Sewell Justin L, Kushel Margot B, Inadomi John M, Yee Hal F
Department of Medicine, University of California San Francisco, Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA 94110, USA.
J Clin Gastroenterol. 2009 Aug;43(7):652-60. doi: 10.1097/MCG.0b013e3181855077.
We sought to identify factors associated with gastroenterology clinic attendance in an urban safety net healthcare system.
Missed clinic appointments reduce the efficiency and availability of healthcare, but subspecialty clinic attendance among patients with established healthcare access has not been studied.
We performed an observational study using secondary data from administrative sources to study patients referred to, and scheduled for an appointment in, the adult gastroenterology clinic serving the safety net healthcare system of San Francisco, CA. Our dependent variable was whether subjects attended or missed a scheduled appointment. Analysis included multivariable logistic regression and classification tree analysis. A total of 1833 patients were referred and scheduled for an appointment between May 2005 and August 2006. Prisoners were excluded. All patients had a primary care provider.
Six hundred eighty-three patients (37.3%) missed their appointment; 1150 patients (62.7%) attended. Language was highly associated with attendance in the logistic regression; non-English speakers were less likely than English speakers to miss an appointment [adjusted odds ratio 0.42 (0.28, 0.63) for Spanish, 0.56 (0.38, 0.82) for Asian language, P<0.001]. Other factors were also associated with attendance, but classification tree analysis identified language to be the most highly associated variable.
In an urban safety net healthcare population, among patients with established healthcare access and a scheduled gastroenterology clinic appointment, not speaking English was most strongly associated with higher attendance rates. Patient-related factors associated with not speaking English likely influence subspecialty clinic attendance rates, and these factors may differ from those affecting general healthcare access.
我们试图确定在城市安全网医疗系统中与胃肠病学门诊就诊相关的因素。
错过门诊预约会降低医疗保健的效率和可及性，但对于已获得医疗服务的患者在专科门诊的就诊情况尚未进行研究。
我们利用行政来源的二手数据进行了一项观察性研究，以研究转介至加利福尼亚州旧金山市安全网医疗系统的成人胃肠病学门诊并已预约就诊的患者。我们的因变量是受试者是否参加或错过预定的预约。分析包括多变量逻辑回归和分类树分析。2005年5月至2006年8月期间，共有1833名患者被转介并预约就诊。囚犯被排除在外。所有患者均有一名初级保健提供者。
683名患者（37.3%）错过预约；1150名患者（62.7%）就诊。在逻辑回归中，语言与就诊率高度相关；非英语使用者比英语使用者更不容易错过预约[西班牙语的调整优势比为0.42（0.28，0.63），亚洲语言为0.56（0.38，0.82），P<0.001]。其他因素也与就诊率相关，但分类树分析确定语言是最密切相关的变量。
在城市安全网医疗人群中，在已获得医疗服务并预定了胃肠病学门诊预约的患者中，不会说英语与较高的就诊率最密切相关。与不会说英语相关的患者因素可能会影响专科门诊就诊率，而且这些因素可能与影响一般医疗服务可及性的因素不同。
