Missed Clinic Appointments Research Articles

Modifying factors of the health belief model associated with missed clinic appointments among individuals with sickle cell disease

ABSTRACT Objectives: Outpatient care is critical in the management of chronic diseases, including sickle cell disease (SCD). Risk factors for poor adherence with clinic appointments in SCD are poorly defined. This exploratory study evaluated associations between modifying variables from the Health Belief Model and missed appointments. Methods: We surveyed adults with SCD (n = 211) and caregivers of children with SCD (n = 331) between October 2014 and March 2016 in six centres across the U.S. The survey tool utilized the framework of the Health Belief Model, and included: social determinants, psychosocial variables, social support, health literacy and spirituality. Results: A majority of adults (87%) and caregivers of children (65%) reported they missed a clinic appointment. Children (as reported by caregivers) were less likely to miss appointments than adults (OR:0.22; 95% CI:(0.13,0.39)). In adults, financial insecurity (OR:4.49; 95% CI:(1.20, 20.7)), health literacy (OR:4.64; 95% CI:(1.33, 16.15)), and age (OR:0.95; 95% CI:(0.91,0.99)) were significantly associated with missed appointments. In all participants, lower spirituality was associated with missed appointments (OR:1.83; 95%CI:(1.13, 2.94)). The most common reason for missing an appointment was forgetfulness (adults: 31%, children: 26%). A majority thought reminders would help (adults: 83%, children: 71%) using phone calls (adults: 62%, children: 61%) or text messages (adults: 56%, children: 51%). Conclusions: Our findings demonstrate that modifying components of the Health Belief Model, including age, financial security, health literacy, spirituality, and lacking cues to action like reminders, are important in missed appointments and addressing these factors could improve appointment-keeping for adults and children with SCD.

Graves Disease in Central Ghana: Clinical Characteristics and Associated Factors.

BackgroundGraves disease (GD) has increased in prevalence over the past decade in Africa. Despite this, the condition is not well described, especially in sub-Saharan Africa.ObjectiveWe have described the clinical characteristics and associated factors of GD in a cohort of patients attending a resource-limited setting tertiary hospital.MethodsPatients were examined thoroughly and systematically tested for the degree of clinical and biochemical thyroid status. Thyroid volume, characteristics, and blood flow were assessed at presentation using ultrasonography. Factors associated with an inability to achieve clinical and biochemical thyroid remission were evaluated using multiple logistic regression analysis.ResultsOverall, 182 patients were studied, 152 (83.5%) were women with a female:male ratio of 5.1:1.0. The mean age at presentation was 39.9 ± 14.7 years with women significantly older than men. Thyroid-associated orbitopathy (TAO) was observed in 56% of the participants and pretibial myxoedema in 6%. About 84% of the participants were hyperthyroid at presentation, 9% were euthyroid, 4% were hypothyroid, and 3% had subclinical hyperthyroidism. Inability to achieve biochemical and clinical remission at 24 months was associated with increased thyroid volume (odds ratio [OR]: 2.35, 95% confidence interval [CI]: 1.85-2.52, P < .001), presence of TAO (OR: 2.15, 95% CI: 2.12-2.33, P < .001), increased FT3/FT4 ratio (OR: 1.33, 95% CI: 1.24-2.56, P = .004), and missed clinic appointment (OR: 5.2, 95% CI: 4.55-7.89, P < .001).ConclusionsGraves disease among Ghanaians is associated with significant signs at presentation. Inability to achieve remission within the first 24 months is associated with increased thyroid volume, TAO, an increased FT3/FT4 ratio, as well as missed clinic appointment.

O-39 Tacrolimus intra-patient variability is an independent factor associated with the need for liver biopsy in paediatric liver transplant recipients

Background The intra-patient variability in tacrolimus exposure (TAC-IPV) after paediatric liver transplantation and its impact on patient outcomes has been poorly studied. The present study aims to investigate whether there is a trend in TAC-IPV during the first 5 years post transplantation, which variables influence IPV and wheth-er the IPV during the first year is associated with liver transplantation outcomes in paediatric patients. Methods We conducted a single centre retrospective study including 41 living paediatric patients transplanted between January 2003 and September 2016 at the Ghent University Hospital. The intra-patient variability in the dose-adjusted tacrolimus pre-dose concentrations was calculated yearly during the first five years following trans-plantation, expressed as coefficient of variation (CV%1–5) The difference in CV% in the years following transplanta-tion was analysed using the Friedman test. A linear uni-variate and multivariate regression analysis was applied to identify factors associated with TAC-IPV. The following parameters were tested: age, gender, origin, the number of missed clinic appointments as a surrogate marker for ther-apy adherence, the total number of medications, concom-itant medications potentially interfering with TAC metabo-lism-CYP3A4/A5 inductors or inhibitors and biochemical parameters. Logistic and linear regression models were fit-ted to test an association of TAC-IPV with patient outcomes: need for biopsy during year 1, 3 and 5; hypertension and renal function at 1, 3 and 5 years; acute rejection and CMV/EBV viremia during year 1 post-transplantation. Results We identified a significant decrease in TAC-IPV during the first 3 years after transplantation with the me-dian CV%1=39,4%; CV%2=30,9%; CV%3=28,5% (p=0,004), after which the CV% reaches a plateau (CV%4=23,6% en CV%5=28,9%). Multivariate analysis showed that serum albumin in the first year (p=0,029), haematocrit in the third year (p=0,019) and the number of missed clin-ic appointments in the fifth year after transplantation (p=0,009) were associated with TAC-IPV.in the 1 st, 3rd and 5th year, respectively. Univariate analysis showed that CV%1 was significantly associated with the need for bi-opsy during the first year post-transplantation (p=0.036) and the occurrence of one or more episodes of acute al-lograft rejection during the first year post-transplantation (p=0.031). In univariate analysis a trend was observed for association with hypertension one year after transplan-tation (p=0,085). Multivariate logistic regression analysis confirmed that CV%1 was an independent factor associ-ated with the need for liver biopsy in the first year follow-ing liver transplantation. (p=0.05; Exp(B)=1.045). Conclusion As expected, tacrolimus intra-patient vari-ability is higher during the first two years after transplantation. Our results suggest that while albumin and hae-matocrit are associated with TAC-IPV in the first 3 years, therapy adherence expressed as the number of missed clinic appointments is associated with TAC-IPV after a longer follow-up. A high TAC-IPV during the first year was an independent factor associated with the need for liver biopsy. Our results therefore highlight the importance of monitoring the variability of the tacrolimus trough levels.

Factors Associated With Missed Appointments at an Academic Pain Treatment Center: A Prospective Year-Long Longitudinal Study.

Interventional pain treatment centers represent an integral part of interdisciplinary care. Barriers to effective treatment include access to care and financial issues related to pain clinic operations. To address these challenges, specialty clinics have taken steps to identify and remedy missed clinic appointments. However, no prospective study has sought to identify factors associated with pain clinic "no-shows." We performed a prospective, longitudinal year-long study in an inner-city, academic pain clinic in which patients scheduled for office visits and procedures were categorized as to whether they showed up or did not show up for their scheduled appointment without cancelling the day before. Twenty demographic (age, employment status), clinical (eg, diagnosis, duration of pain), and environmental (season, time and day of appointment) variables were assessed for their association with missing an appointment. The logistic regression model predicting no-shows was internally validated with crossvalidation and bootstrapping methods. A predictive nomogram was developed to display effect size of predictors for no-shows. No-show data were collected on 5134 patients out of 5209 total appointments for a capture rate of 98.6%. The overall no-show rate was 24.6% and was higher in individuals who were young (<65 years), single, of ethnic minority background, received Medicare/Medicaid, had a primary diagnosis of low back pain or headaches, were seen on a day with rain or snow or for an initial consult, and had at least 1 previous pain provider. Model discrimination (area under curve) was 0.738 (99% confidence interval, 0.70-0.85). A minimum threshold of 350 points on the nomogram predicted greater than 55% risk of no-shows. We found a high no-show rate, which was associated with predictable and unpredictable (eg, snow) factors. Steps to reduce the no-show rate are discussed. To maximize access to care, operation managers should consider a regression model that accounts for patient-level risk of predictable no-shows. Knowing the patient level, no-show rate can potentially help to optimize the schedule programming by staggering low- versus high-probability no-shows.

Medication-related issues associated with adherence to long-term tyrosine kinase inhibitors for controlling chronic myeloid leukemia: a qualitative study.

PurposePoor adherence to tyrosine kinase inhibitors (TKIs) could compromise the control of chronic myeloid leukemia (CML) and contributes to poorer survival. Little is known about how medication-related issues affect CML patients’ adherence to TKI therapy in Malaysia. This qualitative study aimed to explore these issues.Patients and methodsIndividual face-to-face, semistructured interviews were conducted at the hematology outpatient clinics of two medical centers in Malaysia from August 2015 to January 2016. CML patients aged ≥18 years who were prescribed a TKI were invited to participate in the study. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed.ResultsFour themes were identified from 18 interviews: 1) concerns about adverse reactions to TKIs, 2) personal beliefs regarding the use of TKIs, 3) mismanagement of TKIs in daily lives, and 4) financial burden in accessing treatment. Participants skipped their TKIs due to ineffective emesis control measures and perceived wastage of medication from vomiting. Participants also modified their TKI therapy due to fear of potential harm from long-term use, and stopped taking their TKIs based on belief in curative claims of traditional medicines and misconception about therapeutic effects of TKIs. Difficulty in integrating the dosing requirements of TKIs into daily lives led to unintentional skipping of doses, as well as the risk of toxicities from inappropriate dosing intervals or food interactions. Furthermore, financial constraints also resulted in delayed initiation of TKIs, missed clinic appointments, and treatment interruptions.ConclusionMalaysian CML patients encountered a range of medication-related issues leading to a complex pattern of nonadherence to TKI therapy. Further studies should investigate whether regular contact with patients to improve understanding of treatment rationale, to elicit and address patients’ concerns about adverse reactions, and to empower patients with skills to self-manage their medications might promote better adherence to TKIs and improve CML patients’ outcome.

Determinants of Clinic Absenteeism: A Novel Method of Examining Distance from Clinic and Transportation.

Delayed treatment and non-adherence are associated with inferior prostate cancer (CaP) outcomes. Missed clinic appointments (MA) are one form of non-adherence that may be preventable. We conducted a retrospective cohort study of 1341 scheduled clinic encounters for men referred to an academic urology clinic for evaluation of known or suspected CaP. Driving distance and public transit times were calculated using a Google Distance Matrix API algorithm. Zip code level data regarding socioeconomic status was obtained from the 2013 American Community Survey. Logistic regression multivariate analysis was used to identify MA predictors. Of scheduled clinic encounters, 14% were missed. Public health insurance was associated with MA (Private insurance 10%, Public insurance 19%), (p < 0.01) Calendar month was associated with MA with December showing the highest rate (21.2%) and June the lowest (5.3%) rates. (p = 0.02) Appointments for suspected CaP were more likely to be missed (19.3%) than those for known CaP (10.5%), p < 0.01. Driving distance was inversely associated with rate of MA (CA median 11.8 miles, MA median 10.4 miles, p = 0.04) while public transit times were not (66.7min for CA, 65.3min for MA, p = 0.36). Men that missed appointments were from areas with lower household incomes and educational attainment. Patient encounter type, insurance status, and reason for referral remained significantly associated with MA after multivariable adjusted analysis. By computing public transit time to the clinic using a mapping engine, we present a novel way to measure this parameter for studies of urban health care.

MP96-09 PREDICTING PROBABILITY OF MISSED CLINIC VISITS AT AN ACADEMIC MULTI-PROVIDER UROLOGY CLINIC

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III1 Apr 2017MP96-09 PREDICTING PROBABILITY OF MISSED CLINIC VISITS AT AN ACADEMIC MULTI-PROVIDER UROLOGY CLINIC Jordan Foreman, Bryan Wilson, and Julie Riley Jordan ForemanJordan Foreman More articles by this author , Bryan WilsonBryan Wilson More articles by this author , and Julie RileyJulie Riley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3032AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the predicted shortage of urologists nationwide, efficiency in outpatient urology clinics is crucial. Our previous study demonstrated predictable patient demographics and diagnoses associated with missed clinic appointments. The significant characteristics of our study included: age, new versus established patient, and patient diagnoses. This study aims to utilize our previous data to develop a model to predict patient missed clinic appointments. METHODS Utilizing our previous data, logarithmic regression analysis was performed to formulate an equation to predict the probability of a patient missing their appointment. Variables included age, new versus established patient, and groupings of 27 patient diagnoses. Using this equation, a retrospective analysis of clinic patient data was performed for four full-time academic urologists over a six-month period comparing predicted versus actual missed visits. RESULTS A total of 2486 clinic appointments were compiled for four providers in the adult urology clinic over six months. Of the total, 408 were actual missed clinic visits at an overall no-show rate of 16.4%. The calculated number of patients missing their appointments was 488. Of the predicted 488 missed visits, the calculated number of patients was over by 130 with an average of 1.19 patients over per day, and under by 50 with an average of 0.46 patients under per day. The number of perfect days where the predicted number matched the actual number was 26/109 (23.9%), within +/- 1 patients 61/109 (56.0%), and within +/- 2 patients 87/109 (79.8%). Conversely, the model over predicted 4 or greater patient no-shows on 6/109 (5.5%) of days. Over-predicted patients per day ranged from 0.01-6.5 with a mean of 1.58. CONCLUSIONS This review further characterizes the predictable patient characteristics associated with missed clinic visits for an under-served academic urology patient population. This model works well over a large number of patients with a 79.8% efficacy within 2 patients. Applying this to a clinical setting would be limited by overestimating the number of patients that would be scheduled. The model still will require validation when put to test on data from different practice settings and larger patient data sets. Additionally, we predict there may be confounding factors (type of insurance, distance to appointment, previous missed appointments) that we plan to study in order to add to the accuracy of the model. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1297-e1298 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jordan Foreman More articles by this author Bryan Wilson More articles by this author Julie Riley More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Daily Marijuana Use is Associated with Missed Clinic Appointments Among HIV-Infected Persons Engaged in HIV Care.

We assessed the association between marijuana use and retention in HIV care through a retrospective cohort study of patients engaged in care at a large HIV clinic in 2011 and 2012. Two different retention outcomes were assessed: not meeting the Institute of Medicine's (IOM) retention definition (≥2 provider visits ≥90days apart in a calendar year) and no-show visits. Any marijuana use and frequency of marijuana use were obtained from a substance use screening questionnaire administered at each clinic visit. Modified Poisson regression was used to estimate risk ratios and 95% confidence intervals for the association between marijuana use and retention outcomes. Marijuana use was reported by 17% of 1791 patients and 21% were not retained (IOM definition). Marijuana use was not associated with the IOM retention outcome, but was associated with missing the next scheduled appointment. A non-linear dose-response was observed for frequency of marijuana use and missed visits, with daily users having the highest risk compared to non-users. Daily marijuana use had a negative impact on HIV clinic attendance. Further research is needed to elucidate the mechanisms by which marijuana use affects this outcome to inform targeted interventions.

FACTORS AFFECTING ANTIRETROVIRAL DRUG ADHERENCE AMONG HIV ADULT PATIENTS ATTENDING HIV CLINIC AT THE UNIVERSITY TEACHING HOSPITAL IN LUSAKA

BackgroundEffectiveness of anti-retroviral therapy (ART) requires strict adherence. Adherence ≥95% achieves optimum therapeutic levels and reduces drug resistance. We sought to determine factors associated with ART adherence within the context...

High self-reported non-adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors.

Introduction: Globally adolescents and young adults account for more than 40% of new HIV infections, and HIV-related deaths amongst adolescents increased by 50% from 2005 to 2012. Adherence to antiretroviral therapy (ART) is critical to control viral replication and preserve health; however, there is a paucity of research on adherence amongst the growing population of adolescents living with HIV/AIDS (ALHIV) in Southern Africa. We examined levels of self-reported ART adherence, barriers to adherence, and factors associated with non-adherence amongst ALHIV in Malawi.Methods: Cross-sectional study of 519 ALHIV (12–18 years) attending two large HIV clinics in central and south-eastern Malawi. Participants self-reported missed doses (past week/month), barriers to adherence, and completed questionnaires on past traumatic events/stressors, disclosure, depression, substance use, treatment self-efficacy, and social support. Biomedical data were retrieved from existing medical records. Multivariate logistic regression was performed to identify factors independently associated with self-reported ART adherence (7 day recall).Results: The mean age of participants (SD) was 14.5 (2) years and 290 (56%) were female. Of the 519 participants, 153 (30%) reported having missed ART doses within the past week, and 234 (45%) in the past month. Commonly reported barriers to adherence included forgetting (39%), travel from home (14%), busy with other things (11%), feeling depressed/overwhelmed (6%), feeling stigmatized by people outside (5%) and within the home (3%). Factors found to be independently associated with missing a dose in the past week were drinking alcohol in the past month (OR 4.96, 95% CI [1.41–17.4]), missed clinic appointment in the past 6 months (OR 2.23, 95% CI [1.43–3.49]), witnessed or experienced violence in the home (OR 1.86, 95% CI [1.08–3.21]), and poor treatment self-efficacy (OR 1.55 95% CI [1.02–2.34]). Sex and age were not associated with adherence.Conclusions: In our study, nearly half of all ALHIV reported non-adherence to ART in the past month. Violence in the home or alcohol use in the past year as well as poor treatment self-efficacy were associated with worse adherence. Sub-optimal adherence is a major issue for ALHIV and compromise treatment outcomes. Programmes specifically tailored to address those challenges most pertinent to ALHIV may help improve adherence to ART.

PTH-115 Increasing Access to Hepatitis C Treatment in The North East of England

Introduction Chronic infection with hepatitis C (HCV) is a major cause of cirrhosis and hepatocellular carcinoma. Many patients are now eligible for oral direct acting antivirals (DAAs), with cure rates >90% possible. The main challenge for viral hepatitis teams now is to engage known HCV infected individuals in treatment, and to find undiagnosed cases. There are an estimated 2000 HCV infected individuals in North of Tyne (NOT) Region (Newcastle, North Tyneside and Northumberland). However, it is unknown what proportion of HCV infected individuals diagnosed in this region ultimately receive treatment. Aim 1) To determine the proportion of HCV infected individuals in our region who were referred for treatment, received treatment and achieved a sustained virological response (SVR). 2) To determine whether contact can be made with patients who never had HCV RNA confirmatory testing, were never referred, or persistently missed clinic appointments. Methods We conducted a retrospective review of all patients with a NEW positive HCV antibody test between Jan 2011 and Dec 2012 in the NOT region. Patients were identified from the North East Public Health Laboratory. Medical records and treatment databases were accessed to establish outcomes for all patients. For patients never referred or lost to follow up a letter was sent to their GP advising them to contact the patient and discuss re-referral. Results Overall 92% of HCV antibody positive patients have HCV RNA testing performed (Figure 1). 88% of HCV RNA positive patients are referred for consideration for treatment. Of these, 47% commenced antiviral therapy, with an overall SVR of 66%. Persistent non-attendance was the main reason for not starting treatment. Letters were sent to GPs of 77 patients who were never referred or were lost to follow up. The GP response rate was 31% (24/77) after 8 weeks. Six (8%) patients were re-referred to the service. Conclusion There is a high rate of referral for HCV RNA positive patients (88%) in the North of Tyne region, with 47% commencing PEG-IFN based treatment. Some reasons for not starting treatment should resolve in the DAA era, increasing treatment rates.Contacting GPs to re-refer known HCV RNA positive patients is an inexpensive approach, but resulted in relatively few referrals. Improving HCV testing across the region is essential to increase access to treatment. Disclosure of Interest None Declared

Barriers to transition in young adults with neurogenic bladder

'Transition' not only involves finding an adult healthcare provider, but also includes the process of developing the patient's ability to care for him/herself. Recent literature states that 40% of young adults with special healthcare needs are receiving the tools needed for transition. Pediatric urologists treating patients with complex anomalies, such as spina bifida, often anticipate poor outcomes for patients who are ill equipped for transition to adult care. The goal of this study was to identify potential barriers for young adults with neurogenic bladder when transitioning to independent care. A prospective IRB-approved study was performed on all patients with neurogenic bladder referred to the transitional urology clinic. Reasons for missed appointments were tracked, and all patients were asked to complete the Transition Readiness Assessment Questionnaire (TRAQ) in private prior to an appointment. The TRAQ responses are scaled 1-5, with higher numbers corresponding to higher transition readiness of each individual skill. The mean score for each question was calculated across all patients, and the mean TRAQ score was calculated across all questions for each patient. To assess if certain subgroups were more prepared for transition, mean scores were compared between sexes, patients aged <19 and≥19 years old, and between ambulatory and full-time wheelchair users with unpaired t-tests. A total of 73% (58/79) of patients referred to the transitional clinic came to their appointment. The most common reason for missed clinic appointments was related to health insurance coverage (47%). A total of 42 patients completed the TRAQ at a mean age of 19.5 years old; 90% (38/42) had spina bifida. Females, ambulatory patients, and those ≥19 years old had higher overall mean TRAQ scores, but these differences were not statistically significant. The highest TRAQ scores were related to taking and ordering medications, utilization of medical supplies, communication with healthcare providers, and assisting with household duties. The majority of the patients indicated 'I am learning to do this'. The lowest scores were in response to questions about health insurance coverage, payments for medications or medical equipment, financial help, and utilization of community services. Most patients responded 'I do not know how but I want to learn'. Young adults with neurogenic bladder needed the most guidance during transition to independent care, with management of health insurance and finances. Based on these findings, dedicated social work and nurse visits have been included into the transition process.

Factors determining the risk of diabetes foot amputations – A retrospective analysis of a tertiary diabetes foot care service

AimsTo identify which factors predict the need for minor or major amputation in patients attending a multidisciplinary diabetic foot clinic (DFC). MethodsA retrospective analysis of patients who attended over a 27 month period were included. Patients had to have attended ≥3 consecutive consultant led clinic appointments within 6 months. Data was collected on HbA1c, clinic attendance, blood pressure, peripheral arterial disease (PAD), and co-morbidities. Patients were followed up for 1 year. Results165 patients met the inclusion criteria. 121 were male. 33 patients had amputations. There was an association between poor glycaemic control at baseline and risk of amputation when adjusted for other factors, with those patients having HbA1c ≤58mmol/mol (7.5%) at less risk of amputation with an odds of 0.14 (0.04–0.53) of amputation(p=0.0036). Other statistically significant factors predictive of amputation were: missing clinic appointments (p=0.0079); a high Charlson index (p=0.03314); hypertension (p=0.0216). No previous revascularisation was protective against amputation (p=0.0035). However PAD was not seen to be statistically significant, although our results indicated a lower risk of amputation with no PAD. Overall, 34.9% (n=58) of patients had good glycaemic control (HbA1c <58mmol/mol, [7.5%]) at baseline and 81.3% (n=135) had improved their glycaemic control at their last follow up appointment. ConclusionsIn this cohort poor glycaemic control, poor attendance, previous revascularisation and hypertension were associated with higher risk of amputation, with PAD showing a trend. Moreover, we demonstrated benefits in glycaemic control achieved by attending this DFC, which is likely to translate to longer term diabetes related health benefits.

Determinants of Noncompliance to Clinic Appointments and Medications among Nigerian Children with Epilepsy: Experience in a Tertiary Health Facility in Enugu, Nigeria

Purpose. To determine the frequency and determinants of noncompliance to clinic appointment and medication among Nigerian children with epilepsy. Method. This is a cross-sectional survey of noncompliance to clinic appointments and medication among 113 consecutive children with epilepsy attending the Paediatric Neurology Clinic of University of Nigeria Teaching Hospital, Enugu, southeastern Nigeria. Results. Noncompliance to clinic appointment and medication was 23% and 15.3%, respectively. The major reasons given were lack of finance, clashing with school time, and forgetting to take the drugs. Children whose mothers were less educated and unemployed were more likely to miss clinic appointments. Noncompliance to medication was associated with poor seizure control. Children that were on phenobarbitone were more likely to be noncompliant with medication than those on sodium valproate and/or carbamazepine. Conclusion. Missed clinic appointment and medication noncompliance are common among Nigerian children with epilepsy and financial constraint is the most common reason.

Depression and literacy are important factors for missed appointments

Multiple variables are related to missed clinic appointments. However, the prevalence of missed appointments is still high suggesting other factors may play a role. The purpose of this study was to investigate the relationship between missed appointments and multiple variables simultaneously across a health care system, including patient demographics, psychiatric symptoms, cognitive functioning and literacy status. Chart reviews were conducted on 147 consecutive patients who were seen by a primary care psychologist over a six month period and completed measures to determine levels of depression, anxiety, sleep, cognitive functioning and health literacy. Demographic information and rates of missed appointments were also collected from charts. The average rate of missed appointments was 15.38%. In univariate analyses, factors related to higher rates of missed appointments included younger age (p = .03), lower income (p = .05), probable depression (p = .05), sleep difficulty (p = .05) and limited reading ability (p = .003). There were trends for a higher rate of missed appointments for patients identifying as black (p = .06), government insurance (p = .06) and limited math ability (p = .06). In a multivariate model, probable depression (p = .02) and limited reading ability (p = .003) were the only independent predictors. Depression and literacy status may be the most important factors associated with missed appointments. Implications are discussed including regular screening for depression and literacy status as well as interventions that can be utilized to help improve the rate of missed appointments.

High Prevalence of Severe Food Insecurity and Malnutrition among HIV-Infected Adults in Senegal, West Africa.

BackgroundMalnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS; however, the prevalence of malnutrition and food insecurity among people living with HIV/AIDS in Senegal, West Africa is unknown. The objective of this study was to determine the prevalence and severity of food insecurity and malnutrition among HIV-infected adults in Senegal, and to identify associations between food insecurity, malnutrition, and HIV outcomes.MethodsWe conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review.ResultsOne hundred and nine HIV-1 and/or HIV-2 participants were enrolled. The prevalence of food insecurity was 84.6% in Dakar and 89.5% in Ziguinchor. The prevalence of severe food insecurity was 59.6% in Dakar and 75.4% in Ziguinchor. The prevalence of malnutrition (BMI <18.5) was 19.2% in Dakar and 26.3% in Ziguinchor. Severe food insecurity was associated with missing clinic appointments (p = 0.01) and not taking antiretroviral therapy due to hunger (p = 0.02). Malnutrition was associated with lower CD4 cell counts (p = 0.01).ConclusionsSevere food insecurity and malnutrition are highly prevalent among HIV-infected adults in both Dakar and Ziguinchor, and are associated with poor HIV outcomes. Our findings warrant further studies to determine the root causes of malnutrition and food insecurity in Senegal, and the short- and long-term impacts of malnutrition and food insecurity on HIV care. Urgent interventions are needed to address the unacceptably high rates of malnutrition and food insecurity in this population.

Ethnicity, Marital Status, Primary Care Provider Status and Appointment Wait Time Predict Attendance at Outpatient Gastroenterology Clinic

Introduction: Missed clinic appointments reduce clinic efficiency, waste resources and increase costs. Limited data exists on subspecialty clinic attendance. The only US study to examine the factors associated with missed gastroenterology clinic attendance was performed in an urban safety net healthcare population. The goal of this study was to identify the factors associated with missed appointments at a gastroenterology (GI) clinic in an academic setting. Methods: We performed a case-control study using data from the electronic health record (EHR) of patients scheduled for an appointment at one of the adult GI clinics at the University of Arizona Medical Center between 03/03/2014 and 10/31/2014. Patients who missed their clinic appointment during the study period served as cases. Controls were randomly selected from patients who completed their appointment during the study period. Univariate and Multivariate logistic regression analysis were utilized for the data analysis.Table 1: Logistic regression analysis of factors associated with missed clinic appointments.Results: Of 2,331 patients scheduled for appointment, 195 (8.4%) missed their appointment. A random sample of 390 controls was selected from patients who completed their clinic appointment. In the final analysis, there were 192 cases (33.6%) and 379 controls (66.4%). Age, ethnicity, marital status, employment status, primary care status and time from referral to appointment were associated with missed appointment in Univariate analysis. In Multivariate analysis, time from referral to appointment was strongly associated with missed clinic appointment; patients with appointment >28 days from referral were more likely to miss their appointment than patients with appointment in ≤28 days (adjusted odds ratio [AOR] 2.6[1.7,4.0]). Patients with primary care provider were less likely to miss their clinic appointment than those without primary care provider (AOR 0.36[0.2,0.6]). Hispanic (AOR 1.9[1.2,3.2]) and Native American (AOR 6.8[1.9,23.5]) patients were more likely than Caucasian patients to miss their clinic appointment. Single patients were more likely than married patients to miss their appointment (AOR 1.9[1.2,3.0]). Conclusion: Longer time from referral to appointment, ethnicity and marital status were strongly associated with missed clinic appointment. Patients with primary care provider were less likely to miss their clinic appointment than patients without primary care provider. Development of directed strategies that account for these factors involved in GI clinic attendance can enhance patient care and reduce costs.

P17.19 Time to linkage, retention and adherence to hiv care among married couples in the fishing communities on lake victoria

Background Prompt linkage to care, retention in care and adherence to medication are important in achieving the WHO’s 90–90–90 treatment target. Achieving these targets is important for treatment and prevention of new infections. We sought to establish the time to linkage to care, retention in care and adherence to HIV medications in a cohort of people testing HIV positive in the fishing communities on Lake Victoria. Methods We conducted a 2-year resurvey of 128 participants who had tested HIV positive in a previous study. These participants were asked to return to the study clinic to participate in a follow-up study. Returning participants were consented and invited for a face-to-face interview on enrolment into HIV care, time to enrolment, retention in care and adherence to HIV care instructions. We mainly used descriptive statistics to analyse the data. Results Of 128 participants, 47.7% were female and half were aged 33.5 (IQR, 29–38.7) with a median monthly income of $66 (IQR, 33–99). Eighty three percent had enrolled in HIV care within a median of 20 days (IQR, 7–60) after testing HIV positive. Women were more likely to enrol in care compared to men (91.8% vs 74.6%; p = 0.011) but no significant difference in time taken to enrol in care. Over 38% of the participants had ever missed their clinic appointments since they first enrolled into care with half having missed 2 appointments (IQR, 1–3.5) in the preceding 12 months. Similarly, 26% had ever missed taking medications as prescribed with half having missed twice (IQR, 1–8.5) in the preceding 12 months. The most common reason cited for both missing clinic appointments and taking medications prescribed was travelling away from home. Conclusion The numbers enrolled into care falls below the expected 90% to achieve 90–90–90 treatment target by WHO. More innovative ways need to be developed to achieve these targets. Disclosure of interest statement This research was supported by a grant from the Consortium for National Health Research. No pharmaceutical grants were received in the development of this study.

The impact of a text messaging service on orthopaedic clinic Did Not Attend rates

Background Missed clinic appointments cause delays in treatment of other patients, under utilization of clinical manpower or facilities and impact upon hospital finances. Aims The primary aim of this study is to evaluate whether a text messaging reminder service reduces the Did Not Attend rate. The secondary aim is to evaluate the cost-effectiveness of a mobile text message reminder service. Methods The study focused on the outpatient department of a district general hospital. In January 2011 a patient text messaging reminder service was implemented across the outpatient departments in the trust. Data were collected prospectively 24 months prior and 24 months following the implementation of this service. A reminder was sent to patients one week prior to the scheduled appointment as a text message. All patients attending the orthopaedic department were included in the study. Patients who had an appointment and cancelled/rescheduled it prior to their original consultation date were excluded. Children were also excluded from the study. Results The overall Did Not Attend rate was reduced by 12% following the intervention (p < 0.0001). The new appointment follow-up rate was reduced by 2% (p = 0.74) and the follow-up rate decreased by 13.7% (p < 0.0001). The economic analysis revealed a saving of £19,853 over a two-year period following the intervention. Conclusion Thus mobile technology is a feasible tool in improving attendance rates at outpatient clinics and is economically viable.

Substance use and its impact on care outcomes among HIV-infected individuals in Manitoba

The high prevalence of substance use among HIV-infected individuals creates numerous challenges to patient care. This study was undertaken in order to understand the impact of substance use on care outcomes for HIV-infected individuals in Manitoba. Clinical records of 564 HIV-infected individuals in care at Health Sciences Centre in Winnipeg, Manitoba were reviewed. Clinical data were extracted from patient charts for substance users (illicit substance users, alcohol abusers and chronic users of opioids or benzodiazepines) and non-users. Substance users and non-users were analysed using chi-square analysis and logistic regression models to compare basic socio-demographic and clinic variables. Chi-square and analysis of variance were used to compare a subset of substance users based on similar socio-demographic and clinical characteristics. Among HIV-infected individuals in Manitoba, 38% were substance users with over-representation by Aboriginals, females, young adults and residents of Winnipeg's core areas. Opioids and benzodiazepines were the most commonly used substances with the majority of substance users having used multiple classes of substances in their lifetime. Substance users were more likely than non-users to have missed clinic appointments. Among substance users, missed appointments were more common among those who self-identified as Aboriginal, female, young adults, residents of Winnipeg's core areas, heterosexuals and those who had abused alcohol or cocaine/crack. Aboriginal substance users were also less likely to achieve viral load suppression compared to non-Aboriginal substance users. With the high prevalence of substance use among HIV-infected individuals in Manitoba, it is important to identify at-risk individuals in order to implement appropriate care strategies and improve treatment adherence and health outcomes.