). Improvements in post-treatment follow-up appointment adherence and psychosocial outcomes will be analyzed using descriptive statistics, paired samples t-tests to determine changes across time points 1 through 4, and correlation analysis. Qualitative data will be analyzed using thematic analysis. Findings will inform future, larger trials that incorporate evaluation of sustainability and economic implications to improve adherence to TC follow-up guidelines. Findings will be disseminated via infographics, social media, publications and presentations conducted in partnership with TC support organizations and at conferences.

Patient-Centered Outcomes of an Emergency Department Social and Medical Resource Intervention.

Few studies have examined the impact of emergency department (ED) social interventions on patient outcomes and revisits, especially in underserved populations. Our objective in this study was to characterize a volunteer initiative that provided community medical and social resources at ED discharge and its effect on ED revisit rates and adherence to follow-up appointments at a large, county hospital ED. We performed a cross-sectional analysis of ED patients who received medical and social resources and an educational intervention at discharge between September 2017-June 2018. Demographic information, the number of ED return visits, and outpatient follow-up appointment adherence within 30 and 90 days of ED discharge were obtained from electronic health records. We obtained data regarding patient utilization of resources via telephone follow-up communication. We used logistic regression analyses to evaluate associations between patient characteristics, reported resource utilization, and revisit outcomes. Most patients (55.3% of 494 participants) identified as Latino/Hispanic, and 49.4% received healthcare assistance through a local governmental program. A majority of patients (83.6%) received at least one medical or social resource, with most requesting more than one. Patients provided with a medical or social resource were associated with a higher 90-day follow-up appointment adherence (odds ratio [OR] 2.56; 95% confidence interval [CI] 1.05-6.25, and OR 4.75; 95% CI 1.49-15.20], respectively), and the provision of both resources was associated with lower odds of ED revisit within 30 days (OR 0.50; 95% CI 0.27-0.95). Males and those enrolled in the healthcare assistance program had higher odds of ED revisits, while Hispanic/Latino and Spanish-speaking patients had lower odds of revisits. An ED discharge intervention providing medical and social resources may be associated with improved follow-up adherence and reduced ED revisit rates in underserved populations.

Predicting psychosocial risk in pediatric kidney transplantation: An exploratory cluster analysis of a revised Pediatric Transplant Rating Instrument

The Pediatric Transplant Rating Instrument (P-TRI) is a 17-item scale developed to assess psychosocial risk factors for poor outcomes after solid organ transplantation. Research has identified the limitations of the original instrument and proposed revisions to improve clinical utility. This project examined patterns of risk in children being evaluated for kidney transplant using a revised P-TRI. A multidisciplinary kidney transplant team revised the P-TRI. A social worker and a psychologist collaboratively completed the modified instrument for 37 children after the psychosocial pretransplant evaluation. Electronic medical records were reviewed for transplant status (transplanted, active waitlist, inactive) 1 year later. Exploratory cluster analyses and chi-square tests examined patterns of risk and correlates with cluster membership. Three clusters were identified. The high-risk group (29.7%) had difficulties with medication and appointment adherence, strained relationships with the medical team, and the presence of parent psychiatric history. The medium-risk group (35.1%) had difficulties with parent knowledge, financial strain, and risk factors for medication nonadherence. The low-risk group (35.1%) demonstrated no difficulties with adherence or financial strain. Clusters were prospectively associated with transplant status, such that those in the high-risk group were less likely to be transplanted within 1 year post-evaluation. The revised P-TRI demonstrated good construct validity as risk level appeared to be associated with transplant listing status 1 year post-evaluation. These results suggest that standardized pretransplant psychosocial risk assessment tools may have value in optimizing transplant access if they can be paired with targeted, multidisciplinary interventions to address concerns early in the transplant process.

A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study.

Advances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today. The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages). We conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively. The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study. Although perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life. ClinicalTrials.gov NCT03758066; https://clinicaltrials.gov/ct2/show/NCT03758066.

Factors Affecting Adherence With Follow-up Appointments in HIV Patients.

Currently, the majority of new human immunodeficiency virus (HIV) infections are transmitted by individuals with untreated HIV. In this retrospective study, we examined associations between demographic factors, viral suppression, acquired immunodeficiency syndrome (AIDS) status (CD4 count <200), and adherence to clinical follow-up in individuals living with HIV. Of the 489 patients, 135 (27.6%) were females, 235 (48.1%) were over 50 years old, 191 (39.1%) had Medicaid, Medicare, or Ryan White Insurance, 25 (5.1%) had CD4 counts below 200, and 207 (42.3%) were adherent to their clinic appointments. In univariable logistic regression analysis, age and viral load detectability were significantly associated with patient adherence to their clinic appointment. In multivariable analysis, only age remained significantly associated with clinic appointment adherence (Odds Ratio=2.1; 95% Confidence Interval=1.4, 3.1; P<0.001). Patients 50 years old or younger were half as likely to be adherent to their clinic appointments than patients over 50 years old. Gender and insurance status were not associated with viral suppression or AIDS status. The results illustrate the need for increased age-specific outreach to improve clinical adherence in younger individuals.