Phone Reminders Research Articles

Improved continuation rate of depot-medroxyprogesterone acetate in adolescent mothers.

Poor compliance and high discontinuation rates of Depot-Medroxyprogesterone Acetate (DMPA) and other contraceptive methods are major factors in the continuing problem of adolescent pregnancy. In this study we attempted to determine if providing comprehensive health care for teen mothers and their babies would improve continuation rates of DMPA. Patients who started DMPA between 1/1/96 and 1/1/99 were included. Teen mothers and their babies received all their health care in this clinic, supported by State funding. Key elements regarding DMPA in this clinic were continuity of care, phone and mail reminders of appointments, free DMPA for patients without insurance, counseling at each visit and available evening clinic. In the study period a total of 299 (age 13-22 years) patients were started on DMPA. Fifty-one percent were white, 47% black and 2% others. Sixty-three percent were single, 20% married, 3% cohabitating and 14% undetermined (missing data). Seventy-eight percent had one baby and 22% more than one. A total of 189 patients (63.2%) continued to be compliant after one year of use and 101 patients (33.8% of total) continued beyond the second year. The most common side effect reported was bleeding or spotting (32%), However only seven patients (2.3%) discontinued use because of it. It is concluded that continuity of care (same staff and providers on each visit), regular counseling, flexible hours (evening appointments), financial ease (free DMPA and no visit charge for those without insurance), combined Teen-Tot health visits and regular reminders of appointments may help improve compliance and continuation rates in teen mothers leading to better success in preventing repeat teen pregnancy.

Improved continuation rate of depo-provera in teen mothers

BACKGROUND: Poor compliance and high discontinuation rates of Depo-Provera (DP) and other contraceptive methods are major factors in the continuing problem of teen pregnancy. In this study we attempted to determine if providing comprehensive health care for teen mothers and their babies would improve continuation rates of DP.METHODS: Review of clinical data in a Teen-Tot program in regards to DP. Patients who started DP between 1/1/96 and 1/1/99 were included. Teen mothers and their babies receive all their health care in this clinic, supported by State funding. Key elements regarding DP in this clinic are: continuity of care, phone or mail reminders of appointments, free DP for patients without insurance, counseling at each visit and available evening clinic.RESULTS: In the period above a total of 299 (age 13-22) patients were started on DP. 51% were white, 47% black and 2% others. 63% were single, 20% married, 3% cohabitating and 14% undetermined (missing data). 78% had one baby and 22% more than one. A total of 189 patients (63.2%) continued to be compliant after one year of use. 84 patients (28% of total) continued beyond the second year, but the actual percentage of continuation will be higher when patients who are now on DP more than 1 but less than 2 years are included. The most common side effect reported was bleeding/spotting (32%). However only 7 patients (2.3%) discontinued use because of it.CONCLUSION: Continuity of care (same staff and providers on each visit), regular counseling, flexible hours (evening appointments), financial ease (free DP and no visit charge for those without insurance), combined Teen-Tot health visits and regular reminders of appointments help improve compliance and continuation rates in teen mothers leading to better success in prevention of repeat teen pregnancy.

Long-Term Follow Up of NICU Graduates: Social Variables, not Clinical Problems, Determine Drop-Out Rates and Access to Health Care † 1215

King Drew Medical Center is a County hospital in South Central Los Angeles, serving primarily inner city residents. After discharge from our NICU all infants are offered services through the High Risk Clinic (HRV), including well child care, developmental follow-up, referral to state agencies, and interventions by subspecialty clinics (ophthalmology, ENT, neurology, cardiology, orthopedics, surgery). An affiliated clinic (Hub) provides specific services directed to foster families. Coverage for the costs is provided by the State through Medi-Cal, CHDP, California Children Services, and other agencies. Return appointments and reminder phone calls are provided. Nonetheless, the rate of return to the clinic for follow-up is less than 50%. For very low birth weight infants (VLBW, BW ≤ 1500 grams) only 34/74 infants born in 1994 were regularly seen in 1997. When discharge diagnosis is considered, rate and modality of health care access vary. For chronic lung disease, loss of follow-up in HRC corresponded to increased use of emergency services, while patients with severe lung disease and high attendance in the HRC and Allergy clinic had lower rates of access to emergency care. For infants with neurological impairments, severity correlated with close follow up in HRC. Comparing NICU graduates of 1988 vs 1994, we also noticed that the number of admissions for VLBW babies with maternal substance abuse increased from 27% to 36%. Upon discharge, many of these babies are routed through the foster care system of the Greater Los Angeles area, as far as over 50 miles from the hospital of birth. Phone interviews showed that distance was the primary reason for not returning to the HRC. A significant number of Hispanic patients were lost to follow up because of family relocation. No further data were available for most of these patients. Conclusions: we investigated what factors appear to affect return to follow up in a specialized, comprehensive, no or low cost clinical setting. Presence of complications of prematurity was not sufficient to warrant consistent follow up under the described conditions. Population variables appear to affect return to a considerable degree. We believe that this situationm may be common to many County institutions, and carries significant implications for the welfare of a high risk infant population.

COMPLIANCE WITH POST-DISCHARGE FOLLOW-UP: ≤1250g INFANTS. 626

Neonates ≤ 1250g often require multidisciplinary follow-up care, particularly in the first year post-discharge; hence, compliance with keeping clinic appointments (appts) is essential. To assess compliance, we evaluated the number of appts kept and immunization status of 144 neonates discharged from our NICU and followed in our high-risk clinic (Jan., 92 to Dec., 93). Complete immunization was defined as 3 DPTs, 2 OPVs, 3 HIBs, and 3 HBVs ≤1 year post-discharge. Mean BW of the infants was 984± 194g; 87% were African American, 8% Hispanic; 23% of mothers were teenagers; 36% had no prenatal care; 33% were substance abusers (SA); 40% SA had guardian other than mother. Overall compliance, and that of SA patients, compared with No SA, is summarized: Table In summary, although poorer compliance with keeping appts was observed in the SA group, immunization status was not different from that of the No SA group as advantage of all kept appts was taken. Over one-third did not receive complete immunizations and, presumably, other essential follow-up care despite close tracking, phone reminders, and rescheduling efforts. Compliance may be enhanced by incentivizing clinic visits.

Interventions to improve patient appointments in an ambulatory care facility

Failed patient appointments in ambulatory care may result in decreased revenues. The purpose of this study was to determine if patient reminders would affect the "no-show" rate of a medical ambulatory care setting. Patients of 10 physicians participated in a 6-week study. Patients were randomly assigned to one of three groups: 2 weeks of appointment reminder postcards, 2 weeks of appointment reminder phone calls, and 2 weeks of no intervention. Chi-square analysis revealed significant differences between the control group and the two groups receiving interventions. Patient reminders may be a mechanism to decrease the no-show rate in ambulatory care.

Adolescent mothers and postpartum compliance factors associated with patient return

Study Objective: The purpose of this study was to assess the impact of socio-demographic and medical factors on compliance to postpartum care among inner city adolescents.Design: This was a prospective study using random assignment of postpartum adolescent mothers to either a treatment or control group for follow-up appointment reminders.Results: Treatment teens who returned more often for postpartum care had complicated deliveries (χ2 = 14.25, p = 0.0001), preterm infants (χ2 = 6.49, p = 0.03), resided with parents (χ2 = 9.05, p = 0.028), had no educational plans (χ2 = 10.90, p = 0.0009), lacked prenatal care (χ2 = 12.99, p = 0.0003), and a stated presence of a support system (χ2 = 9.85, p = 0.001).Conclusion: Though both groups had marginal compliance, treatment group adolescents who received postcard and phone reminders returned more frequently than control group teens.

Dropping out of substance abuse treatment: A clinically oriented review

Early attrition from substance abuse treatment is very high, although rates do not differ dramatically from those found in medical and psychiatric treatments. The consequences of substance abuse treatment dropout are severe, however, with early dropouts having the same outcome as untreated clients. Evidence is considered regarding the impact of demographic and social variables on continuation in treatment. The effects of client motivation, substance use, criminality and legal pressure, prior treatment history, and psychopathology are also examined. An analysis of treatment factors and procedures used to enhance retention indicates that more conveniently located, smaller, decentralized clinics, with higher clinical staff ratios and more per capita expenditures, have lower attrition rates. Clients are also likely to continue in treatment longer when they receive rapid initial response and individual attention, and when they are seen in smaller groups in friendly, comfortable environments. Inexpensive techniques such as reminder phone calls and personal letters can be employed in the absence of resources needed to mount more extensive attrition prevention interventions.

Increasing compliance through the use of the legitimization of small donations technique and the follow-up procedures of phone reminder and gift incentive

This study investigated the practical tradeoff of using higher and lower paltry amounts in the legitimization of small donations technique in telemarketing fundraising. The results indicate that using lower paltry amounts results in the best return for the least cost. Overall, the follow-up procedures of phone reminder and gift incentives did not effectively increase compliance. The study concludes with a discussion of future directions for additional work in this area.

The effects of patient-initiated phone confirmation strategies on appointment keeping at a hospital dental clinic.

This research reports the effectiveness of three interventions utilized to reduce broken appointments at a hospital dental clinic. Subjects in this study were 306 outpatients receiving dental care at Harborview Medical Center in Seattle. Prior to this investigation the clinic was not using any confirmation strategy; the no show rate was 30.2 percent (N=169). The first intervention was the traditional clinic-initiated phone reminder one day prior to the appointment; the second intervention made use of a mailed reminder, requesting patient-initiated confirmation by phone; and the third gave the same postcard reminder to the patient at the appointment desk, also requesting telephone confirmation. The two patient-initiated strategies were considered more consistent than the traditional phone reminders with the concept of patient responsibility for his own health care. The broken appointment rate for the phone reminder group was 23.5 percent, while for the postcard and the appointment card groups, the rates were 21.2 percent and 11.5 percent respectively. The rate for the appointment card group differed significantly from the phone reminder group and also from the baseline sample.