Re-engage Patients Research Articles

A Randomized Clinical Trial to Improve Health Outcomes Among Argentine Patients Disengaged from HIV Care

Background: Patients disengaged from HIV care, e.g., missed medication pick-ups, not attending physician visits, account for >70% of new HIV infections. Re-engaging and sustaining engagement is essential to controlling the HIV pandemic. This study tested a physician-delivered evidence-based intervention, Motivational Interviewing (MI), to improve health outcomes, adherence to antiretroviral therapy (ART), HIV virologic suppression, CD4+ count, retention in HIV care, and self-efficacy among patients in Argentina disengaged from care. Methods: Regional clinics (n = 6) were randomized to condition, MI Intervention, Enhanced Standard of Care (ESOC), and recruited N = 360 disengaged patients disengaged from HIV care. Participants were assessed at baseline, 6, 12, 18, and 24-months. Indirect effects from condition to main outcomes were examined using patient–provider relationship as a mediator. Findings: Participants were an average age of 39·15 (SD = 10·96), 51% were women; intervention participants were older (p = ·019), and more ESOC participants were women (60% vs. 42%, p = ·001). There was an indirect effect of condition on ART adherence (B = 0·188, p = ·009), HIV viral load (B = -0·095, p = ·027), and self-efficacy (B = 0·063, p= ·001), suggesting the intervention was associated with improved patient–provider relationships, which was in turn associated with increased ART adherence, lower HIV viral load, and higher self-efficacy. Intervention participants reported greater satisfaction with patient-provider relationships (p = ·005), higher ART adherence (p = ·02), CD4+ counts NS, and lower HIV viral load (p = ·015). Retention in HIV care was higher at 12 months but not sustained. Interpretation: Physician-delivered MI enhanced patient-provider relationship, self-efficacy, and ART adherence, and reduced HIV viral load in patients disengaged from HIV care. Implementation of sustained collaborative patient-centered MI in HIV clinical settings could strengthen patient-provider relationships and re-engage patients in their own care. Trial Registration: This study was registered at clinicaltrials.gov, NCT02846350. Funding: National Institutes of Health. Declaration of Interest: The authors declare that they have no conflict of interest. Ethical Approval: This study was approved by the Institutional Review Board at the University of Miami Miller School of Medicine and at by each participating center.

EPID-16. INTEGRATION OF EHR AND CANCER REGISTRY DATA TO CONSTRUCT A PEDIATRIC NEURO-ONCOLOGY SURVIVORSHIP COHORT AND IMPROVE LONG-TERM FOLLOW-UP CARE

BACKGROUNDPediatric neuro-oncology (PNO) survivors suffer long-term physical and neurocognitive morbidity. Comprehensive care addressing late effects of brain tumors and treatment in these patients is important. Clinical guidelines offer a framework for evaluating late effects, yet lack of extended follow-up is a significant barrier. The electronic health record (EHR) allows novel and impactful opportunities to construct, maintain, and leverage survivorship cohorts for health care delivery and as a platform for research.METHODSThis survivorship cohort includes all PNO cases ≤18-years-old reported to the state-mandated cancer registry by our institution. Data mining of the EHR for exposures, demographic, and clinical data identified patients with lack of extended follow-up (>1000 days since last visit). Explanatory variables included age, race/ethnicity, and language. Primary outcome included date of last clinic visit.RESULTSBetween January 1, 2013 and December 31, 2018, there were 324 PNO patients reported to our institutional registry with ongoing analysis to identify the specific survivorship cohort. Thirty patients died with an overall mortality of 9.3%. Two-hundred-and-sixteen patients were seen in PNO clinic, of which 18.5%% (n=40) did not receive extended follow-up. Patients without extended follow-up were an average of 3.5 years older up (p<0.01); however, there was no significant difference in preferred language (p=0.97) or race/ethnicity (p=0.57).CONCLUSIONIntegration of EHR and cancer registry data represents a feasible, timely, and novel approach to construct a PNO survivorship cohort to identify and re-engage patients without extended follow-up. Future applications include analysis of exposures and complications during therapy on late effects outcomes.

Abstract 15423: Hope is Not a Plan: Re-engaging Transition-aged Young Adults With Congenital Heart Disease Actively Missing From Cardiac Care

Introduction: Many studies describe gaps in care for youth with congenital heart disease (CHD), but few reach out to patients actively missing from care. Our study goal was to identify young adults with CHD actively missing from cardiac care to: 1) administer a needs assessment and 2) re-engage patients in cardiac care. Methods: We performed a retrospective review of outpatient medical records (2012-2019) for patients 15-21 yrs with CHD at Texas Children’s Hospital. ICD 9/10 codes identified CHD patients; those ≥1 year beyond requested clinic follow-up were defined as ‘actively missing’. Sociodemographic data was collected, and a telephone needs assessment conducted to determine CHD knowledge, barriers to care, and health status. Either a patient or parent completed the survey and was offered to re-engage in cardiac care. Descriptive statistics were performed on available data. Results: Of 1057 CHD patients, 33% (n=353) were actively missing. Of those missing, 58% were male and median age was 17 yrs (IQR 16-19). Patients were 46% Non-Hispanic White, 9% Non-Hispanic Black, and 33% Hispanic. Moderately complex CHD was noted in 71%. Insurance status was 63% private and 31% public. Ninety-eight patients/parents (28%) participated in our survey. Fifty-two percent reported having no cardiac care, often citing lack of or incompatible hospital insurance (33%; n = 32). Active cardiac symptoms were reported in 25%. Half of patients felt they could explain their cardiac condition well, and 82% could name their medications. Scheduling barriers (26%; n = 25) and being unaware adults could be cared for at our heart center (15%; n = 15) were the most common obstacles to re-engaging in care. Participants felt text messaging and scheduling visits during cardiology clinic would improve care access. More than half of patients/parents (55%) accepted our help to re-engage in cardiac care (scheduling assistance). Conclusions: This data suggests patients require assistance beyond CHD knowledge to stay in care. Problems with insurance, scheduling, and perceptions of adult CHD care were key barriers to maintaining cardiac care despite moderate CHD complexity and active symptoms. Future quality initiatives should include scheduling, insurance coverage, and adult CHD services.

Reporting on patients living with HIV “disengaging from care”. Who is actually “lost to follow-up”?

ABSTRACT Retention in care remains an important concern for health care providers. However, accurately identifying who is or is not retained in care can be problematic. Not all patients believed to be engaged in care are actually in care, and not all patients believed to be disengaged are truly disengaged. Identifying the status of individuals within populations is important for clinical, administrative and surveillance concerns. As part of the Linkage and Retention in Care Project at St Michael's Hospital in Toronto, Canada, we investigated the status of patients diagnosed with HIV. Detailed investigation determined who was actually Lost-to-Follow-Up (i.e., disengaged from care >12 months) and who had disengaged for known reasons. This approach determined more precisely who was currently followed in care and who was not, and to target efforts to contact and reengage patients more effectively. This study illustrates the importance of accurately monitoring populations enhancing disease management.

1314. HOME CARE: Reaching Our Lost to Follow-up Patients and Overcoming Barriers to Care Utilizing Nontraditional Care Models

BackgroundOf the 11098 people living with HIV in southeast Michigan, over 30% are out of care, with transportation being the most commonly identified barriers. To address this barrier and re-engage patients into care, we introduced an HIV homecare program. The objective of this study was to describe the implementation of the homecare program and document the outcomes of patients enrolled.MethodsIn 2016, WSUPG ID clinic saw 1990 patients and had additional 95 clients who were virally unsuppressed and lost to care for 12 months. We called all 95 of these clients and offered homecare. We also advertised our program internally, to the Detroit Public Health Departments’ Data to Care Program (Link up Detroit), and to community-based organizations. Referred patients were seen by a NP/MA team supervised by an infectious disease attending. HIV medical care delivered in home utilized same standards of care as for outpatient setting, including lab draws and counseling. Patients also had the ability to text/call provider directly on the program cell phone. This project was funding through a Part A Ryan White MAI grant.ResultsOf the 95 clients out-of-care, 38 (40%) were unreachable, 41 (43%) were reachable and 16 (17%) did not qualify (relocation, incarcerated, deceased, in-care at the time of call). 5 (5%) enrolled in homecare and additional 29 patients were referred to our program. A total of 34 patients enrolled from September 20, 2017 to September 20, 2018. Among the 34 clients, mental health barriers were the most frequently reported (depression in 20, schizophrenia or bipolar in 7, anxiety in 23, and history of trauma in 11). Of the 34 clients, 24 have achieved virologic suppression at least once during their enrollment. Among the 26 clients with 6+ months of follow-up, 17 have achieved virologic suppression.ConclusionHomecare offers a new, innovative healthcare delivery system which is effective at achieving viral suppression in a challenging patient population and is a successful strategy to re-engage patients in care.Disclosures All authors: No reported disclosures.

Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial

Background“Challenging” HIV-infected patients, those not retained in treatment, represent a critical focus for positive prevention, as linkage to care, early initiation of antiretroviral therapy, adherence and retention in treatment facilitate viral suppression, thus optimizing health and reducing HIV transmission. Argentina was one of the first Latin American countries to guarantee HIV prevention, diagnosis and comprehensive care services, including antiretroviral medication, which removed cost and access as barriers. Yet, dropout occurs at every stage of the HIV continuum. An estimated 110,000 individuals are HIV-infected in Argentina; of these, 70% have been diagnosed and 54% were linked to care. However, only 36% have achieved viral suppression and 31% of those diagnosed delayed entry to care. To achieve meaningful reductions in HIV infection at the community level, innovative strategies must be developed to re-engage patients. Motivational Interviewing (MI) is a patient-centered approach and has been used by therapists in Central and South America to enhance motivation and commitment in substance use and risk reduction. Our pilot feasibility study utilized culturally tailored MI in physicians to target patients not retained in treatment in public and private clinics in Buenos Aires, Argentina. Results demonstrated that a physician-based MI intervention was feasible and effective in enhanced and sustained patient adherence, viral suppression, and patient-physician communication and attitudes about treatment among these patients at 6 and 9 months post baseline.Methods/designThis clinical trial seeks to extend these findings in public and private clinics in four urban population centers in Argentina, in which clinics (n = 6 clinics, six MDs per clinic site) are randomized to experimental (physician MI Intervention) (n = 3) or control (physician Standard of Care) (n = 3) conditions in a 3:3 ratio. Using a cluster randomized clinical trial design, the study will test the effectiveness of a physician-based MI intervention to improve and sustain retention, adherence, persistence, and viral suppression among “challenging” patients (n = 420) over 24 months.DiscussionResults are anticipated to have significant public health implications for the implementation of MI to re-engage and retain patients in HIV treatment and care and improve viral suppression through high levels of medication adherence.Trial registrationClinicalTrials.gov, ID: NCT02846350. Registered on 1 July 2016.

Use of an Outreach Coordinator to Reengage and Retain Patients with HIV in Care.

It is well established that retention in high-quality care and regular visits with an HIV/AIDS provider improve outcomes for people living with HIV/AIDS (PLWHA). However, nationally and regionally in South Carolina, retention rates remain low. We piloted an outreach program focused on characterizing out of care (OOC) patients to identify PLWHA who were lost to care and attempt reengagement through phone call, letter, and home visit interventions. Primary outcomes were reengagement, defined as attendance to a clinic appointment, and retention in care, defined by the Health Resources and Services Administration (HRSA) definition (two visits at least 90 days apart in 2015). There were 1242 adult clinic patients in 2014. A total of 233 patients were included in the OOC cohort, according to the inclusion criteria. Of these 233, the outreach coordinator found that a majority of patients, 119 (51%), were lost to care. Reengagement was seen in 52 (44%) patients lost to care, and among those who reengaged, 26 (50%) were retained in care in 2015. This report represents one of few interventions that target reengagement for patients who are lost to care. The use of an outreach coordinator was successful in reengaging and retaining patients in care. It represents an uncomplicated intervention, functional within the current clinic design and available funding structure of the Ryan White grant. Poor engagement and retention in care continue to be significant problems among PLWHA with resultant poor clinical outcomes. Continued focus on new interventions to improve retention in care is necessary to improve clinical outcomes.

Use of an Outreach Coordinator to Reengage and Retain Patients at Risk of Falling Out of HIV Care, Does the Amount of Time Matter?

Retention in care remains a major problem for people living with HIV and it is well known that retention in high quality HIV care improves clinical outcomes. This project used an outreach coordinator to perform phone and letter interventions to improve retention in patients at risk of falling out of care. Sixty-one (5%) patients were at risk in 2015 and received an intervention by the outreach coordinator. Fifty (82%) had a visit and 22 (36%) met the HRSA definition of retention. The mean time per patient was 59min; therefore, it took 2.7h to achieve each retained patient or 1.2h for each patient with a visit. By calculation, minutes over 75 appeared to be the point of diminishing returns. Cost analysis resulted in a cost of less than $100 per patient.

Use of an Outreach Coordinator to Re-engage and Retain Patients at Risk of Falling Out of Human Immunodeficiency Virus (HIV) Care, Does the Amount of Time Matter?

Use of an Outreach Coordinator to Re-engage and Retain Patients at Risk of Falling Out of Human Immunodeficiency Virus (HIV) Care, Does the Amount of Time Matter?

Potential Impact of Integrating HIV Surveillance and Clinic Data on Retention-in-Care Estimates and Re-Engagement Efforts.

Retention in care is essential to the health of people living with HIV and also for their communities. We sought to quantify the value of integrating HIV surveillance data with clinical records for improving the accuracy of retention-in-care estimates and the efficiency of efforts to re-engage out-of-care patients. Electronic medical records (EMRs) of HIV+ patients ≥18 years old from a public, hospital-based clinic in Minneapolis, MN between 2008 and 2014 were merged with state surveillance data on HIV-related laboratory tests, out-of-state relocation, and mortality. We calculated levels of retention and estimated the number of required case investigations to re-engage patients who appeared to be out of care over the study period with and without surveillance data integration. Retention was measured as the proportion of years in compliance with Health Resources and Services Administration (HRSA) guidelines (two clinical encounters >90 days apart annually) and the proportion of patients experiencing a gap in care >12 months. With data integration, retention estimates improved from an average HRSA compliance of 70.3% using EMR data alone to 77.5% with surveillance data, whereas the proportion of patients experiencing a >12-month gap in care decreased from 45.0% to 34.4%. If case investigations to re-engage patients were initiated after a 12-month gap in care, surveillance data would avoid 330 (29.3%) investigations over the study period. Surveillance data integration improves the accuracy of retention-in-care estimates and would avert a substantial number of unnecessary case investigations for patients who appear to be out of care but, in fact, receive care elsewhere or have died.

HIV provider and patient perspectives on the Development of a Health Department "Data to Care" Program: a qualitative study.

BackgroundU.S. health departments have not historically used HIV surveillance data for disease control interventions with individuals, but advances in HIV treatment and surveillance are changing public health practice. Many U.S. health departments are in the early stages of implementing “Data to Care” programs to assists persons living with HIV (PLWH) with engaging in care, based on information collected for HIV surveillance. Stakeholder engagement is a critical first step for development of these programs. In Seattle-King County, Washington, the health department conducted interviews with HIV medical care providers and PLWH to inform its Data to Care program. This paper describes the key themes of these interviews and traces the evolution of the resulting program.MethodsDisease intervention specialists conducted individual, semi-structured qualitative interviews with 20 PLWH randomly selected from HIV surveillance who had HIV RNA levels >10,000 copies/mL in 2009–2010. A physician investigator conducted key informant interviews with 15 HIV medical care providers. Investigators analyzed de-identified interview transcripts, developed a codebook of themes, independently coded the interviews, and identified codes used most frequently as well as illustrative quotes for these key themes. We also trace the evolution of the program from 2010 to 2015.ResultsPLWH generally accepted the idea of the health department helping PLWH engage in care, and described how hearing about the treatment experiences of HIV seropositive peers would assist them with engagement in care. Although many physicians were supportive of the Data to Care concept, others expressed concern about potential health department intrusion on patient privacy and the patient-physician relationship. Providers emphasized the need for the health department to coordinate with existing efforts to improve patient engagement. As a result of the interviews, the Data to Care program in Seattle-King County was designed to incorporate an HIV-positive peer component and to ensure coordination with HIV care providers in the process of relinking patients to care.ConclusionsHealth departments can build support for Data to Care efforts by gathering input of key stakeholders, such as HIV medical and social service providers, and coordinating with clinic-based efforts to re-engage patients in care.

PTU-112 Hepatology outreach services to overcome inequalities in hepatitis c care in an isolated uk population: Abstract PTU-112 Table 1

Introduction Increasingly effective treatments for Hepatitis C virus (HCV) infection are unlikely to have a significant impact on disease prevalence unless barriers to specialist care and treatment are overcome. The Isle of Wight (IOW) is situated 3 miles off the coast of the UK and is without a local HCV treatment service. The aims of this study are to compare the care outcomes in patients with HCV living in this isolated community to a nearby mainland cohort and describe the initial impact of a hepatology outreach service to the island. Method The medical records of a representative 77 HCV patients from the IOW were compared to a random sample of 79 patients from Southampton City. Patients from the IOW who had been diagnosed by the drug support or sexual health services, but had never been seen by a Hepatology specialist, were contacted and invited to community based Hepatology outreach clinics. Results Patients from the IOW were older (p 0.007) and had a significantly higher prevalence of liver cirrhosis (p 0.01). Significantly more patients with HCV had died from liver disease on the IOW (p 0.03), although similar numbers had been treated (p 0.57) (Table 1). Those patients who were seen in hepatology clinics were reviewed in a similar time frame with 79% of IOW and 89% of Southampton patients being seen within 1 year of diagnosis (p 0.33). 14 patients on the IOW have been invited to 3 community outreach clinics in the sexual health and drug and alcohol support centres. Of these 7 attended, 3 have subsequently been referred for treatment, with 3 declining due to the distance and cost of travel to the mainland. Conclusion The IOW has a higher prevalence of advanced liver disease with excess mortality. In an attempt to address this inequality outreach clinics have been established and have initially proved effective at re-engaging patients with a known diagnosis of HCV into specialist care. However, in an isolated community the effectiveness of this will be limited without the provision of community-based treatment. Disclosure of interest R. Buchanan Grant/ Research Support from: Gilead Fellowship 2014, A. Shalabi: None Declared, L. Grellier: None Declared, J. Parkes: None Declared, S. Khakoo: None Declared.

Retention in care and medication adherence: current challenges to antiretroviral therapy success.

Health behaviors such as retention in HIV medical care and adherence to antiretroviral therapy (ART) pose major challenges to reducing new HIV infections, addressing health disparities, and improving health outcomes. Andersen's Behavioral Model of Health Service Use provides a conceptual framework for understanding how patient and environmental factors affect health behaviors and outcomes, which can inform the design of intervention strategies. Factors affecting retention and adherence among persons with HIV include patient predisposing factors (e.g., mental illness, substance abuse), patient-enabling factors (e.g., social support, reminder strategies, medication characteristics, transportation, housing, insurance), and healthcare environment factors (e.g., pharmacy services, clinic experiences, provider characteristics). Evidence-based recommendations for improving retention and adherence include (1) systematic monitoring of clinic attendance and ART adherence; (2) use of peer or paraprofessional navigators to re-engage patients in care and help them remain in care; (3) optimization of ART regimens and pharmaceutical supply chain management systems; (4) provision of reminder devices and tools; (5) general education and counseling; (6) engagement of peer, family, and community support groups; (7) case management; and (8) targeting patients with substance abuse and mental illness. Further research is needed on effective monitoring strategies and interventions that focus on improving retention and adherence, with specific attention to the healthcare environment.

A Simple Strategy to Classify and Re-engage HIV-Infected Patients Poorly Retained in Care via Personal Outreach by a Social Worker

A Simple Strategy to Classify and Re-engage HIV-Infected Patients Poorly Retained in Care via Personal Outreach by a Social Worker

Use of electronic data to assist with long-term follow-up in an urban HIV clinic

BackgroundThe University of Chicago Medicine (UCM) HIV clinic follows up 565 patients, with case management by one social worker. This large cohort makes active case follow-up difficult. Our clinic is located in a neighbourhood on the south side of Chicago. This area includes four of the six communities with the highest annual HIV diagnosis rates in the city and contains neighbourhoods with an HIV prevalence of 1% or more. We describe a programme that used medical informatics to re-link patients lost to follow-up into care and to assist in the long-term management of this group. MethodsPatients at the UCM HIV clinic were eligible for the study if they had attended at least one appointment but had not been seen in clinic for 6 months or more, our criterion for lost to follow-up. We used an electronic clinic database and electronic medical records to identify these patients. Those patients classified as lost to follow-up were re-linked to care by clinic social workers by phone or, if that failed, by follow-up letters. Patients were contacted from February to June, 2013, by the social worker and a social work intern. In an open programme, patients will become eligible for re-linkage on a rolling basis. FindingsAmong 565 patients, 56 (10%) had not been seen for 6 months to 1 year, 40 (7%) had not been seen for 1–2 years, and 27 (5%) had not been seen for more than 2 years. Overall, 442 (78%) of our patients were retained in care and 123 (22%) patients were determined to be lost to follow-up. Age, sex, race, ethnicity, and insurance coverage did not predict lost to follow-up status. Ten patients (8%) were dead. Among 113 living patients, 64 (57%) were contacted by phone. 32 had moved or were in care elsewhere. 30 of the remaining 32 (94%) scheduled a clinic visit. Ten patients scheduled a visit in response to a letter or voicemail, but 49 (9% of the clinic cohort) remain lost to follow-up. InterpretationOur retention rate is much higher than the US national retention rate of about 40%. Nonetheless, with a large cohort, it is important to implement measures to track retention. With this aim, we found electronic data to be useful for identification of patients lost to follow-up and to aid in efforts towards retention in care. We were very successful at collecting data from or re-linking patients who we could contact by phone, but less so when we had to send a letter. In addition to re-engaging patients into care, it is important for us to know if patients have died or transferred care to adequately assess our local cascade of engagement in care. With this study we hope to show the feasibility and sustainability of clinic-wide re-linkage initiatives. FundingNone.

Datapoints: False Starts in Psychotherapy for Substance Use Disorders and PTSD in the VHA

A of the push toward evidencebased mental health treatment, there is interest in increasing the proportion of patients who engage in evidence-based psychotherapy. However, attrition is a common phenomenon, especially at the beginning of psychotherapy. Using Veterans Health Administration (VHA) data, we examined psychotherapy utilization patterns among patients diagnosed as having a substance use disorder or posttraumatic stress disorder (PTSD) in fiscal year (FY) 2008. Start of a psychotherapy treatment episode was defined as the first psychotherapy visit after 60 dayswith noVHApsychotherapy visits within VHA. Thus psychotherapy visits more than 60 days apart were viewed as separate treatment episodes. This is consistent with a widely used definition of a treatment episode for a substance use disorder (1). Among patients who initiated psychotherapy, we also examined attrition—defined as attending only one or two psychotherapy visits. In FY 2008, of the 380,231 patients with an inpatient or outpatient encounter that included a substance use disorder diagnosis, 210,168 (55%) had at least one outpatient psychotherapy episode start, and among those, 121,257 (58%) attended only one or two visits. Of the 442,359 patients with an inpatient or outpatient encounter in FY 2008 that included a PTSD diagnosis, 297,831 (67%) had at least one outpatient psychotherapy episode start, and, among those, 183,801 (62%) attended only one or two visits (Figure 1). Repeated attempts at psychotherapy engagement were not rare; 40% of those with a substance use disorder and 48% of those with PTSD who started one outpatient psychotherapy episode had at least one additional episode start in the same year. These observations may have significant clinical and measurement implications. Clinically, these results suggest that more needs to be done to encourage patients to initiate and engage in treatment. Although attrition from care is common, both clinicians and patients should be aware that a significant number of patients who initially disengage from care will later make attempts at reengagement. Efforts to reengage patients may improve engagement rates and mental health outcomes. Explaining these rates to patients may reduce discouragement and self-stigma among those having difficulty with adherence during attempts at treatment seeking.Moreover,many patients with PTSD or a substance use disorder may need more than one attempt at psychotherapy to be successful. Some widely used measures of treatment engagement examine only the first episode of care in a year (1). Our results suggest that this approach could underestimate the proportion of patients who engage in treatment during a year because it overlooks subsequent treatment episodes. Our results underscore the importance of the adage, “If at first you don’t succeed, try, try again.”

G179(P) Long Term Follow-Up For Paediatric Oncology Patients at a Paediatric Department of a General Hospital

AimsEstablish how national Long Term Follow Up recommendations can be implemented locally in a paediatric department of a large general hospital.Establish the number of patients who currently have an end...

Effectiveness of Outreach to Patients with Diabetes Who Have Fallen Out of Regular Care at a Federally Qualified Health Center

Re-engaging patients who have fallen out of regular care is a challenge for all primary care practices, but especially for federally qualified health centers (FQHCs). We implemented and evaluated a system of proactive telephone and mail outreach within an FQHC serving a predominantly Latino and Spanish-speaking population for patients with diabetes who had not had a visit to the health center for at least six months. The primary study outcome was the proportion of patients who completed a follow-up visit within three months of the outreach. We also examined patient characteristics associated with completing a follow-up visit. Of 208 patients eligible for outreach, 24% (n = 49) completed a follow-up visit. Thirty-six percent (n = 74) had a disconnected or incorrect phone number, 16% (n = 34) were not reached within three phone call attempts, and 20% (n = 22) of letters mailed were returned to sender. Future efforts to re-engage patients in diabetes care should examine shorter intervals before outreach and other outreach strategies.

A Low-Effort, Clinic-Wide Intervention Improves Attendance for HIV Primary Care

Retention in care for human immunodeficiency virus (HIV)-infected patients is a National HIV/AIDS Strategy priority. We hypothesized that retention could be improved with coordinated messages to encourage patients' clinic attendance. We report here the results of the first phase of the Centers for Disease Control and Prevention/Health Resources and Services Administration Retention in Care project. Six HIV-specialty clinics participated in a cross-sectionally sampled pretest-posttest evaluation of brochures, posters, and messages that conveyed the importance of regular clinic attendance. 10,018 patients in 2008-2009 (preintervention period) and 11,039 patients in 2009-2010 (intervention period) were followed up for clinic attendance. Outcome variables were the percentage of patients who kept 2 consecutive primary care visits and the mean proportion of all primary care visits kept. Stratification variables were: new, reengaging, and active patients, HIV RNA viral load, CD4 cell count, age, sex, race or ethnicity, risk group, number of scheduled visits, and clinic site. Data were analyzed by multivariable log-binomial and linear models using generalized estimation equation methods. Clinic attendance for primary care was significantly higher in the intervention versus preintervention year. Overall relative improvement was 7.0% for keeping 2 consecutive visits and 3.0% for the mean proportion of all visits kept (P < .0001). Larger relative improvement for both outcomes was observed for new or reengaging patients, young patients and patients with elevated viral loads. Improved attendance among the new or reengaging patients was consistent across the 6 clinics, and less consistent across clinics for active patients. Targeted messages on staying in care, which were delivered at minimal effort and cost, improved clinic attendance, especially for new or reengaging patients, young patients, and those with elevated viral loads.

P69 How to re-engage patients with Hepatitis C infection: linking to Methadone prescribing works

IntroductionNew patients’ attendance rates at the specialist clinic for hepatitis C virus (HCV) management in Grampian are around 45% and a significant proportion of those attending fail to remain under...