Significant Difference In Attendance Research Articles

Texting in the Fourth Trimester: mHealth for Postpartum Care.

Objective Rising maternal morbidity and mortality in the US is a complex problem and is often tied to the postpartum period. Postpartum visits are poorly attended leading to gaps in contraception, mental healthcare, and care for chronic conditions. mHealth, healthcare supported by mobile technologies, has been shown to improve antenatal care adherence. Our study aims to determine whether an mHealth intervention of interactive, educational text messages can improve care for women postpartum. Study Design We conducted a randomized-control trial of 191 women receiving OB/GYN care in our clinic from November 2019-April 2020. Patients were randomized postpartum to receive either routine care or routine care with mHealth text messages and appointment reminders specific to delivery type. The primary endpoint was attendance to the six-week postpartum visit with secondary endpoints of breastfeeding, contraception use, emergency visits, and postpartum depression scores (EPDS). A subgroup analysis was additionally conducted to assess the impact of some visits shifting to telehealth due to the timing of the COVID-19 pandemic. Results Patient demographics were similar between the two groups. There was no significant difference in postpartum appointment attendance between text message (n=57, 59%) and control groups (n=62, 66%, p=0.31). 117 patients were scheduled for in-person postpartum visits, and 74 for telehealth visits during the COVID-19 pandemic, with no significant difference in attendance rate between groups for either visit modality. Conclusion Automated text messages alone did not increase our primary outcome of adherence to postpartum care, even when visits were conducted by telehealth. While mHealth has proven successful in other care areas, such as antepartum follow-up, further research is needed to determine whether it is an effective method to improve adherence to postpartum care, or whether other strategies must be developed, including augmentation with human navigators.

Exploring the appointment factors affecting pediatric patients with swallow disorders: Implications for speech and language pathology attendance

IntroductionFeeding and swallowing disorders have become increasingly prevalent among children, necessitating effective management to prevent long-term complications. Speech and language pathology (SLP) services play a crucial role in diagnosing and treating these disorders. The objective of this study was to explore the factors that influence patient attendance to SLP appointments for swallow disorders. MethodsThis study was conducted at Boston Medical Center, involving 359 pediatric patients referred to SLP for swallow-related concerns. De-identified patient and appointment information was obtained from the electronic medical record. Various factors such as age, gender, race/ethnicity, primary language, appointment date/time, and COVID-19 lockdown status were analyzed to determine their impact on patient no-shows. Statistical analyses, including Chi-Square tests and binary logistic regression, were conducted using appropriate methodologies. Results355 individual patient records were included in the analysis. Lockdown status and appointment time of day did not significantly affect patient no-shows. However, appointments conducted through telemedicine showed a significant difference in attendance. Patient referral department, gender, race, language, and being born at the medical center did not significantly influence patient attendance. Notably, having a primary care provider (PCP) at the medical center significantly affected patient attendance. Furthermore, previous appointment cancellations made a patient more likely to no-show. ConclusionThis study provides valuable insights into the factors influencing patient attendance at SLP appointments for pediatric swallowing disorders. Having a PCP at the medical center and utilizing telemedicine appointments were associated with higher attendance rates. Addressing appointment cancellations and investigating underlying reasons behind missed appointments should be prioritized in future research. Understanding these factors will facilitate the development of interventions to optimize patient attendance and improve the delivery of SLP services in pediatric populations.

Effect of COVID-19 Pandemic on Urology Clinic Attendance: Which Diseases are Important for Patients?

Introduction: We assessed whether there were changes in the characteristics of the patient population attending our urology clinic during the COVID-19 pandemic. 
 Material and Method: Patients attending the general urology clinic of SB-ODU Education and Research Hospital were assessed. Dates from 3 February 2020-10 March 2020 were accepted as before the pandemic, with 11 March 2020-29 May 2020 accepted as after the pandemic. Complaints of patients on attendance were grouped as follows: benign prostate hyperplasia, ureteral diseases, kidney diseases, testis and scrotum diseases, incontinence, bladder diseases, sexually transmitted diseases, penile diseases, emergency urologic problems, sexual problems, urethral diseases, kidney and ureter stones, pediatric diseases and urologic tumors. 
 Results: While 638 patients attended the urology clinic in the 1.5-month period before the pandemic, 398 patients attended in the 2.5-month period after the pandemic. Additionally, 30.9% of patients attending the clinic before the pandemic were women, while this rate fell to 23.6% after the pandemic. After the pandemic, there were statistically significant reductions identified for attendance due to BPH, ureteral diseases, kidney diseases, incontinence, bladder diseases and urethra diseases. There was no significant difference in attendance due to urinary system tumors, pediatric urologic patient group, attendance due to kidney and ureter stones, sexual problems and emergency urology problems. There were increases identified for attendance for testis and scrotum diseases and sexually-transmitted diseases. 
 Conclusion: During the pandemic, the numbers of patients attending the urology clinic significantly reduced. During the pandemic, there were increases identified for attendance at our clinic for testis and scrotum diseases and sexually-transmitted diseases. While attendance reduced for many disease groups, rates of attendance for urologic emergencies, urinary tumors, pediatric patient group, stone disease and sexual problems continued as usual.

Fewer teams, more games, larger attendance? Evidence from the structural change in basketball's EuroLeague

This study investigated whether an increased number of games between a reduced number of high-quality teams has a positive effect on stadium attendance. We did this by taking advantage of a recent structural change that occurred in basketball's EuroLeague tournament. Starting from the 2016/17 season, the two short round-robin tournaments (regular season and Top 16) among 24 teams merged into a longer round-robin tournament among 16 teams. In the new structure, the number of each team's games per season increased by more than 25 percent, which increased the aggregate attendance. In our empirical analyses, we investigated attendance per game by using data from the three seasons before and after the change. Comparing the attendance of the same teams that played before and after the change, our fixed effects estimation reveals a significant decrease of close to nine percent in attendance per game after the change compared to the Top 16 stage. We also found no significant difference in attendance after the change compared to the regular season before the change. Finally, we found that the main decrease in attendance after the change appears in the first half of the season, when the games are likely to be perceived as less decisive than in the second half of the season.

Impact of TeleHealth in Gastroenterology Clinic Attendance

Telehealth has become an important part of medical care during the COVID-19 pandemic. Previous studies have demonstrated patient preference for telehealth care due to convenience and time and cost savings related to travel. The increased ease of access for patients with telehealth may improve the attendance rate. Improving clinic attendance could increase clinic efficiency, decrease cost, and possibly improve patient outcomes. We intended to assess if telehealth in gastroenterology (GI) clinic improves the attendance rate. We performed a retrospective observational cross-sectional study using data from the electronic health record (EHR) of patients scheduled for an appointment at the adult gastroenterology/hepatology clinic from February 1st to May 1st, 2020. Continuous variables were compared using the independent t-test and categorical variables were compared using the chi-square test or Fisher’s exact test, where applicable. Multivariate logistic regression analysis was performed for the missed appointment using the variable visit type as the predictor of interest and patient demographics, and appointment-related factors as covariates. Of 2,258 patients scheduled for appointment, 210 (9.3%) missed their appointment. Before COVID-19 pandemic response (before March 13, 2020), all 1,133 appointments were in-person visits. During the COVID-19 era (after March 13, 2020), 806 (71.6%) appointments were televisits, conducted via telephone. In the pre-COVID era, the non-attendance rate was 7.7%; this increased to 10.9% during the COVID era (P=0.008). There was no significant difference in the non-attendance rate between televisits and in-person visits (10.7% and 8.5%; P=0.09). In the multivariate analysis, there was no significant association between visit type and attendance (adjusted odds ratio [AOR] 1.11 [0.73-1.69]). There was no significant difference in attendance before and after March 13, 2020 (AOR 1.50 [0.99-2.27]). The use of telehealth increased significantly during the COVID era. Televisit was not associated with an improved attendance rate in GI clinic. Further studies are needed to investigate the impact of telehealth in clinical practice.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Increasing support group attendance for metabolic and bariatric surgery patients with online groups.

Support group attendance for patients undergoing metabolic and bariatric surgery has been shown to improve outcomes. Finding meaningful ways to engage as many patients as possible with these group sessions is important. Attendance records of 120 in-person and 48 virtual support groups that took place over 6-years were reviewed and compared from a metabolic and bariatric surgery (MBS) program in the USA. No significant difference in attendance for in-person groups or the first year of virtual support groups was found. The second consecutive year of virtual support groups were found to have a significant increase in patient attendance when compared to in-person groups and also the first year of virtual groups. Support groups for MBS patients are valuable experiences. Offering these virtually can help increase the number of patients that attend groups after the first year.

Factors Influencing Spectator Attendance in Sports: A Comparison Between Kedah FA and Johor Darul Takzim Fans (JDT FC)

One of the biggest draws for people watching a game at any sporting facility or stadium is the scenery. The quality of the sport scape will influence the enjoyment of viewers attending the match; this study focuses on the sport scape factors influenced by KEDAH FA and JDT FC fans’ attendance. The purpose of this study is to identify the differences in sport scape characteristics that influenced attendance between Kedah FA and Johor Darul Takzim fans (JDT FC). A total of 380 questionnaires were handed out to Kedah FA and JDT FC supporters. The instrument’s questionnaire for this study was based on the sport scape variables and attendance motivation. The results demonstrate a significant difference in attendance motivated by sport scape variables between Kedah FA and Johor Darul Takzim (JDT FC) fans (p<0.05), with JDT FC fans having a higher mean of 3.10 compared to Kedah FA fans who had a mean of 2.68. According to the survey, JDT FC fans are more motivated to attend the match due to the high quality of the sporting environment. This study agrees that sport scape features will drive spectators to visit the stadium or sports facility; nevertheless, future research could focus on other variables such as satisfaction.

S3424 Effect of TeleHealth in Gastroenterology (GI) Clinic Attendance

Introduction: Telehealth has become an important part of medical care during the COVID-19 pandemic. Previous studies have demonstrated patient preference for telehealth care due to convenience and time and cost savings related to travel. The increased ease of access for patients with telehealth may improve the attendance rate. Improving clinic attendance could increase clinic efficiency, decrease cost, and possibly improve patient outcomes. We intended to assess if telehealth in gastroenterology (GI) clinic improves the attendance rate. Methods: We performed a retrospective observational cross-sectional study using data from the electronic health record (EHR) of patients scheduled for an appointment at the adult gastroenterology/hepatology clinic from February 1st to May 1st, 2020. Continuous variables were compared using the independent t-test and categorical variables were compared using the chi-square test or Fisher's exact test, where applicable. Multivariate logistic regression analysis was performed for the missed appointment using the variable visit type as the predictor of interest and patient demographics, and appointment-related factors as covariates. Results: Of 2,258 patients scheduled for appointment, 210 (9.3%) missed their appointment. Before COVID-19 pandemic response (before March 13, 2020), all 1,133 appointments were in-person visits. During the COVID-19 era (after March 13, 2020), 806 (71.6%) appointments were televisits, conducted via telephone. In the pre-COVID era, the non-attendance rate was 7.7%;this increased to 10.9% during the COVID era (P=0.008). There was no significant difference in the non-attendance rate between televisits and in-person visits (10.7% and 8.5%;P=0.09). In the multivariate analysis, there was no significant association between visit type and attendance (adjusted odds ratio [AOR] 1.11 [0.73-1.69]). There was no significant difference in attendance before and after March 13, 2020 (AOR 1.50 [0.99-2.27]). Conclusion: The use of telehealth increased significantly during the COVID era. Televisit was not associated with an improved attendance rate in GI clinic. Further studies are needed to investigate the implications of telehealth in clinical practice..

Trends in obstetric emergency department attendance the first months of the coronavirus pandemic

Many medical disciplines reported a decline in patient attendance during the coronavirus pandemic. Our paper examines the effects that the coronavirus pandemic had on obstetric Emergency Department (ED) attendances in a tertiary maternity centre in the Republic of Ireland. A retrospective cross-sectional analysis was performed on administrative data regarding the number of obstetric patients attending the ED from January to July in 2019 and 2020. These numbers were compared to the number of reported coronavirus cases in Ireland as released in official government publications. A paired sample t-test was carried out to see if there was a significant difference in attendance in the obstetric ED in 2020 compared to in 2019. When COVID-19 cases peaked at 17,377 in April 2020, ED attendance showed their largest decline of 27%. The cumulative decline in ED attendances from January to July in 2019 to 2020 was 13%. However, this decline was not found to be statistically significant. In contrast to other disciplines, the COVID-19 pandemic did not cause a decrease in obstetric ED attendance.

A prospective study on COVID-19 convalescent plasma donor (CCP) recruitment strategies in a resource constrained blood centre.

Background and ObjectivesThe COVID‐19 pandemic has spread across 87 million people with more than 1·8 million deaths in the world. As there is no definite treatment modality, the use of convalescent plasma has become increasingly popular worldwide. This study aimed to identify an appropriate strategy of donor recruitment and to evaluate the appropriateness of pre‐set plasma donation guidelines.Material and MethodsIn this prospective study conducted from May to September 2020, the donors were recruited under the following two circumstances: Group I, patients in the post–COVID‐19 follow‐up in the clinic, and Group II, patients recovered from COVID‐19 recruited through mass and electronic media. A pre‐set donor selection criteria and laboratory investigation was designed according to national and international guidelines. Approximately 500 ml of COVID‐19 convalescent plasma (CCP) was collected from recovered individuals in each group by two different cell separators. The overall donor’s attendance rate, deferral rate, adverse events and donor compliance was analysed and compared between the two groups.ResultsThere was a significant difference in attendance in relation to registration between the groups (P < 0·0001). Donor deferral was significantly higher in group II compared with group I. The single most frequent cause of donor deferral was low antibody index (P = 0·0001). The total donor adverse event rate in CCP donation was significantly lower compared with routine plateletpheresis procedures. The donor’s compliance to blood centre’s protocol was satisfactory in both the groups.ConclusionRecruitment of patients in the post–COVID‐19 follow‐up in the clinic was more effective than the general recruitment through mass and electronic media for convalescence plasma donation in a resource‐constrained blood centre.

Nursing home patients and Emergency Department attendance in a single urban Irish catchment area: an observational study surrounding the introduction of a community medicine for older person service.

Nursing home (NH) patients are at a high risk of Emergency Department (ED) attendance, and adverse events in the ED. With an increasing NH population, monitoring trends in ED utilization is important to aid service planning, and attention to potentially preventable attendances should be paid, to identify areas that may benefit from specialist support. This 12-year (2008-2019) study aimed to observe trends in ED utilization of NH patients in a single urban Irish catchment area, surrounding the introduction of a Community Medicine for the Older Person (CMOP) outreach program. A retrospective review of all NH attendances within the catchment area was performed based upon NH address. Attendance, admission, discharge, and died in department (DID) were adjusted per annual NH bed numbers (PBC). Trends were observed and compared pre and post the CMOP activation. Comparisons of continuous variables were performed using an unpaired parametric Student's t test. There were 6877 attendances, with 58% (n = 3989) admitted, 40% (n = 2785) discharged, and 2% (n = 123) DID. There was a statistically significant difference in mean discharge rate PBC pre and post the CMOP introduction (0.22 vs 0.16, P = 0.04). There was no statistically significant difference in attendance, admission, or DID. This is the first Irish study of NH ED utilization over an extended period. ED attendances PBC have not decreased since the introduction of the CMOP. Discharges PBC, however, have decreased and may represent a decrease in potentially preventable attendance/improvement in appropriateness of ED transfers, following the introduction of this intervention.

Can a motivational letter increase attendance to psychological treatment for gambling disorder?

High rates of treatment refusal and dropout have complicated the delivery of psychological treatment for gambling disorder, which continues accumulating evidence for efficacy. Incorporating motivational interviewing and addressing outcome expectations into psychological treatments has been shown to increase overall attendance. However, no studies have investigated whether motivational interviewing and outcome expectations can increase attendance at the initial and subsequent sessions of psychological treatment for gambling disorder. Participants were 69 prospective clients who contacted an outpatient training clinic requesting treatment services for gambling-related problems. They were randomly assigned to receive a mailed letter that incorporated principles of motivational interviewing and addressed outcome expectancies plus a telephone reminder call or to receive a telephone reminder call only. Clients who received the letter plus reminder call were more likely to attend the initial session than were clients who received the reminder call only. Clients receiving the letter were also more likely to reschedule their initial session and less likely to not show up than were clients receiving the reminder call only. There was no significant difference in attendance at subsequent sessions. These results suggest that mailing a similar letter to prospective clients of psychological treatment for gambling disorder is worthwhile, given the associated ease and low cost. Future investigations should further investigate the value of strengthening the motivation of prospective clients and clinics before initial treatment sessions, and they should investigate the distinction between clients who reschedule versus not show up. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Child-Adult Relationship Enhancement in Primary Care: A Randomized Trial of a Skill-Based Parent Training with Parent Mentor Adaptation.

Child-Adult Relationship Enhancement in Primary Care (PriCARE) is a 6-session group training designed to teach positive parenting skills. Parent engagement in such programs is a common implementation barrier. Our objectives were to (1) examine the impact of a peer mentor on attendance and stigma and (2) replicate a previous study by measuring PriCARE's impact on child behavior and parenting practices. Parents of 2- to -6-year-old children without specific behavior problems were randomized to mentored PriCARE (n = 50), PriCARE (n = 50), or control (n = 50). Stigma was measured at 10 weeks. Child behavior and parenting practices were measured at baseline and 10 weeks using the Eyberg Child Behavior Inventory (ECBI) and Parenting Scale (PS). Analysis of variance models were used to examine differences across groups. There was no significant difference in attendance between mentored PriCARE and PriCARE arms (mean 3.80 vs 3.36 sessions, p = 0.35). Parents randomized to the mentor reported lower stigma (3.75 vs 5.04, p = 0.02). Decreases in the mean ECBI scores between 0 and 10 weeks were greater in the PriCARE arms (n = 100) compared with the control arm (n = 50), reflecting larger improvements in behavior [intensity: -7 (-2 to -13) vs 4 (-3 to 12) to p = 0.014; problem: -3 (-1 to -4) vs 1 (-1 to 3) to p = 0.007]. Scores on all PS subscales reflected greater improvements in parenting behaviors in PriCARE arms compared with control (all p < 0.04). Adapting PriCARE with a peer mentor may decrease stigma but does not improve program attendance. PriCARE shows promise in improving behavior in preschool-aged children and increasing positive parenting practices.

270 Telehealth-Based Colonoscopy Education May Be a Viable Alternative to In-Person Colonoscopy Education Among Veterans

INTRODUCTION: The VA Loma Linda Healthcare System (LLVA) offers an in-person colonoscopy education class (IPCC) and a telehealth based education class to patients who live closer to outlying VA designated Community Based Outpatient Clinics (CBOCs). Anecdotally, we noticed a significant number of cancellations and no-shows for colonoscopy from patients who sought care from CBOCS. We developed a telehealth based colonoscopy class (TBCC) to be given at CBOCs. The primary aim of the study was to determine effectiveness of TBCC compared to the existing IPCC by evaluating class attendance rates, colonoscopy attendance and quality measures of colonoscopy. METHODS: We retrospectively reviewed records of 1429 LLVA and CBOC patients referred for colonoscopy class between April 2014 and April 2015. Patients were given the choice of attending IPCC or TBCC. The primary end points were polyp detection rate (PDR), adenomas detection rate (ADR) and adenocarcinoma detection rate (ACDR). Secondary endpoints were attendance to TBCC and IPCC and attendance to colonoscopy. Attendance was defined as the percentage of patients who complied with their first scheduled appointment. We examined the relationship between age, BMI, sex, race, and indication for colonoscopy in the IPCC and TBCC populations. RESULTS: TBCC attendance rate was higher than IPCC (P = 0.001). There was no significant difference in attendance to colonoscopy between TBCC and IPCC (P = 0.50). Patients receiving primary care at CBOCs more likely chose TBCC versus patients receiving primary care at LLVA who chose IPCC (92.53% vs. 24.77%, P &lt; 0.0001). African Americans and Hispanics more likely chose IPCC, while whites more likely chose TBCC (P = 0.01). Patients with family history of colorectal cancer and bright red blood per rectum as indications for colonoscopy more likely chose IPCC (P = 0.004, P = 0.008). Sixty eight percent of colonoscopy preparations were noted to be good. There was no difference in the number of good preparations between TBCC and IPCC (94.3% and 96%, P = 0.025). ADR was higher in patients who received IPCC (44.55% and 52.17%, P = 0.02). There was no significant difference in PDR and ACDR between TBCC and IPCC groups. CONCLUSION: A TBCC program is a means of increasing patient attendance to colonoscopy preparation training without negatively affecting quality of colonoscopy preparation. Prospective, randomized studies on differences in adenoma detection and distance from home residence on class and colonoscopy attendance rates is needed.

Parental health shocks and schooling: The impact of mutual health insurance in Rwanda

The goal of this study was to look at the educational spill-over effects of health insurance on schooling with a focus on the Rwandan Community Based Health Insurance Programme, the Mutual Health Insurance scheme. Using a two-person general equilibrium overlapping generations model, this paper theoretically analyses the possible effect of health insurance on the relationship between parental health shocks and child schooling. Individuals choose whether or not they want to incur a medical cost by seeking care in order to reduce the effect of health shocks on their labour market availability and productivity. The theoretical results show that, health shocks negatively affect schooling irrespective of insurance status. However, if the health shock is severe (incapacitating) or sudden in nature, there is a discernible mitigating effect of health insurance on the negative impact of parental ill health on child schooling. The results are tested empirically using secondary data from the third Integrated Household Living Conditions Survey (EICV) for Rwanda, collected in 2011. A total of 2401 children between the ages of 13 and 18 are used for the analysis. This age group is selected due to the age of compulsory education in Rwanda. Based on average treatment effect on treated we find a statistically significant difference in attendance between children with MHI affiliated parents and those with uninsured parents of about 0.044. The negative effect of a father being severely ill is significant only for uninsured household. For the case of the mother, this effect is felt by female children with uninsured parents only when the illness is sudden. The observed effects are more pronounced for older children. While the father's ill health (sever or sudden) significantly and negatively affects their working hours, health insurance plays appears to increase their working hours. The effects of health insurance extend beyond health outcomes.

Impact of the provision of school lunch on attendance in remote rural Jamaican primary schools

This study examined the attendance patterns by region of schools which participated in School Feeding Programmes (SFPs) in poor, remote rural areas of Jamaica and determined whether there was a significant difference in attendance over a 10 year period between children who took different lunch types. The study revealed peaks and troughs in the average annual attendance by region, but found no significant difference in attendance by lunch type. Variations in poverty levels and the effect of a conditional cash grant to poor parents are offered as possible explanations for the peaks and troughs in attendance.

Effect of screening for Type 2 diabetes on population‐level self‐rated health outcomes and measures of cardiovascular risk: 13‐year follow‐up of the Ely cohort

AimsThere is continuing uncertainty regarding the overall net benefits of population-based screening for Type 2 diabetes. We compared clinical measures, prescribed medication, cardiovascular morbidity and self-rated health in individuals without diabetes in a screened vs. an unscreened population.MethodsA parallel-group, cohort study of people aged 40–65 years, free of known diabetes, identified from the population register of a general practice in Ely, Cambridgeshire (n = 4936). In 1990–1992, one third (n = 1705), selected randomly, received an invitation for screening for diabetes and cardiovascular risk factors at 5-yearly intervals (screened population). From the remainder of the sampling frame, 1705 randomly selected individuals were invited to diabetes screening 10 years later (unscreened population). Patients without known diabetes from both populations were invited for a health assessment.ResultsOf 3390 eligible individuals without diabetes, 1442 (43%) attended for health assessment, with no significant difference in attendance between groups. Thirteen years after the commencement of screening, self-rated functional health status and health utility were identical between the screened and unscreened populations. Clinical measures, self-reported medication and cardiovascular morbidity were similar between the two groups.ConclusionsScreening for diabetes is not associated with long-term harms at the population level. However, screening has limited long-term impact on those testing negative; benefits may largely be restricted to those whose diabetes is detected early through screening.

The Q**** Study – basic randomised evaluation of attendance at a children's emergency department

IntroductionHealth Professionals are superstitious; be it a little ritual before sitting a cannula, or wearing a particular item of clothing while on-call, there are many things that we irrationally do...

A Review of Patient Adherence to the Recommendation for Voice Therapy

Voice therapy is a preferred treatment for many voice problems. Many patients referred to voice therapy by their otolaryngologist fail to follow through with the recommendation. Unlike other behavior change therapies, there are no studies documenting the incidence of poor patient attendance in voice therapy. The primary purpose of this study was to document initial patient adherence to the physician's recommendation for voice therapy. A retrospective review of 294 charts was conducted at 2 voice institutions in Atlanta, GA. Reviews included adherence to (1) the physician's referral to the speech-language pathologist and (2) the speech-language pathologist's recommendation for follow-up voice therapy. Thirty-eight percent of patients did not adhere to the physician's recommendation to attend voice therapy. Of those who initiated follow-through, 47% did not return after the initial speech-language pathology evaluation session. There was no significant difference in attendance by gender or by age group. The primary reasons reported for nonattendance were insurance denials, resolution of the problem, and distance to the clinic. The attendance rates described in this study were low but consistent with research published in the fields of otolaryngology, gastroenterology, and psychology. Poor patient attendance is an important area to consider in outcomes research and the cost to healthcare.

Two Sequential Randomized Trials of Community Participation to Recruit Women for Mammographic Screening

Background.If mammographic screening is to reduce mortality from breast cancer, it is essential that a high proportion of the target population attend for screening. In order to achieve this, effective recruitment strategies are needed. This paper reports two trials of recruitment strategies for mammographic screening involving eight communities in rural New South Wales (NSW), Australia.Methods.Each trial involved two matched pairs of towns in the Hunter Valley region of NSW. Towns were randomly allocated to intervention, receiving either mass media promotion or community participation in Trial 1 and community participation or family physician involvement in Trial 2.Results.In Trial 1, significantly higher attendance rates were observed in the two towns that received the community participation intervention compared with their matched media promotion towns (63% vs 34%,P< 0.001 and 51% vs 34%,P< 0.01). In Trial 2, a significantly higher attendance rate was observed in one town that received the family physician involvement intervention compared with its matched town which received the community participation intervention (68% vs 51%,P< 0.01). There was no significant difference in attendance in the other pair of towns (68% vs 58%,P= 0.11).Conclusions.Both community participation and family practitioner involvement are more promising strategies for the promotion of attendance at mammographic screening facilities than media promotion alone.