Appointment Attendance Research Articles

Evaluation of a community based dental clinic for youth experiencing homelessness in Brisbane.

The relationship between homelessness and ill health is complex, and many risk factors for homelessness such as unemployment, low income, and substance abuse are also risk factors for poor oral health. In order to overcome barriers to access dental care, previous studies have recommended integrating dental care, referral pathways, and information within the overall care provided by support services available to people at risk of homelessness. This study aimed to evaluate a dental service developed and implemented to improve access to oral health care of disadvantaged youth in Brisbane. A mobile dental clinic run by volunteer dental professionals was implemented into a community organisation for disadvantaged youth. Participants were clients of Brisbane Youth Services who were disadvantaged youth, ≤25years and attended the dental clinic in a 1year period. A questionnaire collected demographic information, a self-assessment of oral health and an evaluation of their experiences with the dental clinic. Clinical data including DMFT, appointment attendance and items of service provided were collected. One hundred and twelve clients participated in the four dental clinic weeks and its evaluation. Cost was the greatest reported barrier to accessing dental care among participants. More than half (57%) of participants who pre-booked an appointment failed to attend. A total of 640 services were delivered, with an estimated value of $48,000. The majority (69%, n=444) of the services provided were preventative services. Almost all of the clients felt the service they received was suitable for them (97%, n=98) and would use the service again (98%, n=99). This dental clinic model is feasible and sustainable due to its integration into an existing homeless youth service, low running costs, acceptability to clients and an interest by dental practitioners to volunteer. It provides a useful model which could be scaled up and implemented in other regions.

Reasons for non-attendance nutrition appointment among medically underserved community in Rural Mississippi

Objective: This study sought to examine the reasons for nonattendance of nutrition appointments and explore the determinants that contribute to this phenomenon among medically underserved and uninsured individuals.Methods: A cross-sectional quantitative study was conducted with five sections questionnaires distributed at a healthcare clinic in a rural area in south Mississippi. Participants (n=346) were surveyed who had attended the clinic for a health appointment. Nutrition appointment attendance, reasons to miss a scheduled nutrition appointment, and effective appointment reminders were evaluated. Descriptive statistics were determined for the variables, Chi square and bivariate correlation tests were used to determine relationships between participants’ demographics, health conditions, and other variables.Results: About 87% of participants indicated that they had not attended a nutrition appointment and 26.8% indicated that they had missed a nutrition appointment. Most participants specified that forgetfulness (39%) and transportation problems (25%) were the most likely reasons to miss a nutrition appointment. Most indicated that a phone call would be the most effective appointment reminder. About half of participants believed the reason behind missing a nutrition appointment is that their physicians did not place importance on attending such appointment. No significant association or differences were found between the variables.Conclusion: Findings can be used to improve access to nutrition counseling among underserved patients, and to develop effective appointment reminders to decrease nonattendance rates. Future research is warranted to analyze the effect that nutrition appointments has on individual’s health.

Mental imagery in dentistry: Phenomenology and role in dental anxiety

Dental anxiety is a prevalent problem with marked psychological, physical and public health implications. Based on cognitive theory and evidence, we hypothesized that vivid, sensory image-based cognitions play a role in dental anxiety. A quantitative online survey (N = 306) and qualitative semi-structured interviews (N = 18) found that vivid sensory images were common irrespective of dental anxiety levels, but that their content, associated distress and responses varied. Participants reporting higher anxiety experienced intense and intrusive fear-provoking dental imagery focusing on unpleasant sensations, which were associated with the intrusive recollection of negative past experiences and avoidance of dentistry. Participants with lower anxiety ratings, reported images that were less distressing and centered around reassuring aspects and positive appointment outcomes, potentially acting as protective factors against dental anxiety and facilitating appointment attendance. The inclusion of components aimed at reducing intrusive memories and dental imagery rescripting may help improve interventions for dental anxiety.

Multi-level Determinants of Clinic Attendance and Antiretroviral Treatment Adherence Among Fishermen Living with HIV/AIDS in Communities onLake Victoria, Uganda.

This cross-sectional study assessed determinants of HIV clinic appointment attendance and antiretroviral treatment (ART) adherence among 300 male fisherfolk on ART in Wakiso District, Uganda. Multi-level factors associated with missed HIV clinic visits included those at the individual (age, AOR = 0.98, 95% CI 0.97-0.99), interpersonal (being single/separated from partner, AOR: 1.25, 95% CI 1.01-1.54), normative (anticipated HIV stigma, AOR: 1.55, 95% CI 1.05-2.29) and physical/built environment-level (travel time to the HIV clinic, AOR: 1.11, 95% CI 1.02-1.20; structural-barriers to ART adherence, AOR: 1.27, 95% CI 1.04-1.56; accessing care on a landing site vs. an island, AOR: 1.35, 95% CI 1.08-1.67). Factors associated with ART non-adherence included those at the individual (age, β: - 0.01, η2 = 0.03; monthly income, β: - 0.01, η2 = 0.02) and normative levels (anticipated HIV stigma, β: 0.10, η2 = 0.02; enacted HIV stigma, β: 0.11, η2 = 0.02). Differentiated models of HIV care that integrate stigma reduction and social support, and reduce the number of clinic visits needed, should be explored in this setting to reduce multi-level barriers to accessing HIV care and ART adherence.

How to Improve Clinical Outcome of Epileptic Seizure Control Based on Medication Adherence? A Literature Review.

Anti-Epileptic Drugs (AEDs) are the main therapy for epilepsy to prevent seizures. Non-adherence situation plays an important factor in the failure of seizure control. Such a condition may generate several impacts on clinical, social, and economic aspect. Several methods are used to measure adherence in epilepsy patients, including direct and indirect measurement. The direct measure involves measurement of drug levels in hair or body fluids such as blood and saliva. Whereas, indirect measure involves the non-biological tools, for example, a self-report measure, pill counts, appointment attendance, medication refills, and seizure frequency. Numerous factors may affect adherence in epilepsy patients, such as age, sex, and seizure aetiology, seizure sites, which are categorised as irreversible factors and hardly to be improved. However, there are factors that can be influenced to improve adherence such as patient knowledge, medication, cultural, health care professionals, and national health policies, which are related to treatment and education factor which is associated with behaviour to be likely adherence.

Prescribing Opioids as an Incentive to Retain Patients in Medical Care: A Qualitative Investigation into Clinician Awareness and Perceptions

HIV treatment retention remains a significant public health concern. Our qualitative analysis used emergent data from a larger HIV treatment study to explore clinician perspectives on prescribing opioids to incentivize retention in HIV care. Data from individual interviews with 29 HIV and substance use clinicians were analyzed using thematic analysis. Prescribing opioids as a retention strategy emerged as a theme. Nine of 11 HIV clinicians reported prior knowledge of this practice; only one of 12 substance use clinicians indicated prior knowledge. Positive perceptions included: harm reduction approach, increased appointment attendance, and sustained engagement in HIV care. Negative perceptions included: addiction potential, increased engagement not leading to better health outcomes, and prescriptions becoming the appointment focus. Some clinicians used prescriptions as a strategy to improve treatment retention, which may be particularly problematic in light of the current opioid epidemic. Understanding motives, outcomes, and clinical decision-making processes is needed.

Self-Management in Liver Transplant Recipients: A Narrative Review.

Although self-management is essential for liver transplant recipients, there is no review that has synthesized findings related to self-management in this population. This narrative review aimed to synthesize the current findings and identify the gaps in knowledge about self-management in liver recipients. A search of PubMed, CINAHL Plus, PsychINFO, ProQuest, and Web of Science was conducted using the following terms: [Self-care OR Self-management OR Health behavior] AND [Liver transplantation]. Peer-reviewed published research articles focusing on self-management of adult recipients were selected. A total of 23 articles were included for review. Two reviewers independently reviewed the full text of selected articles and extracted the data about definitions, measurements, and findings regarding self-management. Three areas of self-management were identified, including medication nonadherence (n = 11), alcohol recidivism (n = 11), and health maintenance (n = 5). Reported rates of medication nonadherence ranged from 8% to 66%. Medication nonadherence was related to recipients' demographic (eg, age or sex), transplant-related (eg, time since transplant), and pretransplant variables (eg, history of substance/alcohol abuse). Reported alcohol recidivism rates ranged from 3% to 95%. Age, pretransplant variables (eg, abstinent time before transplant), and personality disorder were identified to be related to alcohol recidivism after transplant. The health maintenance studies discussed behaviors such as smoking, clinic appointment attendance, or vaccination/health screening behaviors of recipients. Self-management studies in liver recipients have been narrowly focused on medication nonadherence and alcohol recidivism. To improve self-management in recipients, self-management beyond medication nonadherence and alcohol recidivism should be comprehensively examined.

Association of Increased Chronicity of Depression With HIV Appointment Attendance, Treatment Failure, and Mortality Among HIV-Infected Adults in the United States

ImportanceDepression commonly affects adults with HIV and complicates the management of HIV. Depression among individuals with HIV tends to be chronic and cyclical, but the association of this chronicity with HIV outcomes (and the related potential for screening and intervention to shorten depressive episodes) has received little attention.ObjectiveTo examine the association between increased chronicity of depression and multiple HIV care continuum indicators (HIV appointment attendance, treatment failure, and mortality).Design, Setting, and ParticipantsThe study comprised an observational clinical cohort of 5927 patients with 2 or more assessments of depressive severity who were receiving HIV primary care at 6 geographically dispersed US academic medical centers from September 22, 2005, to August 6, 2015.Main Outcomes and MeasuresMissing a scheduled HIV primary care visit, detectable HIV RNA viral load (≥75 copies/mL), and all-cause mortality. Consecutive depressive severity measures were converted into a time-updated measure: percentage of days with depression (PDD), following established methods for determining depression-free days.ResultsDuring 10 767 person-years of follow-up, the 5927 participants (5000 men, 926 women, and 1 intersex individual; median age, 44 years [range, 35-50 years]) had a median PDD of 14% (interquartile range, 0%-48%). During follow-up, 10 361 of 55 040 scheduled visits (18.8%) were missed, 6191 of 28 455 viral loads (21.8%) were detectable, and the mortality rate was 1.5 deaths per 100 person-years. Percentage of days with depression showed a dose-response relationship with each outcome. Each 25% increase in PDD led to an 8% increase in the risk of missing a scheduled appointment (risk ratio, 1.08; 95% CI, 1.05-1.11), a 5% increase in the risk of a detectable viral load (risk ratio, 1.05; 95% CI, 1.01-1.09), and a 19% increase in the mortality hazard (hazard ratio, 1.19; 95% CI, 1.05-1.36). These estimates imply that, compared with patients who spent no follow-up time with depression (PDD, 0%), those who spent the entire follow-up time with depression (PDD, 100%) faced a 37% increased risk of missing appointments (risk ratio, 1.37; 95% CI, 1.22-1.53), a 23% increased risk of a detectable viral load (risk ratio, 1.23; 95% CI, 1.06-1.43), and a doubled mortality rate (hazard ratio, 2.02; 95% CI, 1.20-3.42).Conclusions and RelevanceGreater chronicity of depression increased the likelihood of failure at multiple points along the HIV care continuum. Even modest increases in the proportion of time spent with depression led to clinically meaningful increases in negative outcomes. Clinic-level trials of protocols to promptly identify and appropriately treat depression among adults living with HIV should be conducted to understand the effect of such protocols on shortening the course and preventing the recurrence of depressive illness and improving clinical outcomes.

Motivational Interviewing to Increase Outpatient Attendance for Adolescent Psychiatric Patients.

Motivational interviewing (MI) is a therapeutic technique that has been demonstrated to increase adherence to various treatment regimens. Nonattendance at outpatient appointments is associated with read-mission to psychiatric hospitals. The purpose of the current study was to examine the effectiveness of MI in promoting treatment adherence and increasing pediatric attendance rates at patients' first follow-up appointment after inpatient admission. A sample of 111 patients discharged from one of two child and adolescent units at an urban, inpatient psychiatric hospital in Southwestern Pennsylvania participated in the MI discharge process. Compared to hospital population data from 1 month prior to the current study, the MI discharge process demonstrated an increase of approximately 10% in attendance at the scheduled follow-up appointments and a decrease of approximately 4% in cancellations and no-show appointments. It was concluded that particularly for adolescents, MI may be a valuable treatment approach grounded in partnerships with health care providers, patients, and families to enhance outpatient appointment attendance. [Journal of Psychosocial Nursing and Mental Health Services, 56(6), 31-35.].

Extending access to care across the rural US south: Preliminary results from the Alabama eHealth programme

Purpose Using a mixed-methods formative evaluation, the purpose of this study was to provide a broad overview of the Alabama eHealth programme set-up and initial patient outcomes. The Alabama eHealth programme uses telemedicine to provide medical care to people living with HIV in rural Alabama. It was led by a community-based organisation, Medical Advocacy and Outreach (MAO), and supported by AIDS United and the Corporation for National Community Service’s Social Innovation Fund with matching support from non-federal donors. Methods We conducted and transcribed in-depth interviews with Alabama eHealth staff and then performed directed content analysis. We also tracked patients’ (n = 240) appointment attendance, CD4 counts, and viral loads. Findings Staff described the steps taken to establish the programme, associated challenges (e.g., costly, inadequate broadband in rural areas), and technology enabling this programme (electronic medical records, telemedicine equipment). Of all enrolled patients, 76% were retained in care, 88% had antiretroviral therapy and 75% had a suppressed viral load. Among patients without missing data, 96% were retained in care, 97% used antiretroviral therapy and 93% had suppressed viral loads. There were no statistically significant demographic differences between those with and without missing data. Conclusions Patients enrolled in a telemedicine programme evaluation successfully moved through the HIV continuum of care.

One-Way SMS and Healthcare Outcomes in Africa: Systematic Review of Randomised Trials with Meta-Analysis

Background: The impact of one-way SMS on health outcomes in Africa is unclear. We aimed to conduct a descriptive systematic review of one-way SMS randomised trials in Africa and a meta-analysis of their effect on healthcare appointments attendance and medicine adherence. Methods: PubMed, Embase, CENTRAL, The Global Health Library, ClinicalTrials.gov, ICTRP, and PACTR were searched for published and unpublished trials in Africa without language restriction (up to April 2018). Trials reporting effect estimates on healthcare appointment attendance and medicine adherence were assessed for risk of bias and included in meta-analyses using random-effects models. Other outcomes were reported descriptively. The protocol is registered in PROSPERO, ID:CRD42018081062. Findings: We included 38 one-way SMS trials conducted in Africa within a broad range of clinical conditions. There was no clear evidence of one-way SMS improving facility delivery, knowledge level (reproductive/antenatal health, hypertension), diabetes- and hypertension management. Eighteen trials were included in the meta-analyses, and four were assessed as overall low risk of bias. One-way SMS improved appointment attendance, OR:2·03; 95% CI:1·40-2·95 (12 trials, 6448 participants), but not medicine adherence, RR:1·10; 95% CI:0·98-1·23 (nine trials, 4213 participants). Subgroup analyses showed that one-way SMS had the highest impact on childhood immunization attendance, OR:3·69; 95% CI:1·67-8·13. Interpretation: In an African setting, the clinical effect of one-way SMS is uncertain except for appointment attendance where the effect seems to vary depending on which clinical setting it is used in. Funding: No external funding received. All authors were funded by institutional salaries. Declaration of Interest: AL, MK and JK have no conflicts of interest. DSL, VR, MSA are currently conducting a trial in Tanzania assessing the effect of one-way SMS on attendance to cervical cancer screening follow-up appointment attendance.

Effectiveness of text messages, calls and e-mail on adherence to medical appointments. Review of systematic reviews and meta-analysis

Background : Mobile phones and all other forms of modern communication such as the Internet and instant messaging applications have become tools to improve attendance rates for medical appointments. Objectives : To evaluate the effectiveness of reminders to improve adherence to medical appointments. Methods : An overview of studies comparing the effectiveness and attendance rates for medical appointments between patients that did and did not receive reminders. Also, a meta-analysis was conducted to estimate the overall effect of keeping appointments depending on the age of the patients. Results : Seven reviews were identified which show that Short Message Service (SMS) improves adherence to medical appointments. However, the meta-analysis showed a relative risk of 1,09 (CI 95%: 1,03 -1,11) for people with ages between 24 – 40 and 1,09 (CI 95% 1,05 – 1,14) for people with ages between 50 – 63, with regard to appointment assistance via SMS. Conclusions : The use of SMS reminders has a positive impact on medical appointment attendance. However, while reviewing the impact by age groups no differences were found. DOI: http://dx.doi.org/10.21615/cesmedicina.32.1.2

An Attempt to Stem the Tide: Exploring the Effect of a 90-Day Transitional Care Intervention on Readmissions to an Acute Male Psychiatric Unit in South Africa

IntroductionPressure on inpatient beds often results in premature discharges, which may precipitate early readmission. This has prompted an increased interest in transitional care interventions to bridge the gap between in- and outpatient care to reduce such readmissions. Our study aimed to assess the effect of a Transitional Care Service (TCS) on readmission rates in a high pressure inpatient service which utilizes a premature discharge policy to address bed pressures. MethodsSixty male patients identified for crisis discharge were offered a TCS for the first ninety days after discharge. Patients received a structured intervention consisting of four phone calls and one home visit, focusing on maintaining adherence, appointment reminders and psychoeducation. The TCS patients were retrospectively compared to a matched control group in terms of readmission after 90days. Data was collected on adherence to medication, attendance of appointments and incidence of substance use. ResultsThere was no significant difference in readmission rates. Prevalence of substance use was very high (90%), especially methamphetamine use (48%). Adherence dropped from 45% (n=27) at one week post-discharge to 25% (n=15) at 90days. ConclusionStructured telephone-based transitional interventions have no effect on readmission rates in this setting. Prematurely discharged patients require more comprehensive support with focus on comorbid substance use.

Message Framing and Engagement in Specialty Mental Health Care.

Engagement rates in specialty mental health care for depression are suboptimal. This study examined the extent to which framing-by gain, by loss, or neutral- of health messages promotes appointment attendance among patients referred to specialty mental health care. The study employed a randomized, prospective, experimental design. Patients meeting criteria for major depression and referred to specialty mental health care at the Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center were randomly assigned (N=360) to receive a patient reminder letter routinely mailed prior to scheduled specialty care appointments (neutral) or one of two messages (gain framed versus loss framed) that were added to the routine letter. Appointment and attendance data were extracted from the computerized system. Logistic regression was used to determine the association between message frame condition and initial appointment attendance. The sample (mean±SD age=51.5±13.5) was primarily male (85%) and nonwhite (62%), and the mean depressive symptom score indicated moderately severe depression. Participants who received the gain-framed message after being referred to specialty mental health care were significantly more likely to attend their appointment than those who received a neutral letter (p=.04). No statistically significant differences were noted among those receiving a loss-framed message compared with the other two arms. Findings suggest that highlighting the benefits of attending an initial specialty mental health care appointment, even if in writing, can affect engagement rates. If replicated, results have the potential to improve mental health treatment initiation rates in a timely, efficient, and cost-effective manner.

Clinic Appointment Attendance in Adults with Serious Mental Illness and Diabetes.

We assessed characteristics that may predict outpatient appointment attendance in outpatient medical clinics among patients comorbid for serious mental illness (SMI) and type 2 diabetes (DM). Baseline covariate data from 200 individuals with SMI-DM enrolled in a randomized controlled trial (RCT) were used to examine characteristics associated with electronic health record-identified clinic appointment attendance using a generalized estimating equations approach. The analyses evaluated the relationship between clinic attendance and potentially modifiable factors including disease knowledge, self-efficacy, social support, physical health, and mental health, as well as demographic information. Demographic and mental health characteristics were most associated with clinic attendance in adults with SMI-DM. Physical health was not associated with clinic attendance. Information on clinical and demographic characteristics and factors potentially modifiable by psychological interventions may be useful in improving adherence to treatment among SMI-DM patients. It is our hope that clinicians and researchers will use these results to help tailor adherence-facilitating interventions among people at particular risk for poor engagement in care.

Behavioural text message reminders to improve participation in breast screening: a randomised controlled trial

BackgroundBreast screening coverage in London, UK, consistently falls below the national average (69·3% vs 75·6% in 2016). West London has among the lowest coverage rates nationally. Text message reminders (SMS-R) can improve screening rates. Evidence shows that message content can further improve the impact of SMS-R on hospital appointment attendance. This randomised controlled trial aimed to test the effect of SMS-R message manipulations on breast screening participation. MethodsWomen aged 47–73 years in the West of London Breast Screening Service (WoLBSS) catchment area, who were due for screening between Aug 10, 2016, and Nov 2, 2016, and who had provided their mobile number to the service, were eligible. Two intervention messages were tested against the current SMS-R (appendix). A survey of 1000 women informed the content, which indicated that women who prioritised or planned to attend breast screening were more likely to attend. Participants were randomised to control, planning, and priority arms (1:1:1) by the SMS provider platform iPLATO using a Mersenne twister algorithm and sent two SMS-R before their appointment. Participants and the routine care team, but not researchers, were masked to allocation. The primary outcome was uptake of screening by trial arm. Analysis was by intention to treat. Ethics approval was obtained from IRAS (IRAS project ID 185492, REC reference 16/YH/0276). This trial is registered with ClinicalTrials.gov, number NCT02872363. Findings2696, 2614, and 2634 women were allocated to the control, planning, and priority arms, respectively (mean age 58·8 years, SD 6·09), with 854, 883, and 860 women analysed after exclusions for opt-outs, self-referrals, and SMS-R cross-contamination. Uptake was 82·8% (n=707), 84·4% (745), and 82·7% (711), respectively (χ2 [df 2]=1·131, p=0·568). No adverse events were observed. InterpretationAlthough no statistical difference between trial arms was noted, the target sample size (11 496) was not achieved because of a reconfiguration of services prematurely ending the trial. A large number of participants received different SMS-R messages or more than two SMS-R in total, probably because of appointment rescheduling, which re-entered women into the randomisation process. These participants were excluded. Owing to information governance regulations, women who provided their mobile number to their general practitioner but not directly to WoLBSS could not be sent an SMS-R. Consequently, the sample is likely to represent highly motivated women, reflected in the high participation rate. Therefore, first-time attenders and non-attenders may be disadvantaged by SMS-R interventions for breast screening. FundingNational Institute for Health Research Imperial Patient Safety Translational Research Centre and the Association of Breast Surgeons and Prevent Breast Cancer.

No-Show Rates When Phone Appointment Reminders Are Not Directly Delivered.

Promoting patient engagement in treatment and reducing frequency of missed appointments result in higher value through both improved outcomes and improved efficiency. For this reason, continuous quality improvement (CQI) efforts to increase engagement are important in service operations. This column illustrates the results of a CQI study to determine the impact of method of delivery of phone appointment reminders on attendance rates for a cohort of 250 primary care patients with depression. Results indicated that the type of reminder had a significant impact on attendance. Live reminders had the lowest no-show rate (3%), then message or voice mail reminders (24%) and no answer (39%). These findings illustrate the value of CQI efforts for even such basic interventions as appointment reminders. Appointment attendance rates were considerably higher when there was a live contact. CQI efforts related to reminders therefore may benefit from rapid change cycles that incorporate monitoring of the type of reminder delivery and that continuously seek better strategies for engagement.

Evaluation of mHealth Intervention in COPD: CareMessage

SESSION TITLE: Medical Education SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: The interactive mobile health information service was designed to supplement the standard of care by supporting patient-empowerment strategies through educating participants, encouraging behavior change, and promoting adherence. Through the delivery of the text-based messages to participants, the goal of the intervention is to improve their 1) appointment attendance, 2) medication adherence, and 3) disease self-management behaviors. METHODS: To conduct the CareMesssage trial a convenience sample of COPD patients assigned to the COPD Access To Community Health (CATCH) were recruited to participate voluntarily. Case Managers informed eligible, potential participants when they first presented to the CATCH Program, and provided them with an informational brochure. The CareMesssage group received and responded to messages, tips, appointment reminders, administrative notifications, and questionnaires. RESULTS: CATCH program has 273 participants on the platform, out of 1840 enrolled in the CATCH Program, with 4 health education programs in use resulting in 4,815 text messages: COPD: 236 participants, 85% retention rate, 20% response rate to questions.We do not know exactly why these participants have a low response rate; however, a number of factors could be at play - e.g., participants are reading the messages but do not have time to respond or feel like responding (our user interviews have shown this to be a common reason for low response rates). Across all CareMessage programs, the average response rate is 42%. Nutrition: 184 participants. Everyone who has completed the COPD program is automatically enrolled into the Nutrition program. 32% response rate. 88% retention rate . Essentially 12% of the participants opted out of the program Smoking Cessation: 21 participants - 20% response rate 72% retention rate Stress Management: 145 participants - everyone who was not currently enrolled in another program but was on the CareMessage platform was enrolled in Stress Management 55% response rate, 95% retention rate. Outreach and direct messaging utilization to help increase engagement and efficiency - over 45 reminders were sent about events, support groups, and appointments CONCLUSIONS: The percentage of health app users who abandon an app after one use is now 23%. But clearly, with about one in four users still only using an app once, not enough has been done to match what consumers want and restore apps to the success of just a few years ago. The targeted interventions in the specific disease state offered a sub menu of services in COPD education, Nutrition education, Smoking cessation, and stress management appears to result in high retention rate. CLINICAL IMPLICATIONS: This technology has been instrumental in maintaining patient engagement and keeping the communication flowing. Key messages are sent out on a weekly basis. CATCH technology is not limited to the occasional text message. Patients also receive e-mails and phone calls, however, the text messaging service has been most efficient. Although only one in eight patients elected to sign up for the program, this selection of motivated patients should guide the use of health related apps in other disease states as well. DISCLOSURE: The following authors have nothing to disclose: Chris Landon No Product/Research Disclosure Information

How is adult patient adherence recorded in orthodontists' clinical notes? A mixed-method case-note study.

BackgroundPatient adherence in orthodontic treatment is extremely important as it is linked with better treatment outcomes. Despite its importance, however, there is no shared definition of the concept. This makes the recording of adherence-related behaviors in patient notes difficult. The current study explored how, and to what extent adherence is recorded in adult patients’ medical records by orthodontists working in a large National Health Service (NHS) London hospital.Materials and methodsA mixed-methods approach was used. A total of 17 clinicians with a mean age of 31 years (SD =4.87) provided N=20 case notes spanning N=324 appointments with patients they judged to be non-adherent. The notes were inspected for evidence of recording of patient adherence using adherence indicators identified in the literature.ResultsThe term “adherence” did not feature in any notes. The quantitative analysis showed that the three most frequent adherence-related behaviors recorded in notes were “oral hygiene,” “appointment attendance” and “breakages of appliances.” Qualitative analysis not only confirmed these factors but also showed that 1) the clinical aspects of treatment, 2) clinician–patient interaction factors and 3) patient attitudes also featured. This part of the analysis also highlighted inconsistencies across case notes in terms of the amount of information being recorded.ConclusionAdherence as a term does not feature in the clinical case notes of clinician-identified non-adherent adult patients, while predictors of adherence are recorded with varying degrees of consistency.

How practices can facilitate access for the gypsy traveller community.

Gypsy travellers have poor health in comparison to the UK average. They may struggle to access emergency and routine dental care because of social, educational and cultural barriers. General dental practitioners can facilitate better oral health within the community by improving access, which may require some adaptation to conventional practice. This paper discusses the experiences of a practice within West Oxfordshire and highlights areas in which the authors have found small modifications to aid appointment attendance and patient motivation. Primary care dental practitioners come across a wide variety of patients from very diverse backgrounds. Following a year working in West Oxfordshire, one group of patients has particularly stood out - the travelling community. The term 'traveller' or 'gypsy' refers to 'persons who wander or travel for the purpose of making or seeking their livelihood (not persons who move from place to place without any connection between their movements and their means of livelihood)' and includes those who live permanently or temporarily in settled housing. There are many different socio-cultural groups within this broad definition, including Romany Gypsies, Irish Travellers, Scottish Travellers and Eastern European Roma Communities.