Missed Clinic Appointments Research Articles

Implementing a Directly Observed Therapy Program in an Urban Community Hospital

St. Clare's Health and Hospital Center has implemented a directly observed therapy (DOT) program for a challenging urban population of largely HIV+ patients in response to a need for the prevention of the spread of multidrug-resistant tuberculosis in the population. Identified treatment barriers are needs of patient subgroups within the population. Issues in the implementation include: patient compliance, effectiveness of patient identification and follow-up, and continuity of care. Challenges to continuity of care include patients signing out of the hospital against medical advice and missed clinic appointments. Patient identification and follow-up is enhanced by coordinating DOT treatment with the methadone maintenance treatment program.

Implementing a Directly Observed Therapy Program in an Urban Community Hospital

St. Clare's Health and Hospital Center has implemented a directly observed therapy (DOT) program for a challenging urban population of largely HIV+ patients in response to a need for the prevention of the spread of multidrug-resistant tuberculosis in the population. Identified treatment barriers are needs of patient subgroups within the population. Issues in the implementation include: patient compliance, effectiveness of patient identification and follow-up, and continuity of care. Challenges to continuity of care include patients signing out of the hospital against medical advice and missed clinic appointments. Patient identification and follow-up is enhanced by coordinating DOT treatment with the methadone maintenance treatment program.

An Evaluation of the Transportation Needs of Disadvantaged Cancer Patients

In an earlier study, 128 socioeconomically disadvantaged cancer patients who were receiving follow-up care in a general medicine clinic were surveyed to assess their concrete needs. Respondents reported a variety of transportation problems (e.g., cost of transportation, cost of parking). A large number of these patients also reported missing clinic appointments because of transportation difficulties. Fifty-three of the original 128 patients participated in the present study, which compared the effects of providing patients with information only about transportation resources and providing patients with this information plus assistance in selecting the appropriate transportation resource. The authors found that the transportation needs of disadvantaged cancer patients could be better met. Information about transportation resources alone was insufficient to improve disadvantaged cancer patients' compliance with clinic appointments. However, helping them select an appropriate transportation resource did help...

Recruitment of members of high-risk Utah pedigrees

Cardiovascular Genetics Research Projects in Utah are designed to investigate genetic and environmental determinants of early coronary disease, stroke, and hypertension in population-based pedigrees. Early coronary disease is defined as the occurence of documented coronary death or myocardial infarction before age 55. Detailed recruitment experience is reported for 2500 persons age 3–83 years in 98 high-risk pedigrees from three ascertainment groups: 1. 1. Descendants of sibships with two or more stroke deaths before age 75. 2. 2. Descendants of sibships with two or more coronary deaths before age 55. 3. 3. First- and second-degree relatives of hypertensive and normotensive probands randomly selected from the Utah Hypertension Detection and Follow-up Program. A response rate of 94% of invited adults attending the first 4-hour clinic visit for detailed screening in 1980–1983 was achieved by multiple telephone, mail, and personal contacts and rescheduling of missed clinic appointments. For the same participants, a second screening cycle in 1983–1986 showed a 91% response of invited adults. Second visit response rates were examined within subgroups according to data collected at the first clinic visit. Below average response rates included 79% of persons with fewer than 12 years of education, 84% of current smokers, and 86% of divorced persons. Above average response rates included 93% of persons attending college and 95% of persons with total family income above $25,000. There were no differences in response according to sex or age. The average cost of recruitment was $59 per person and represented about 10% of the total budget for the High-Risk Pedigree Project.

Health Problems During the First Year of Life in Infants Born to Adolescent Mothers

The role of maternal age at birth was investigated to determine its impact on an infant's health status during the first year of life. A sample population of 112 healthy term infants born to young primiparous mothers (less than or equal to 17 years) was compared using a chart audit with a population of 92 infants born to older primiparous mothers (greater than or equal to 18 years). There was no significant difference between the two groups in the number of missed clinic appointments, number of emergency room visits, number of hospitalizations, number of infants fully immunized, or incidence of child abuse. Poor weight gain and fewer outpatient visits for medical problems were more frequent in the infants of the younger population. Education programs designed for pregnant adolescents should stress the proper use of health professionals and appropriate methods of infant feeding.

Contraception and Pregnancy After Dropping Out of Family Planning Clinics: A National Interview Survey in Jamaica.

Abstract A random national sample of 299 clinic dropouts from the Jamaica National Family Planning Program were interviewed at least five months beyond their first missed clinic appointment. Correl...

Contraception and pregnancy after dropping out of family planning clinics: a national interview survey in Jamaica.

Abstract A random national sample of 299 clinic dropouts from the Jamaica National Family Planning Program were interviewed at least five months beyond their first missed clinic appointment. Correlates of early (after 1 or 2 visits) versus late (3+ visits) dropping out, continued contraceptive practice, and pregnancy since visiting the clinic were identified. The Health Belief Model of “compliance” behavior is proposed as an appropriate theoretical basis for future studies of clinic dropouts.

District Clinics for Out Patient Treatment of Tuberculous Problem Patients

1.The development of a special team to operate district clinics for the out-patient treatment of tuberculous problem patients has been described. 2.The clinics are specifically designed to meet ethnic, social, educational and behavioral patterns of the various groups who live in areas of high incidence and high prevalence of tuberculosis. 3.The effectiveness of the program has been demonstrated by the reduction of the number of missed clinic appointments from 25 per cent to 6.6 per cent during the first year of operation. The most significant reduction was among the Chinese where an afternoon clinic was more acceptable in the cultural patterns of Chinatown. 4.The clinics serving Skid Row and the lowest socioeconomic level of Negroes in the Fillmore area showed a marked improvement, but were not as successful as the clinic in Chinatown.