Attending Clinic Appointments Research Articles

Looking under the hood of a hybrid two-way texting intervention to improve early retention on antiretroviral therapy in Malawi: an implementation fidelity evaluation

BackgroundWhile key to interpreting findings and assessing generalizability, implementation fidelity is underreported in mobile health (mHealth) literature. We evaluated implementation fidelity of an opt-in, hybrid, two-way texting (2wT) intervention previously demonstrated to improve 12-month retention on antiretroviral therapy (ART) among people living with HIV (PLHIV) in a quasi-experimental study in Lilongwe, Malawi.MethodsShort message service (SMS) data and ART refill visit records were used to evaluate adherence to 2wT content, frequency and duration through the lens of the Conceptual Framework for Implementation Fidelity. Message delivery and 2wT participant interactions were considered across four core 2wT components: 1) weekly motivational SMS messages; 2) proactive SMS appointment reminders; 3) SMS reminders after missed appointments; and 4) interactive messaging with 2wT staff about transfers and appointment rescheduling. Using mixed-effects logistic regression models adjusted for participant demographics, we examined the effect of core 2wT component fidelity on a) on-time appointment attendance and b) timely return to care after a missed appointment, presenting adjusted odds ratios (aORs) and 95% confidence intervals (CIs).ResultsThe 468 2wT participants had a median of 52 study weeks (interquartile range [IQR] 34 – 52) with 6 ART appointments (IQR 4—7) of which 2 (IQR 1 – 3) were missed. On average, participants received a motivation message for 75% (IQR 56%—83%) of enrolled weeks, a reminder before 83% (IQR 67%—100%) of appointments, and after 67% (IQR 0%—100%) of missed appointments. Participants reported 9 transfers and rescheduled 46 appointments through 2wT prompts; 196 appointments were changed via unprompted interaction. Participants with 10% higher expected motivation message delivery were more likely to attend clinic appointments on time (aOR: 1.08; 95%CI: 1.01 – 1.16, p = 0.03). Receiving and responding to an appointment reminder in any way were also associated with increased on-time appointment attendance (aOR: 1.35; 95%CI: 1.03 – 1.79, p = 0.03 and aOR: 1.47, 95%CI: 1.16 – 1.87, p = 0.001, respectively). No associations were found for 2wT messages and timely return to care following a missed appointment.ConclusionGreater 2wT implementation fidelity was associated with improved care outcomes. Although implementation fidelity monitoring of mHealth interventions is complex, it should be integrated into study design.

Association of Unmet Social Needs With Disease-Related Outcomes in Pediatric Patients With Sickle Cell Disease.

Social determinants of health (SDoH) are socioeconomic factors that influence health and well-being, though when unmetcan greatly contribute to health disparities. Individuals with sickle cell disease (SCD) are at increased risk of mortality, disability, and healthcare utilization. However, there are limited data linking specific social needs with disease outcomes in this population. Therefore, we sought to identify the unmet needs in one institution and their association with healthcare utilization. Children with SCD and their guardians answered demographic and SDoH questionnaires during routine Sickle Cell Clinic appointments. We defined an unmet social need as any positive answer to the SDoH questionnaire. Disease outcome variables were electronic health record (EHR)-documented emergency department (ED) visits, hospitalizations, clinic appointment attendance, and guardian-reported acute SCD events in the previous year. A total of 114 parent-guardian dyads participated, with 103 having complete data to analyze. In all, 52% of subjects reported at least one unmet social need with food insecurity (36%), trouble paying utility bills (28%), and unemployment (16%) being the most prevalent. Subjects with at least one unmet need had two times the rate of ED visits and/or hospitalizations and were 1.15 times more likely to have an SCD event in the past year. However, only the association with ED visits was statistically significant (p = 0.03). Over half of subjects reported at least one unmet need; the most common being reliable access to food, which has the potential to impact health outcomes of sickle cell patients. Furthermore, unmet social needs are linked to healthcare utilization and SCD-related complications, supporting routine screening for SDoH in this population.

Implementing palliative care in hepatocellular carcinoma ambulatory clinics—study protocol for Accelerated translational research in PRImary liver CAncer (APRICA) randomised controlled palliative care trial

BackgroundIntegration of symptom and palliative care for people with advanced cancer is established in many tumour types, but its role in people with hepatocellular carcinoma (HCC) has not been clearly defined. This study aims to evaluate the clinical and cost effectiveness of an intervention involving a suite of strategies designed to assess and treat palliative care symptoms and needs in adult outpatients with HCC attending four New South Wales (NSW) metropolitan tertiary hospitals.MethodsThis trial will use a pragmatic cluster-based randomised-controlled design, with ambulatory HCC services as the clusters. HCC patients will be recruited if they have Barcelona Clinical Liver Cancer (BCLC) stage A disease with active tumour or a current or prior diagnosis of BCLC stage B or C disease regardless of tumour activity. Patients with BCLC stage D disease will be excluded as palliative care is the standard of care (SOC) in this group. Cluster sites will be randomised to the study intervention or control where patients are managed according to SOC. All participants will complete the liver-specific Edmonton Symptom Assessment Scale (ESAS) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at regular ambulatory clinic appointments. At intervention sites, patients scoring ≥ 5 on any liver-specific ESAS symptom will be referred to palliative care physicians for consultation. The primary clinical outcome will be improvement in all symptoms scored ≥ 5 on the liver-specific ESAS by 50% within 3 months and the primary implementation outcome will recording the liver-specific ESAS in ≥ 80% of all participants attending clinic appointments. Caregivers of patients enrolled in the trial will be invited to perform Carer Support Needs Assessment Tool at each appointment.DiscussionThis trial will inform if earlier palliative care involvement significantly reduces the symptom burden associated with HCC. If found to be effective, earlier implementation of palliative care consultation should be included in HCC treatment guidelines.Trial registrationACTRN12623000010695. Registered on September 1, 2023.

Dyadic Effects of Attachment on Illness Acceptance in Patients with Breast Cancer and Spousal Caregivers: Sense of Coherence as a Mediator.

Background: Attachment styles have been found to play a significant role in adjustment to cancer. Couples often cope with breast cancer through an interdependent approach to the disease rather than just acting as individuals, and a sense of coherence is an important factor that influences these relationships. This study examined how attachment styles and sense of coherence impact illness acceptance in couples facing breast cancer within a dyadic perspective. Methods: Data were analyzed from 145 women with recently diagnosed breast cancer and their 145 partners, who attended clinic appointments related to medical treatment. They completed self-report measures of attachment, sense of coherence, and illness acceptance. Results: Higher secure attachment and low insecure attachment scores were associated with a higher sense of coherence and better illness acceptance both in women and partners. Results of actor-partner interdependence mediation models indicated that most associations between attachment styles and illness acceptance were mediated by sense of coherence within both intrapersonal (actor-actor) and interpersonal (actor-partner) effects. Conclusions: The interdependence in attachment and sense of coherence brought noticeable benefits to couples' illness acceptance when facing breast cancer. In line with the salutogenic model, these relationships predominantly depended on the mediational function of comprehensibility, manageability, and meaningfulness, which determined cognitive and emotional reactions that influenced both patients' and spouses' acceptance of the disease.

Influence of Social Cultural Factors on Male Involvement in Antenatal Care in Baringo County Referral Hospital Kenya

Purpose: Male participation in the Antenatal Care is essential for realization of social, cultural factors. This study sought to analyze the factors influencing male involvement in the care of their expectant wives, collect views of mothers attending the clinics and men found there and come up with measures on how to enable both parents be responsible to the unborn. Methodology: This research was guided by use of cross-sectional survey in which both qualitative and quantitative data was collected. Data was obtained by means of questionnaires, interview guides and observation schedules. Questionnaires were used to collect primary data. Secondary data was collected from documented information to support primary data. Systematic random sampling technique was used to select the sample from the target population of expectant mothers in the antenatal clinic at Baringo County Referral Hospitals to explore their views on why their husbands do not attend clinic appointments with them. The men who accompanied their wives were also engaged in an in-depth interview to examine their reasons for coming to the clinic. The researchers sampled 150 participants and 3 nurses. Data collection was done by the investigator assisted. Findings: The data collected was processed, coded and analyzed using Statistical Package for Social sciences (SPSS). The findings of the research which were presented using tables were that; social cultural factors, and health related services influenced male participation in the antenatal clinic. Unique Contribution to Theory, Practice and Policy: The researchers also found out that the clients were impressively aware of the services offered and other activities carried out in the clinic. The researchers however, concluded that there was need for the facility especially the clinic area to improve in terms of space and sitting arrangements to accommodate all mothers and their spouses comfortably and add more doctors to facilitate quick and quality services to the clients. The researchers also felt the need to advocate for policy formulation so.

Using FRAME to characterize provider-identified adaptations to a stepped care intervention for adolescents and youth living with HIV in Kenya: a mixed methods approach.

The Data-informed Stepped Care (DiSC) study is a cluster-randomized trial implemented in 24 HIV care clinics in Kenya, aimed at improving retention in care for adolescents and youth living with HIV (AYLHIV). DiSC is a multi-component intervention that assigns AYLHIV to different intensity (steps) of services according to risk. We used the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to characterize provider-identified adaptations to the implementation of DiSC to optimize uptake and delivery, and determine the influence on implementation outcomes. Between May and December 2022, we conducted continuous quality improvement (CQI) meetings with providers to optimize DiSC implementation at 12 intervention sites. The meetings were guided by plan-do-study-act processes to identify challenges during early phase implementation and propose targeted adaptations. Meetings were audio-recorded and analysed using FRAME to categorize the level, context and content of planned adaptations and determine if adaptations were fidelity consistent. Providers completed surveys to quantify perceptions of DiSC acceptability, appropriateness and feasibility. Mixed effects linear regression models were used to evaluate these implementation outcomes over time. Providers participated in eight CQI meetings per facility over a 6-month period. A total of 65 adaptations were included in the analysis. The majority focused on optimizing the integration of DiSC within the clinic (83%, n = 54), and consisted of improving documentation, addressing scheduling challenges and improving clinic workflow. Primary reasons for adaptation were to align delivery with AYLHIV needs and preferences and to increase reach among AYLHIV: with reminder calls to AYLHIV, collaborating with schools to ensure AYLHIV attended clinic appointments and addressing transportation challenges. All adaptations to optimize DiSC implementation were fidelity-consistent. Provider perceptions of implementation were consistently high throughout the process, and on average, slightly improved each month for intervention acceptability (β = 0.011, 95% CI: 0.002, 0.020, p = 0.016), appropriateness (β = 0.012, 95% CI: 0.007, 0.027, p<0.001) and feasibility (β = 0.013, 95% CI: 0.004, 0.022, p = 0.005). Provider-identified adaptations targeted improved integration into routine clinic practices and aimed to reduce barriers to service access unique to AYLHIV. Characterizing types of adaptations and adaptation rationale may enrich our understanding of the implementation context and improve abilities to tailor implementation strategies when scaling to new settings.

Comparison of 30-day retention in treatment among patients referred to opioid use disorder treatment from emergency department and telemedicine settings

IntroductionTelemedicine is a feasible alternative to in-person evaluations for people with opioid use disorder (OUD). The literature on medications for opioid use disorder (MOUD) telemedicine has focused on ongoing OUD treatment. Emergency department (ED) visits are an opportunity to initiate MOUD; however, little is known regarding the outcomes of patients following telemedicine referrals for MOUD from emergency settings. The current study describes rates of initial outpatient clinic appointment attendance and 30-day retention in care among patients referred by telemedicine compared to ED referrals. MethodsThis paper reports a retrospective review of data for patients referred from EDs or telemedicine through the Medication for Addiction Treatment and Electronic Referrals (MATTERS) Network. The MATTERS online platform collects data on patient demographic information (e.g., age, gender, race/ethnicity, and insurance type), reason for visit, prior medical and mental health history, prior OUD treatment history, and past 30-day substance use behaviors. Analyses compared initial visit attendance and 30-day retention among the patients for whom follow-up data were received from clinics by demographic and initial treatment factors. ResultsBetween October 2020 and September 2022, the MATTERS Network made 1349 referrals; 39.7 % originated from an ED and 47.8 % originated from telemedicine. For patients with available data, those referred from telemedicine were 1.64 times more likely to attend their initial clinic appointment and 2.59 times more likely be engaged in treatment at 30 days compared to those referred from an ED. More than two-thirds of patients referred from the emergency telemedicine environment followed up at their first clinic visit and more than half of these patients were still retained in treatment 30 days after referral. ConclusionsThe rates of initial clinic visit and 30-day retention when referred following a telemedicine evaluation are encouraging. Further development of telemedicine programs that offer evaluations, access to medications, and referrals to treatment should be considered.

Calculation of the Forearm and Hand Three-Dimensional Anthropometry Based on Two-Dimensional Image Feature Extraction: An Approach for Cock-up Splint Design.

An alternative to both the time-consuming traditional and the expensive three-dimensional (3D) methods for splint design is to use two-dimensional (2D) images. The present study utilized image processing to achieve an automatic and practical method of anthropometry measurement to design and build a personalized and remote cock-up splint. This method is applicable for patients unable to personally attend clinic appointments. The defined landmarks of the cock-up splint of 100 adult participants were measured manually. Each individual had a 2D image taken of their upper limb using a customized imaging device. The 2D image portions that corresponded to the manual measurements were then identified, and their sizes were retrieved in pixels using MATLAB software. To find equations between manual 3D measurements and 2D image processing ones, multiple linear regression analysis was performed on landmark variables. We were able to determine equations to estimate manual dimensions based on 2D image data. In the men's group, we could predict the third finger length, forearm circumference at three levels, and the largest forearm circumference. In the women's group, in addition to variables predicted for men, hand circumference at the distal palmar crease and first web levels, as well as arm circumference, could be predicted using the identified equations. Based on the findings, 2D image processing could be an appropriate method for designing personalized cock-up splints.

Telepsychiatry and In-Person Care for Pediatric Patients During COVID-19: Patients’ Perspectives

The COVID-19 pandemic has changed how child and adolescent psychiatrist’s practice. Nationwide restrictions and public health recommendations have reshaped the patient care setting to avoid spread of the virus. A major shift came in the form of telehealth, which allowed patients to attend clinic appointments online. Some of our clinic’s child and adolescent psychiatrists began practicing telehealth in March 2020 and continued completely virtually for one year. Other providers in our practice continued with in-person visits.

Impact of a pharmacist-led patient-centred care intervention along with textmessage reminders, on the management of newly diagnosed tubercular patients: A protocol for a randomized controlled trial.

Non-adherence to tuberculosis (TB) treatment is the leading cause of the increase in drug resistance cases. This study will determine the effectiveness of pharmaceutical-care-based interventions coupled with short messages delivered by a pharmacist on treatment outcomes and adherence among TB patients. The study will be conducted in TB Control Center of Pakistan Institute of Medical Sciences Hospital, Islamabad and District Bannu TB Control Center time period will be from August 2019 to September 2021. The patients will be included into the control group (usual care) or the intervention group pharmaceutical care and SMS reminder. The primary outcome includes a change in mean score from baseline in treatment outcomes and adherence, measured by Morisky Medication Adherence Scale, and clinic appointment attendance registration. Secondary outcomes include health-related quality of life of patients, disease knowledge, and patient satisfaction with the intervention. The major issues in patients with TB are cure rate and medication adherence. The method anticipated in this manuscript could set the foundation of pharmaceutical care and mobile SMS for the future provision of care to improve TB treatment outcomes. The study will make available fundamental information about the influence of the patient centered program on the adherence and clinical outcomes of patients with TB.Trial status and registration: Clinical Trials.gov assigned Identifier NCT04645836.

The Relationships between Family Resources, Parental Stress, and Child Well-Being in Pediatric Sickle Cell Disease

Introduction: Parents and caregivers play an important role in the management of pediatric chronic illness. In sickle cell disease (SCD), families often manage multiple components simultaneously, such as attending clinic appointments, following a medication regimen, and treating pain symptoms. The availability of resources is known to affect disease management. However, it is unknown how children and parents view their resource availability, and how this can impact both parent stress and child quality of life (QoL). The current study examined the ways in which family resources, parental stress, and child well-being interact with and potentially influence each other. We hypothesize the following: 1) There is a relationship between family resources and child well-being such that more family resources leads to higher quality of life reporting; 2) There is a relationship between family resources and parental stress such that more family resources leads to lower parental stress; and 3) Parental stress moderates the relationship between family resources and child well-being. Methods : Parents of youth with SCD reported on the adequacy of their family's resources by completing the 30-item Family Resource Scale (FRS), rating items on a 5-point Likert scale (1 = not adequate at all to 5 = almost always adequate). Parents also reported on their parental stress by completing the 42-item Pediatric Inventory for Parents (PIP), rating items on a 5-point Likert scale (1 = never/not at all to 5 = very often/extremely). Children and parents reported on the child's overall well-being by completing the 43-item PedsQL SCD Module self-report form and 43-item parent proxy-report, rating items on a 5-point Likert scale (0 = never to 5 = almost always). Pearson's correlation coefficients were calculated to measure relationships between family resources (FRS) and child well-being (PedsQL), family resources (FRS) and parental stress (PIP), and parental stress (PIP) and child well-being (PedsQL). Multiple regressions were used to determine if parental stress moderated, or changed the effect of, family resources on child well-being. Results: Seventy-eight primary caregivers of youth aged 7-16 with SCD (Mean age = 10.37, SD = 2.86; 58% female; 68% HbSS; 87% African American or Black; 90% Not Hispanic) completed measures on their family resources and parental stress. Preliminary correlation analyses show the relationship between family resources and child self-reports on QoL was weak, positive, and not significant (r = 0.18, p = .167). The relationship between family resources and parent proxy-reports on QoL, however, was moderate, positive, and significant (r = .36, p = .001). The correlation between family resources and parental stress was moderate, negative, and significant (r = -.42, p &amp;lt; .001). The correlation between parental stress and child QoL self-reports was weak, negative, and significant (r = -.225, p = .05). The correlation between parental stress and parent proxy-reports on child QoL was moderate, negative, and significant (r= -.50, p = &amp;lt;.001). Multiple regression results for parent proxy-reports on child QoL show parental stress significantly and negatively impacts parent proxy-reports on child QoL (b = -5.52, p = .034). The relationship between family resources and parent proxy-reports on child QoL was not moderated by parental stress (b = 2.44, p = .207). Conclusion: There is a relationship between family resources and child well-being such that more resources reflect higher quality of life, but only when the parents are reporting on their child's well-being. Current results also show that as family resources decrease, parental stress moderately increases. Parental stress significantly impacted both self-reports and parent proxy-reports on child quality of life, though there was a weaker relationship shown in child self-reports. It's likely that parents who are more stressed view their child as being more stressed. Future interventions should consider including parent components to 1) further understand the role of parental stress as it relates to pediatric SCD management and 2) identify ways to best support families experiencing resource inadequacy or high levels of parental stress. Developing screeners to give to parents of youth with SCD during clinic appointments could offer a destigmatized way of connecting families to resources and providing tools for parental stress management.

The Association of Frailty and Malnutrition With Dietary Intake and Gastrointestinal Symptoms in People With Kidney Failure: 2-Year Prospective Study

Frailty and malnutrition are both associated with worsening morbidity and mortality and become more prevalent in the elderly and as kidney function declines. Anorexia and reduced oral intake are common features of both frailty and malnutrition. However, there are sparse data evaluating the impact of other gastrointestinal (GI) symptoms, such as taste changes, on rates of frailty and malnutrition in people with kidney failure. The aim of this study is to describe the prevalence of frailty and malnutrition and their association with dietary intake and nutrition-related symptoms in people with kidney failure. This observational study recruited people with kidney failure who were commencing Conservative Kidney Management or elderly people (aged > 75years) newly commenced on dialysis from 3 renal units. Participants underwent assessments of frailty, nutritional status, dietary intake, and GI symptom burden when they attended clinic appointments, approximately every 6months. Of the 85 participants, 57% were assessed as being frail and 33% were assessed as being malnourished. Participants assessed as frail reported more GI symptoms (3 vs. 2, P<.001) that were more severe (1.75 vs. 1.0, P<.001) compared to nonfrail participants. Being malnourished was associated with a 5 times higher chance of being frail (odds ratio 5.8; 95% confidence interval 1.5, 21.8; P=.015) and having more severe symptoms was associated with a 2 times higher chance (odds ratio 2.8; 95% CI 1.1, 7.0; P=.026) of being frail. In addition to experiencing more GI symptoms, that were more severe, participants who were malnourished consumed significantly less energy (1234kcal vs. 1400kcal, P=.01) and protein (51 g vs. 74 g, P<.001). Frailty and malnutrition are common and are associated with a higher GI symptom burden and poorer dietary intake. Future research is needed to determine effective interventions targeting frailty and malnutrition, including nutrition-related symptoms and optimal protein intake.

1154-P: Racially and Ethnically Inclusive Recruitment Strategies from the CoYoT1 to California (CTC) Study

Background: The prevalence of type 1 diabetes (T1D) is increasing within racially and ethnically marginalized populations, highlighting the need for effective recruitment strategies that not only address healthcare disparities but also rebuild trust in medical research. Recently, the CoYoT1 to California (CTC) study evaluated a person-centered care model designed to support racially and ethnically diverse young adults (YA) who receive care at a hospital-based pediatric T1D clinic. In addition to treatment effectiveness, the study examined the success of recruitment strategies. Methods: Potential YA participants were approached in-person or remotely (by phone, email, or text). Those with clinic appointments during study recruitment were approached in-person, with recruiters focusing on cultural humility to connect with families; the concept and process of research was introduced, and families were allowed to ask questions as needed. Remote recruitment utilized multiple pre- and post-appointment messages with basic descriptions of the study or follow-up details as needed. Categorical data were compared using chi-squared tests. Results: The study approached 338 potential participants and recruited 68 (20%). Reflecting successful recruitment of diverse YA, study participants were representative of the clinic population in terms of racial and gender identities, and identified as Latinx (29, 43%) more often than those who declined (100, 37%; P=0.40). Recruitment strategy was significantly associated with participation, as most participants were recruited in-person (40, 59%), while most who declined did so remotely (200, 74%; P&amp;lt;0.0001). Conclusion: In-person recruitment is more effective for enrolling diverse YA and their families, as it allows recruiters to build rapport, and empowers families with information and choice. Internal and external barriers may prevent diverse YA from attending clinic appointments in-person, ultimately impacting research equity. Disclosure F.Gonzalez: None. M.W.Reid: None. E.Salcedo-rodriguez: None. J.Flores garcia: None. S.Hiyari: None. A.Torres sanchez: None. E.Pyatak: Research Support; Abbott Diabetes. D.Fox: None. J.Raymond: None. Funding Patrick and Catherine Weldon Donaghue Medical Research Foundation

P415 A service evaluation to quantify real-world spirometry grading and frequency data following the introduction of the NuvoAir Air Next lung function device in one UK cystic fibrosis (CF) centre

Prior to the introduction of remote spirometry devices, people with cystic fibrosis (CF) would typically attend clinic appointments every three months or acutely where a lung function test may be performed. Evaluation of the frequency and grading of spirometry results was undertaken following the introduction of the NuvoAir Air Next lung function device.

Evaluating quality of life and satisfaction with pharmaceutical care services among patients with type II diabetes mellitus receiving care in a resource-limited setting

Objectives: Quality of life assessment is considered an important measure of outcome in long-term illness and management. Patient satisfaction surveys are essential in obtaining a comprehensive understanding of the patient’s needs and their opinion of the service received. The purpose of this study was to determine the health-related quality of life (HRQOL) and satisfaction with pharmaceutical care services among patients with type II diabetes mellitus (DM) receiving care in Nigeria. Materials and Methods: A cross-sectional prospective study was conducted among 120 patients with type II DM receiving treatment at General Hospital Ikot Ekpene in Akwa Ibom state, Nigeria. Patients who met the eligibility criteria and attended clinic appointments at the medical outpatient clinic as well as those admitted into the medical wards of the hospital during the period of the study were recruited. Data on the extent of patients’ satisfaction with pharmaceutical care as well as their quality of life in diabetes were obtained using the patient satisfaction with pharmaceutical care questionnaire, and the patient quality of life based on diabetes related complaints questionnaire. The duration of the study was 7 months. Data obtained were analyzed using the Statistical Program and Service Solutions version 25.0 computer package with statistical significance set at P &lt; 0.05. Results: The quality of life of the patients based on diabetes-related complaints was poor. Fatigue was the most frequently reported complaint (n = 116; 96.6%), followed by polyuria (n = 106; 88.33%). The overall mean scores of patient satisfaction with pharmacists’ friendly explanation and management of therapy were 4.03 (±0.52) and 3.53 (±0.44), respectively. There was a statistically significant relationship between patients’ satisfaction with pharmacists’ friendly explanations and patient complaints of weight changes (r = 0.219; P &lt; 0.05), decreased energy levels (r = 0.205; P &lt; 0.05), and numbness (r = 0.270; P &lt; 0.01). Furthermore, there was a statistically significant relationship between patients’ satisfaction with pharmacists’ therapy management and patients’ complaint of fatigue (r = 0.187; P &lt; 0.05), numbness (r = 0.189; P = 0.05), and blurred vision (r = 0.204; P &lt; 0.05). Conclusion: The HRQOL of the patients was poor as the majority of the patients had diabetes-related complaints. Patients’ satisfaction with the pharmaceutical care services offered was good. Periodic evaluation of the quality of life and satisfaction with health-care services among patients with DM is recommended.

The Health Belief Model Modifying Factors Associated with Missed Clinic Appointments among Individuals with Sickle Cell Disease in the Jazan Province, Saudi Arabia.

In treating chronic illnesses, such as sickle cell disease (SCD), outpatient care is essential; poor adherence in attending clinic appointments can lead to serious outcomes. SCD is highly prevalent in Saudi Arabia, and patients with SCD are advised to follow up with their treating physician in order to control this disease manifestation and to better forecast its complications. Studies evaluating missed appointments among patients with SCD are rare. Therefore, the current study aimed to use the health belief model's modifying factors in order to evaluate the variables associated with poor adherence in attending appointments. A total of 381 participants with SCD from various regions in the Jazan Province, southwestern Saudi Arabia, were included. The survey instrument included socioeconomic determinants, factors associated with poor adherence in attending outpatient appointments, and solutions under the conceptual framework of the health belief model. A descriptive analysis was conducted and the factors that impacted adherence in attending the appointments were evaluated. In the current sample, respondents with SCD from 21 to 30 years represented 41%, which was followed by participants who were 11 to 20 years at 21.5%. In addition, about 60% of the participants were women. Further, approximately 62% of the patients admitted were missing one or more outpatient appointments in the previous year, which was significantly related to various factors, such as socioeconomic characteristics and patient residence. Forgetting the appointment was the main reason for skipping outpatient appointments for patients with SCD; as such, reminders appear to be a good solution for most participants. Our findings indicated that modifying components of the health belief model, including age, level of education, income, patients' residence, and lacking cues to action (such as reminders) are important in explaining the reason for poor adherence in attending appointments. Thus, efforts are needed to address these factors and to ensure that SCD patients uphold their appointments. Future studies should examine the clinical, psychological, and epidemiological aspects that are linked with missed consultations.

A New Look at Barriers to Clinical Care Among Appalachian Residents Living With Diabetes.

In the United States, diabetes is the seventh leading cause of death and continues to rise in prevalence, with type 2 diabetes accounting for 90-95% of all cases. Rates of diabetes in Kentucky, and, in particular, the Appalachian region, are among the highest in the nation and are increasing faster than the national average. Despite this disproportionate burden, barriers to clinical appointment attendance have not been fully explored in this population. This article examines the association among perceived barriers to clinical attendance, glycemic control, and diabetes self-care as part of an ongoing study. We used a 25-item checklist developed using the Chronic Care Model to assess participants' barriers to clinic attendance. Glycemic control was assessed via A1C measurement. Diabetes self-care was assessed using the Summary of Diabetes Self-Care Activities measure. At the time of analysis, 123 of the 356 participants (34.6%) did not report any barriers to clinic attendance. For the remainder, the major reported barriers included forgetting appointments, inability to afford medicines or other treatment, and placing faith above medical care. The average A1C was 7.7%, and the average diabetes self-care summary score was 17.1 out of 35 points (with higher values indicating better self-care). Missing clinic appointments is associated with lower health outcomes, especially in vulnerable populations. This study can help educate clinic staff on perceived barriers to type 2 diabetes management among people with diabetes in Appalachia.

Viability of telepsychiatry - results from an ambulatory academic tertiary care clinic

During the 2020 COVID-19 pandemic, telemedicine became an important method of providing patient care and minimizing person-to-person contact. For example, it has been considered a reasonable option for patients who have been discharged from the intensive care unit (ICU) and other acute settings. Previous studies have indicated that using telemedicine with psychiatry, also known as telepsychiatry, may be preferred by certain patient groups, such as rural patients. This study aims to evaluate the impact of transitioning to telepsychiatry services in response to the pandemic on patient appointment compliance of a university affiliated ambulatory clinic in Lubbock, Texas. Retrospective data on clinic appointment attendance from three separate three-month time periods (March-June 2019, December 2019- March 2020, March-June 2020) were used to determine their respective no-show prevalence. Results were analyzed with chi square testing (

HIV outcomes within the context of orphans and vulnerable children programing: the 4Children project in South Sudan

BackgroundPoor antiretroviral therapy (ART) adherence is a challenge to containing the spread of HIV. This is an especially difficult challenge in conflict and post-conflict settings. This study investigates the relationship between attendance in an Orphan and Vulnerable Children program in South Sudan and HIV-related outcomes, including clinic appointment attendance, frequency of viral load testing and viral load suppression rates.MethodsPatient records (n = 295) were selected from project-supported clinics in Juba, South Sudan, and analyzed to measure the association between enrollment status and select health outcomes. Data were collected at multiple time points between 2018 and 2019, to measure the strength of relationship between select treatment variables (e.g., viral load, retention in care, etc.). Given the structure of the data, non-parametric tests were applied to answer the research questions.ResultsAnalysis revealed three important trends: (1) enrollment in the 4Children project was associated with a statistically significant increase in the frequency of viral load testing; (2) there was an increase in median appointment attendance after program enrollment; and (3) there was improved management of viral load and CD4 count, albeit small, during the time period before and after enrollment.ConclusionsData from South Sudan suggests that caregivers and children receiving project services saw improvement in treatment-related indicators. After enrolling in the project, overall amount of viral load testing increased from previous counts before enrollment. This suggests that after providing additional services with psychosocial and financial support to patients at the two hospitals in Juba, there was potential that similar interventions can support improved HIV outcomes.

Factors affecting optimal adherence to antiretroviral therapy and viral suppression amongst HIV-infected prisoners in South Ethiopia: a comparative cross-sectional study

BackgroundMaintaining optimal adherence and viral suppression in people living with HIV (PLWH) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of treatment adherence and viral suppression in incarcerated populations in low-income countries is unknown. This study aimed to determine factors affecting optimal adherence to antiretroviral therapy and viral suppression amongst HIV-infected prisoners in South Ethiopia.MethodsA comparative cross-sectional study was conducted between June 1, 2019 and May 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWH. Patient information including demographic, socio-economic, behavioral, and incarceration-related characteristics were collected using a structured questionnaire. Medication adherence was assessed according to self-report and pharmacy refill. Plasma viral load measurements undertaken within the study period were prospectively extracted to determine viral suppression. Univariate and multivariate logistic and fractional regression models were used to analyse data.ResultsSeventy-four inmates living with HIV (ILWH) and 296 non-incarcerated PLWH participated in the study. While ILWH had a significantly higher pharmacy refill adherence compared to non-incarcerated PLWH (89 vs 75%), they had a slightly lower dose adherence (81% vs 83%). The prevalence of viral non-suppression was also slightly higher in ILWH (6.0%; 95% confidence interval (CI): 1.7–14.6%) compared to non-incarcerated PLWH (4.5%; 95%CI: 2.4–7.5%). Overall, missing ART appointments, dissatisfaction with ART services, inability to comply with a specified medication schedule, and types of methods used to monitor the schedule (e.g., news time on radio/TV or other social cues) were significantly associated with non-adherence according to self-report. In ILWH specifically, accessing ART services from a hospital, inability to properly attend clinic appointments, depressive symptoms, and lack of social support predicted NA. Viral non-suppression was significantly higher in males, people of age 31to 35 years and in those who experienced social stigma, regardless of their incarceration status.ConclusionsSub-optimal dose adherence and viral suppression are generally higher in HIV-infected prisoners in South Ethiopia compared to their non-incarcerated counterparts. A multitude of factors were found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.