Cronin Robert M, Hankins Jane S, Byrd Jeannie, Pernell Brandi M, Kassim Adetola, Adams-Graves Patricia, Thompson Alexis A, Kalinyak Karen, DeBaun Michael R, Treadwell Marsha
a Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , TN , USA.
b Department of Internal Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.
Hematology. 2018 Oct;23(9):683-691. doi: 10.1080/10245332.2018.1457200. Epub 2018 Mar 29.
Outpatient care is critical in the management of chronic diseases, including sickle cell disease (SCD). Risk factors for poor adherence with clinic appointments in SCD are poorly defined. This exploratory study evaluated associations between modifying variables from the Health Belief Model and missed appointments.
We surveyed adults with SCD (n = 211) and caregivers of children with SCD (n = 331) between October 2014 and March 2016 in six centres across the U.S. The survey tool utilized the framework of the Health Belief Model, and included: social determinants, psychosocial variables, social support, health literacy and spirituality.
A majority of adults (87%) and caregivers of children (65%) reported they missed a clinic appointment. Children (as reported by caregivers) were less likely to miss appointments than adults (OR:0.22; 95% CI:(0.13,0.39)). In adults, financial insecurity (OR:4.49; 95% CI:(1.20, 20.7)), health literacy (OR:4.64; 95% CI:(1.33, 16.15)), and age (OR:0.95; 95% CI:(0.91,0.99)) were significantly associated with missed appointments. In all participants, lower spirituality was associated with missed appointments (OR:1.83; 95%CI:(1.13, 2.94)). The most common reason for missing an appointment was forgetfulness (adults: 31%, children: 26%). A majority thought reminders would help (adults: 83%, children: 71%) using phone calls (adults: 62%, children: 61%) or text messages (adults: 56%, children: 51%).
Our findings demonstrate that modifying components of the Health Belief Model, including age, financial security, health literacy, spirituality, and lacking cues to action like reminders, are important in missed appointments and addressing these factors could improve appointment-keeping for adults and children with SCD.
门诊护理在慢性病管理中至关重要，包括镰状细胞病（SCD）。SCD患者门诊预约依从性差的风险因素尚不明确。这项探索性研究评估了健康信念模型中的调节变量与错过预约之间的关联。
2014年10月至2016年3月期间，我们在美国六个中心对成年SCD患者（n = 211）和儿童SCD患者的照料者（n = 331）进行了调查。调查工具采用了健康信念模型的框架，包括：社会决定因素、心理社会变量、社会支持、健康素养和精神信仰。
大多数成年患者（87%）和儿童照料者（65%）报告他们错过了门诊预约。儿童（由照料者报告）比成人更不容易错过预约（比值比：0.22；95%置信区间：(0.13,0.39)）。在成年患者中，经济不安全（比值比：4.49；95%置信区间：(1.20, 20.7)）、健康素养（比值比：4.64；95%置信区间：(1.33, 16.15)）和年龄（比值比：0.95；95%置信区间：(0.91,0.99)）与错过预约显著相关。在所有参与者中，较低的精神信仰与错过预约相关（比值比：1.83；95%置信区间：(1.13, 2.94)）。错过预约最常见的原因是健忘（成年患者：31%，儿童：26%）。大多数人认为提醒会有帮助（成年患者：83%，儿童：71%），方式包括电话（成年患者：62%，儿童：61%）或短信（成年患者：56%，儿童：51%）。
我们的研究结果表明，健康信念模型的组成部分，包括年龄、经济安全、健康素养、精神信仰以及缺乏提醒等行动线索，在错过预约方面很重要，解决这些因素可以提高成年和儿童SCD患者的预约遵守率。
