Appointment Availability Research Articles

Factors and Reasons Associated With Appointment Non-attendance in Hospitals: A Narrative Review.

Non-attendance at hospital appointments is an extremely prevalent issue impacting healthcare systems on a daily basis. This phenomenon adversely affects patient health and healthcare providers, leading to delays in diagnosis and treatment, inefficient resource utilization, and increased healthcare expenses. The detrimental impact of non-attendance is not limited to patients who miss appointments, the knock-on effects of extended waiting times and reduced appointment availability are felt throughout healthcare systems. The purpose of this narrative review is to explore the factors underlying appointment non-attendance in hospital settings, to improve healthcare delivery and patient adherence. An extensive review of the existing global literature was conducted. Quantitative studies that explored the relationship between appointment non-attendance and patient characteristics, such as age, gender, marital status, education level, distance from the hospital, and source of referral, were included. Younger patients, males, individuals with lower levels of education, and those living farther from hospitals were more likely to miss appointments. Marital status was significant, with married patients showing better attendance, as was referral source, with general practitioner referrals associated with higher non-attendance. Qualitative studies identifying both patient-centered and hospital-specific reasons, such as forgetfulness, appointment time, protracted waiting times, patient-physician relationship, and patients' knowledge and perception of their health condition, were also included in the review. Lack of appointment reminders, difficulties in managing appointments, and inadequate patient-physician communication were significant hospital-specific reasons given for non-attendance. Patients' lack of awareness regarding the importance of attending appointments and limited understanding of their health conditions were also identified as patient-centered contributors. Non-attendance at hospital appointments is a multifaceted issue influenced by a range of socioeconomic, personal, and systemic factors. Addressing these factors requires a holistic approach that includes patient education, improved communication, and tailored healthcare delivery strategies, especially for vulnerable populations in rural areas. Enhanced reminder systems and streamlined appointment management could serve as pivotal interventions to reduce non-attendance rates, ultimately improving healthcare outcomes and resource utilization.

Understanding patient perspectives on vaccine decision making in adults with autoimmune bullous diseases: a qualitative study.

Patients with autoimmune bullous diseases are at an increased risk of infection, both from the underlying skin disease and from immunosuppressive treatments. Limited information is available on vaccine beliefs and behaviors in dermatology patients and adults with autoimmune bullous diseases in particular. To understand vaccine decision making, identify perceived risks and benefits of vaccinations, and discuss individual experiences in patients with autoimmune bullous diseases in the United States. A qualitative study was performed utilizing semi-structured interviews, and analysis was conducted on NVivo. Patterns were identified in the coded data, and representative quotations were recorded for each major theme. Interviews were conducted between February 15, 2022 and September 15, 2022. Twenty patients with a diagnosis of bullous pemphigoid, mucous membrane pemphigoid, pemphigus vulgaris, or pemphigus foliaceous were interviewed. Of the 20 participants, 14 (70%) were female, with a mean (SD, range) age of 64.8 (13.2, 34-83) years. Key themes that emerged from qualitative analysis of the interviews included patient concerns regarding their increased susceptibility to infection, potential exacerbation of skin disease following vaccination, and the effect of immunosuppressive medications on humoral response to vaccines. Lack of appointment availability, difficulty accessing vaccines, and cost were commonly identified barriers to vaccination. These findings provide valuable knowledge for dermatologists in regard to providing counseling specific to patient concerns and to improve communication surrounding vaccination in the dermatology setting.

Perceptions of dengue risk and acceptability of a dengue vaccine in residents of Puerto Rico

ABSTRACT Dengvaxia is the first dengue vaccine recommended in the United States (U.S.). It is recommended for children aged 9–16 y with laboratory-confirmed previous dengue infection and living in areas where dengue is endemic. We conducted focus groups with parents and in-depth interviews with key informants (i.e. practicing pediatricians, physicians from immunization clinics, university researchers, and school officials) in Puerto Rico (P.R.) to examine acceptability, barriers, and motivators to vaccinate with Dengvaxia. We also carried out informal meetings and semi-structured interviews to evaluate key messages and educational materials with pediatricians and parents. Barriers to vaccination included lack of information, distrust toward new vaccines, vaccine side effects and risks, and high cost of/lack of insurance coverage for laboratory tests and vaccines. Motivators included clear information about the vaccine, a desire to prevent future dengue infections, the experience of a previous dengue infection or awareness of dengue fatality, vaccine and laboratory tests covered by health insurance, availability of rapid test results and vaccine appointments. School officials and parents agreed parents would pay a deductible of $5–20 for Dengvaxia. For vaccine information dissemination, parents preferred an educational campaign through traditional media and social media, and one-on-one counseling of parents by healthcare providers. Education about this vaccine to healthcare providers will help them answer parents’ questions. Dengvaxia acceptability in P.R. will increase by addressing motivators and barriers to vaccination and by disseminating vaccine information in plain language through spokespersons from health institutions in P.R.

Barriers and Lack of Access to Veterinary Care in Canada 2022

Introduction: Despite concerns about access to veterinary care in Canada, there are no previously published national survey data. The study aimed to estimate the prevalence of barriers to veterinary care faced by Canadian dog and cat owners, and to identify associated factors. Methods: This was a national online survey conducted in mid-2022, the third year of the COVID-19 pandemic. It was nationally representative of English and French-speaking Canadian adults as regards region, age, and sex. Results: Eighteen per cent of the respondents (440/2,500) could not access wanted or needed preventative veterinary care in the past 12 months; 12% (305/2,500) could not access sick care; and 8% (195/2,500) could not access emergency care. The most frequent barriers were the inability to afford care (preventative – 124/440, 28% of those who were unable to access care; sick – 75/305, 25%; emergency – 34/195, 17%); and the inability to obtain an appointment (preventative – 95/440, 22% of those who were unable to access care; sick – 80/305, 26%; emergency – 47/195, 24%). Twenty-one per cent (522/2,500) could not access other pet needs, most frequently pet food (43% of those who lacked access); grooming (34%); and training (28%). Recent immigrants (<5 years) and young people (18–34 years old) were more likely to report barriers. Affordability and appointment availability were the two most frequently occurring barriers. Conclusions: This survey identified a large number of pet owners who faced barriers to veterinary care. There is a need for industry leaders, educators and regulators to help support initiatives to expand access to care.

Exploring the experiences and preferences of South Asian patients' of primary care in England since COVID-19.

Remote (digital and/or telephone) access and consultation models are being driven by national policy with the goal being that the National Health Service operateon a remote-first (digital-first) basis by 2029. Previous research has suggested that remote methods of access to care and consulting may act to widen health inequalities for certain patients and/or groups such as those from ethnic minorities. South Asian (SA) patients comprise the largest ethnic minority group in England. Understanding the experiences and needs of this group is critical to ensuring that general practice can deliver equitable, quality health care. Qualitative study. 37 participants (from Indian, Pakistani and/or Bangladeshi background) were recruited to take part in either in-person preferred language focus groups or remote semistructured interviews in the English language. Thematic analysis was conducted to identify themes in the qualitative data. Three major interlinked themes were identified: (1) reduced access, (2) reduced patient choiceand (3) quality and safety concerns. The findings highlight access issues split by (i) general issues with appointment access via any remote means and (ii) specific issues related to language barriers creating additional barriers to access and care. Some patients valued the convenience of remote access but also raised concerns regarding appointment availability and reduced patient choice. Face-to-face consultations were preferable but less available. The findings underscore how participants perceived remote care to be of lesser quality and less safe. Concerns were greatest for those with limited English proficiency (LEP), with the removal of non-verbal aspects of communication and 'hands-on' care leading to perceptions of reduced psycho-social safety. SA patients' experiences of remote-led primary care access and care delivery were negative with only a minority viewing it positively and for certain limited scenarios. Face-to-face models of care remain the preferred mode of consultation, particularly for those with LEP. Hybrid models of access offer patients the greatest choice, and are likely to meet the varying needs of the South-Asian patient population going forwards. The remote first approach to primary care may be achievable as a service ideal, but its limitations need to be recognised and accounted for to ensure that primary care can be an equitable service, both now and in the future. Members of the public were involved in all phases of research in the study. This included co-working in partnership throughout the study including, reviewing patient-facing documents, recruiting participants, data facilitation, translation work, interpretation of the data and co-authors on this manuscript. The key to the success of our study was collaborative teamwork, which involved experienced members of the public with SA cultural knowledge working together with and integral to the research team for all components.

Factors Influencing the Decision Process within Seeking Orthodontic Care among the Saudi Population: A Cross-sectional Survey

Aims & Background Orthodontic treatment is the first choice for the treatment of many different types of malocclusions, and patients’ decision processes while seeking orthodontic treatment are multifactorial. The aim of the present study is to assess these factors influencing the decision process regarding the public and orthodontic treatment for themselves or for their children, as well as the factors influencing the selection of an orthodontist versus a general dentist in Saudi Arabia. Materials and Methods A survey-based questionnaire was distributed through social media accounts that included questions about demographic data, reasons for seeking orthodontic care, barriers to care, and sources of information that may influence the decisions regarding the choice of orthodontic treatment for the participants and their children. Results The final sample included 320 responses from eligible participants (181 men & 139 women with a mean age of 39.98). ‘Family dentist recommendation’ was the most important reason for participants to seek out orthodontic treatment for themselves or a child while finding a caregiver who can handle complications and the availability of appointments were the most important barriers in seeking orthodontic treatment. Participants also assumed an orthodontist would be more reliable in finishing the treatment in the expected duration, yet they expected that treatment with a general dentist would be less costly and more convenient. Conclusion A referral from the family dentist has the most impactful influence on seeking orthodontic care. People are keen to have their treatment done by an orthodontist, but the major barrier in seeking orthodontic care is finding a suitable candidate. Parents prioritize orthodontic treatment for their children more than for themselves.

Help-seeking behaviour in dysmenorrhoea: A cross-sectional exploration using the Behavioural Model of Health Services Use.

Dysmenorrhoea, or period pain, is a prevalent gynaecological condition that can result in functional interference during menstruation. Despite the significant disruption dysmenorrhoea can have on functioning and well-being, medical help-seeking rates are low. Little is known about what factors may predict help-seeking for dysmenorrhoea. The current study aimed to test the predictive validity of the Behavioural Model of Health Services Use (BMHSU) for help-seeking behaviour in dysmenorrhoea, whereby help-seeking behaviour was operationalised as having attended to a healthcare professional for dysmenorrhoea-related care. A cross-sectional observational design was used. Participants (N = 439) completed an online survey, which measured the following eight predictor variables: menstrual pain characteristics, health beliefs, self-efficacy, social support utilisation and satisfaction, perceived healthcare availability, and pain intensity and interference. Participants were also asked to report whether they had ever attended to a healthcare professional for their menstrual pain. The BMHSU accounted for 8% of the variance in help-seeking behaviour. Pain interference and appointment availability were significant predictors of the variance in past help-seeking behaviour, such that those who experienced greater pain interference, and those who perceived greater availability of healthcare appointments were less likely to have visited a healthcare professional for their menstrual pain. The BMHSU had an overall 69% classification accuracy in predicting help-seeking behaviour. Although the BMHSU demonstrated reasonably good model fit, it does not appear to be a particularly robust model for predicting help-seeking behaviour for dysmenorrhoea. Future research should explore whether a refined BMHSU or an alternative theoretical model can provide more useful insight into this behaviour. Better understanding of the determinants of help-seeking behaviour will enable the development of interventions to promote appropriate help-seeking and improve health outcomes for individuals with menstrual pain.

Development of a Pipeline for Removing Allergy Labels in Patients Undergoing Hematopoietic Stem Cell Transplantation

Penicillin allergy is reported by 10-20 % of patients, but when evaluated only 1-2% may have a true allergy. Patients undergoing HSCT have a high likelihood of requiring beta-lactam antibiotics due to increased infection risk, which can be limited by a penicillin allergy label. When a penicillin allergy is recorded, alternatives are needed including more-expensive, broader-spectrum antibiotics, with increases in drug-resistant bacteria, longer hospital stays, higher expenditures, and increases in nosocomial infections such as C. difficile colitis. This group of patients already has extensive pre-treatment testing, and would particularly benefit from allergy de-labeling. This study aimed to develop a self-sustaining, low-cost pipeline between a HSCT clinic and an allergy clinic to identify and successfully de-label low-risk patients who endorse an allergy to penicillin, amoxicillin, amoxicillin-clavulanate, piperacillin-tazobactam, or ampicillin before admission to the hospital. We developed a survey to triage allergy risk, identified key stakeholders in building the pipeline, and underwent four plan, do, study, act (PDSA) cycles. Changes were made in each of the PDSA cycles to minimize cost and uncompensated provider time as well as increase patient retention throughout the pipeline by increasing appointment availability and decreasing reliance on patients to independently progress through the pathway. Of the 410 patients with planned HSCT who were screened over 11 months, we found that 89 (21.7%) patients were listed as having penicillin and/or beta lactam allergy. 98.5% (n=66/67) of participants completed the survey accurately when confirmed by an allergist, and the survey was 100% accurate in predicting de-labeling success in low-risk patients. Of eligible patients, 43.8% (n=39) were successfully de-labeled before their transplant date and 97.4% (n=38) have undergone HSCT to date. This pipeline is maintained by approximately 5 hours of work per week (1 hour of allergy physician time, 4 hours of nurse and/or clinical coordinator time) and no other direct costs. There is an estimated direct savings of at least $1,914.93 per patient de-labeled. We successfully designed and implemented a pipeline between the HSCT clinic and the allergy clinic as a quality improvement initiative to identify and address high rates of reported beta-lactam allergies. We identified and addressed patient-based factors, logistical, temporal, and financial barriers that impacted patient retention and sustainability. This model is expected to have significant and sustained cost-savings for the healthcare system as well as improve patient outcomes, and this hypothesis is currently undergoing formal analysis. We anticipate that this model can be used to create a similar pipeline in other healthcare systems for HSCT patients as well as other clinical settings such as oncology and CAR-T therapy.

Quality And Factors influencing Healthcare in KSA (Systematic literature review)

The aim of this review is to identify the factors that impact the quality of healthcare service in KSA based on locally published studies, There are a several factors that contribute to the quality of healthcare in KSA from the perspective of patients and healthcare providers (HCPs) and nurses. Factors such as infrastructure and device availability, emotional, social, and physical support, clinic duration time and appointment availability, HCPs experience and competencies, and specialists and drugs availability were identified as important for quality healthcare. HCPs and nurses in KSA prioritize delivering care that meets international standards, embracing evidence-based practices, and valuing continuous professional development. They also emphasize the significance of patient-centeredness, interdisciplinary teamwork, and respecting patients' cultural beliefs. A robust regulatory framework, healthcare policies, and accreditation standards play a vital role in ensuring consistent quality healthcare services. Additionally, healthcare management and information, hospital supervision, and training and development programs for HCPs were identified as important factors for improving the quality of healthcare in KSA. In conclusion, several factors have shown to be impacting quality of healthcare service in KSA, Policymakers and healthcare providers in KSA shall strive to improve the quality of healthcare services by acknowledging and tackling these factors.

Adoption of virtual prenatal visits linked to recurrent virtual or forgone visits for postpartum care

BackgroundTo investigate the association between prenatal and postpartum visits, with a specific focus on the modality of these visits, and to assess whether barriers to virtual visits experienced during the prenatal period are linked to types of postpartum visits. MethodsThe repeated cross-sectional study used the Pregnancy Risk Assessment Monitoring System from 2020 through 2021. Women who had prenatal visits and who also reported their postpartum visits were included (n = 11,258). The outcome was the modality of postpartum visits, and the key independent variable was virtual prenatal visit experience. Multinomial logistic regression analysis was performed to examine the relationship of postpartum visits with virtual prenatal visit experience. ResultsAmong those who had virtual prenatal visits, about one-third used virtual visits again for postpartum care. Individuals who had virtual prenatal visits showed greater odds of utilizing virtual visits (OR 8.54, 95%CI 7.05–10.35, p=<0.001) or no office visits (OR 1.61, 95%CI 1.25–2.07, p=<0.001) compared to in-person visits during the postpartum period. Women who reported a lack of virtual appointment availability (OR 0.58, 95%CI 0.40–0.86, P = 0.006) or cellular data (OR 0.18, 95%CI 0.05–0.68, p = 0.012) in their prenatal care had lower odds of virtual postpartum visits. ConclusionsWhile virtual prenatal visits are linked to greater virtual visits for postpartum care, they are also associated with increased forgone care. The unavailability of virtual appointments and cellular data is a significant barrier to virtual visits. The findings provide practical implications for advancing equitable and sustainable care in a rapidly changing healthcare landscape.

Oral Health Advice for Looked-After-Children: A pilot care pathway in Buckinghamshire, UK.

Looked-After-Children (LAC) frequently are more likely to have untreated dental caries, periodontal diseases or dental trauma (McMahon et al., 2018). The COVID-19 pandemic reduced the availability of dental appointments, including for LAC. This initiative piloted the inclusion of a dental pathway into the existing LAC care pathway in Buckinghamshire. The key principle was providing oral health messaging around maintaining good oral health and preventing disease in these children by training those involved with their care. A working group was convened, which included dental public health, clinical and training expertise. A care pathway was developed with resources drawn from existing programmes including mini Mouth Care Matters (mMCM). The care pathways were designed to identify children who needed care urgently due to pain or discomfort, signpost them to the relevant/most appropriate providers and provide oral health improvement advice for everyone. Local partners were engaged to ensure that the processes and training were appropriate. A pilot training session was then carried out for a range of staff engaged in the care of LAC within Buckinghamshire. The pilot dental pathway, launched in March 2022, initiative was welcomed by all stakeholders, including dental commissioners. The pilot training session received positive feedback from participants, with requests for more sessions. Training sessions were subsequently translated into video sessions, accessible when needed, for new staff or as refresher sessions. There are opportunities to reduce future inequalities for these children by inculcating positive behaviours early in their care journey. This will reduce their need for care. Identifying and implementing the most appropriate initiatives requires collaboration and commitment from all stakeholders.

The COVID‐19 pandemic and primary care appointment availability by physician age and gender

AbstractUsing data generated through simulated patient calls to a national random sample of primary care physicians between February and July 2020, we examine the effects of the first wave of COVID‐19 on the availability of the U.S. primary care physician workforce for routine new patient appointments. As states enacted stay‐at‐home orders, physicians overall became less selective by insurance, and there was a 7 percentage‐point increase in acceptance of patient insurance. Telemedicine appointment offers increased 10.2 percentage points from near zero. However, relative to younger counterparts, physicians older than the sample mean (53.1 years) became 18.1 percentage points less likely to offer appointments and decreased their estimated appointment duration by 7.1 min. Compared to male physicians, female physicians became 10 percentage points more likely to accept new patients. These insights into appointment offers during the first wave of COVID‐19 may help policymakers seeking to ensure an adequate physician workforce during future crises.

A qualitative study exploring healthcare workers' lived experiences of the impacts of COVID-19 policies and guidelines on maternal and reproductive healthcare services in the United Kingdom.

During the COVID-19 pandemic, pregnant women were regarded as vulnerable to poor health outcomes if infected with the SARS-CoV-2 (COVID-19) virus. To protect the United Kingdom's (UK) National Health Service (NHS) and pregnant patients, strict infection control policies and regulations were implemented. This study aimed to understand the impact of the COVID-19 policies and guidelines on maternal and reproductive health services during the pandemic from the experiences of healthcare workers (HCWs) caring for these patients. This qualitative study involved HCWs from the United Kingdom Research study into Ethnicity and COVID-19 outcomes in Healthcare workers (UK-REACH) project. Semi-structured interviews and focus groups were conducted online or by telephone with 44 diverse HCWs. Transcripts were thematically analyzed following Braun and Clarke's principles of qualitative analysis. Three key themes were identified during analysis. First, infection control policies impacted appointment availability, resulting in many cancellations and delays to treatment. Telemedicine was also used extensively to reduce risks from face-to-face consultations, disadvantaging patients from minoritized ethnicities. Secondly, staff shortages and redeployments reduced availability of consultations, appointments, and sonography scans. Finally, staff and patients reported challenges accessing timely, reliable and accurate information and guidance. COVID-19 demonstrated how a global health crisis can impact maternal and reproductive health services, leading to reduced service quality and surgical delays due to staff redeployment policies. Our findings underscore the implications of policy and future health crises preparedness. This includes tailored infection control policies, addressing elective surgery backlogs early and improved dissemination of relevant vaccine information.

Improving access to care with implementation of a virtual anemia clinic.

113 Background: In 2022, our cancer center saw a rapidly rising number of new hematology consult requests, specifically for anemia. This increase created access challenges, especially for our regional hematology oncology practices, who see both malignant and benign consult diagnoses. Our enterprise target metric for assessing access is defined as “median of appointments within 7 days.” This metric was rapidly as far out as 15 days (YTD) in the hematology disease group briefly, therefore calling the leadership team to action. An additional concern was provider dissatisfaction from frequent add-on requests for consults and a pivot from an even split of hematology oncology patients to heavily classical hematology consults. Timely triage and assessment of anemia is necessary for identification of potentially serious underlying cancer diagnoses. Methods: Upon investigation, opportunities to improve patient access were identified as: 1) underutilized APPs; 2) scheduler turnover, communication barriers resulting in up to 30% of new patient slots going unused; 3) anemia consults scheduled at 60 minutes which typically take 30-45 minutes to complete; 4) patients are interested in a virtual appointment for non-oncologic consult diagnoses but scheduling these visit types has been challenging. An APP lead virtual only anemia clinic (VAC) was launched in Sept 2022. The clinic consisted of with five 45-minute consults per day. A decision tree was created to for efficiency and to assist in appropriate diagnoses scheduled. Biweekly huddles for quality assurance of patient care were initiated. No additional FTEs were required to initiate this clinic. Results: In 6 weeks, we were able launch the VAC with utilization strongly in the upper 90%. 5 APPs trained in anemia consults divided Monday-Friday with one virtual day per week. Follow up patients were scheduled in person at regional or main campus locations as indicated. The access metric for hematology consults improved from 15 days (YTD) to 8 (YTD) within the initial 6 months. More specifically, anemia consult diagnoses improved to less than 7 days almost immediately. Anecdotally, patients were satisfied with the appointment availability and care received. Patient experience scores for the participating APPs remained steady throughout the initial first 6 months and are continuing to be followed. Conclusions: A VAC is a potential way to achieve improved patient access to an anemia consult, further providing timely evaluation and treatment. Additional professional revenue that does not utilize physical space, caregivers, building facilities is a positive outcome, in addition to expedited triage, assessment, diagnosis, and treatment for anemia in straightforward and complex patients. There is an added benefit for patients who have an opportunity for virtual care such as quick access to care, decreased financial toxicity, and removal of barriers to care like transportation and taking time off work.

Is the emergency department used as a substitute or a complement to primary care in Medicaid?

Policies to decrease low-acuity emergency department (ED) use have traditionally assumed that EDs are a substitute for unavailable primary care (PC). However, such policies can exacerbate ED overcrowding, rather than ameliorate it, if patients use EDs to complement, rather than substitute, their PC use. We tested whether Medicaid managed care enrolees visit the ED for nonemergent and PC treatable conditions to substitute for or to complement PC. Based on consumer choice theory, we modelled county-level monthly ED visit rate as a function of PC supply and used 2012-2015 New York Statewide Planning and Research Cooperative System (SPARCS) outpatient data and non-linear least squares method to test substitution vs complementarity. In the post-Medicaid expansion period (2014-2015), ED and PC are substitutes state-wide, but are complements in highly urban and poorer counties during nights and weekends. There is no evidence of complementarity before the expansion (2012-2013). Analyses by PC provider demonstrate that the relationship between ED and PC differs depending on whether PC is provided by physicians or advanced practice providers. Policies to reduce low-acuity ED use via improved PC access in Medicaid are likely to be most effective if they focus on increasing actual appointment availability, ideally by physicians, in areas with low PC provider supply. Different aspects of PC access may be differently related to low-acuity ED use.

SAT123 Treatment Satisfaction And Barriers To Diabetes Care In Patients With Uncontrolled Diabetes Mellitus: A Cross-Sectional Study

Abstract Disclosure: S. Alghrid: None. O. Refadah: None. D. Alharbi: None. N. Aljuhani: None. S. Albalawi: None. S. Aljuhani: None. R. Alaradi: None. A. Yzeed: None. S. Albalawi: None. P. Amirthalingam: None. S.F. Alqifari: None. Background: Diabetes prevalence is reaching 25% in Saudi Arabia. Although diabetes care is provided free of charge, barriers to care and treatment satisfaction among patients remain unknown. Objectives: This study aims to examine diabetes patients’ treatment satisfaction and barriers to care in Saudi Arabia. Methods: We utilized the validated Diabetes Treatment Satisfaction Questionnaire (DTSQ) survey tool to assess diabetes treatment satisfaction among 782 adult Arabic-speaking patients with type 2 diabetes. An additional survey construct was utilized to assess patients’ perspectives on possible barriers to receiving diabetes care. Multivariate linear regression, r Pearson regression, and U Mann-Whitney tests were analyzed. Results: Of the 782 participants interviewed, 55.3% were females. The mean age of the study sample was 59.4 years. The average DTSQs value was 13.5. A strong correlation was observed between DTSQs score and glycemic control, female gender, and utilization of governmental healthcare. Patients of primary healthcare centers had higher satisfaction than tertiary care. Among the barriers to care reported, living in a rural area, transportation, and availability of appointments were the most frequent. Conclusion: Diabetes treatment satisfaction correlated well with glycemic control. The degree of treatment satisfaction in patients with type 2 diabetes was higher in female patients receiving government healthcare. Logistics constituted the most frequent barriers to care reported including living in rural areas, availability of transportation, and appointments. Presentation: Saturday, June 17, 2023

Using RE-AIM to examine implementation of a tele-nephrology program for veterans living in rural areas.

Chronic kidney disease (CKD) and refractory hypertension (rHTN) are common, chronic conditions that affect 10%-16% of Veterans. Several small studies have suggested that tele-nephrology can deliver nephrology care effectively to rural Veterans. The purpose of this evaluation was to examine perceptions and experiences with this tele-nephrology program among spoke site staff and clinicians using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to guide our understanding of tele-nephrology implementation. We conducted semi-structured interviews with fourteen clinicians at five tele-nephrology spoke sites. We used content analysis to analyze the results using our RE-AIM framework. Five major themes arose: (1) Active engagement of a centralized clinical champion was a key factor in early success of tele-nephrology program; (2) Transition from community-based nephrology to VA tele-nephrology was heralded as the most meaningful indicator of the effectiveness of the intervention; (3) Effective adoption strategies included bi-weekly training with Hub nephrology staff and engagement of a local renal champion; (4) Meeting the needs of Veterans through proper staffing during tele-nephrology examinations was a key priority in facility program implementation; and (5) Growing reliance on Hub nephrologists may give rise to insufficient availability of nephrology appointments in some Spoke sites. This evaluation represents an important step forward as VA considers how to provide care to Veterans at facilities without VA specialty providers. The COVID-19 pandemic has drastically shifted options for Veterans, and increasingly, the VA is moving to shift care from community to VA via virtual care. Further research should examine how the VA manages potential problems related to access to virtual providers and examine Veteran perspectives on community in-person vs. virtual VA care.

Accessibility to Obstetric Care in South Florida Based on Insurance: A Cross-Sectional Study.

Introduction Obstetrical research confirms that earlier onset prenatal care significantly improves pregnancy and birth outcomes. Initiating care in the second trimester or having less than 50% of recommended visits has been associated with an increased risk of prematurity, stillbirth, neonatal, and infant death. Studies have shown that women on public health insurance plans initiate prenatal care substantially later into pregnancy than those on private plans. The purpose of this study is to assess whether public health insurance limits Florida patients' access to obstetric care. Methods A cross-sectional study was conducted by collecting data on the four most populated zip codes for Medicaid in South Florida using HealthGrades.com. The following search parameters were used: "obstetric care", "four stars and up" and "10-mile distance". Each obstetrician was called three times to assess appointment availability for fictional nulliparous women at eight weeks of gestation requesting prenatal care. Accepted insurance types (Medicaid, Cigna, and United Health Group (UHG)), time to an appointment in business days, and self-pay rates were recorded. Practices with invalid contact information and retired obstetricians were excluded. Summary statistics, chi-squared analysis, and a two-way t-test were conducted for the primary outcome. Results Seventy-one out of 178 obstetricians were successfully contacted, of which 31 physicians accepted all three insurances, and 40 physicians did not accept at least one insurance. Of those, 97.2% acceptedUnitedHealthcare, 98.6% accepted Cigna, and 45.1% accepted Medicaid. There was a statistically significant difference when comparing acceptance rates between UHC and Medicaid as well as Cigna and Medicaid (p<0.001). There was no statistically significant difference in acceptance rates in the direct comparison of the two private insurances, Cigna and UnitedHealthcare (p=0.559). The average number of days until the next available appointment was 12.7 (SD= 7.2) for UnitedHealthcare, 20.0 (SD=6.7) for Cigna, and 17.0 (SD=8.6) for Medicaid. There was a statistically significant trend between the type of insurance and the time to the earliest appointment (p=0.002). Conclusion This study demonstrated patients enrolled in Medicaid in South Florida have significantly less access to prenatal care than those with private insurance. This evidence shows that decreased access to care from Medicaid plans can possibly increase the risk of adverse outcomes associated with inadequate prenatal care. This information should be considered by policymakers when considering future Medicaid expansion.

SP1.10 Predicting unplanned readmissions after emergency laparotomy

Abstract Aims St James’s University Hospital in Leeds performs the highest number of emergency laparotomies in the UK. This operation remains one of the highest risk surgical procedures but little is known about the patient journey after discharge from hospital. This service evaluation aimed to assess the rate of unplanned readmissions after discharge, and how to predict those at higher risk of readmission, to inform the implementation of a specialist emergency laparotomy follow-up clinic. Methods The Leeds NELA data were used to collate the clinical details of all patients who underwent an emergency laparotomy between 1st October 2021 – 1st October 2022. The local electronic patient record was searched to identify those who were readmitted within 30 days of discharge. A univariate analysis determined the factors which most accurately predict the risk of readmission. Results The clinical details of 343 patients were analysed, of whom 318 survived to discharge. There were 41 unplanned readmissions to hospital within 30 days of discharge (13%). The most frequent reasons for unplanned readmission were sepsis, wound infection, post-operative pain, high-output stoma and acute kidney injury. Frailty score (OR 1.276; CI 1.031-1.579; p=0.025) and ASA score (OR 1.803; CI 1.218-2.669; p=0.003) were statistically significant predictors of readmission after emergency laparotomy. Conclusions St James’s University Hospital employs two dedicated NELA nurses, and has implemented a weekly outpatient follow-up clinic for patients who have been discharged after emergency laparotomy. The availability of clinic appointments should be prioritised for frail and comorbid patients to enhance the patient’s postoperative journey.

Identifying barriers to obstructive sleep-disordered breathing care: Parental perspectives.

Despite established clinical practice guidelines for pediatric obstructive sleep-disordered breathing (SDB), disparities persist for this common condition. Few studies have investigated parental experiences about challenges faced in obtaining SDB evaluation and tonsillectomy for their children. To better understand parent-perceived barriers to treatment of childhood SDB, we administered a survey to assess parental knowledge of this condition. A cross-sectional survey was designed to be completed by parents of children diagnosed with SDB. Two validated surveys were administered: 1) Barriers to Care Questionnaire and 2) Obstructive Sleep-Disordered Breathing and Adenotonsillectomy Knowledge Scale for Parents. Logistic regression modeling was performed to assess for predictors of parental barriers to SDB care and knowledge. Eighty parents completed the survey. Mean patient age was 7.4±4.6 years, and 48 (60%) patients were male. The survey response rate was 51%. Patient racial/ethnic categories included 48 (60.0%) non-Hispanic White, 18 (22.5%) non-Hispanic Black, and 14 (17.5%) Other. Parents reported challenges in the 'Pragmatic' domain, including appointment availability and cost of healthcare, as the most frequently described barrier to care. Adjusting for age, sex, race, and education, parents in the middle-income bracket ($26,500 - $79,500) had higher odds of reporting greater barriers to care than parents in the highest (>$79,500) income tier (OR 5.536, 95% CI 1.312-23.359, P=0.020) and lowest income tier (<$26,500) (OR 3.920, 95% CI 1.096-14.020). Parents whose children had tonsillectomy (n=40) answered only a mean 55.7%±13.3% of questions correctly on the knowledge scale. Pragmatic challenges were the most encountered barrier that parents reported in accessing SDB care. Families in the middle-income tier experienced the greatest barriers to SDB care compared to lower and higher income families. In general, parental knowledge of SDB and tonsillectomy was relatively low. These findings represent potential areas of improvement to target interventions to promote equitable care for SDB.