Bedford Lydia K, Weintraub Collin, Dow Alan W
School of Medicine, Virginia Commonwealth University, Richmond, VA USA.
School of Medicine, Virginia Commonwealth University, Box 980071, 1301 E. Marshall, VA 23298-00071 Richmond, USA.
SN Compr Clin Med. 2020;2(11):2271-2277. doi: 10.1007/s42399-020-00585-6. Epub 2020 Oct 15.
Non-attendance of healthcare appointments impact individual health outcomes and the capacity and financial stability of clinics. While non-attendance of appointments has been associated with a variety of factors, interventions to increase attendance have had mixed success. The most widely used intervention, reminder systems like phone calls or text messages, generally improves attendance rates but is insufficient for many clinics as a sole intervention. This study of underresourced patients who did not attend appointments at two clinics for uninsured individuals describes the multifactorial, individualized, and interacting reasons for non-attendance among these methods: Forty-three patients were interviewed by phone within 3 weeks of missing a clinic appointment using a scripted interview based on the literature. Responses were coded and analyzed. For 57% of respondents, a competing priority such as work or caregiving was a reason for missing an appointment. Forgetting about the appointment was a barrier for 38% of participants despite reminder systems being in place. Contributions to non-attendance were identified through thematic analysis: emotional and physical exhaustion, prioritization of work over healthcare, unreliable transportation, financial stress, and being unaware of an appointment. These findings demonstrate the need to test multiple patient-centered interventions, particularly in the context of underresourced communities.
不按时赴约看诊会影响个人健康状况以及诊所的运营能力和财务稳定性。虽然不按时赴约与多种因素有关，但提高就诊率的干预措施成效不一。最常用的干预措施，如电话或短信提醒系统，通常能提高就诊率，但对许多诊所来说，仅靠这一措施还不够。这项针对在两家为未参保者服务的诊所未按时就诊的资源匮乏患者的研究，描述了这些未按时就诊的多因素、个体化且相互作用的原因：在患者错过诊所预约后的3周内，通过电话对43名患者进行了访谈，访谈采用基于文献编写的脚本。对回答进行编码和分析。57%的受访者表示，工作或照顾他人等其他更重要的事情是错过预约的原因。尽管有提醒系统，但仍有38%的参与者因忘记预约而未能就诊。通过主题分析确定了导致未按时就诊的因素：身心疲惫、将工作置于医疗保健之上、交通不可靠、经济压力以及不知道有预约。这些发现表明，有必要测试多种以患者为中心的干预措施，尤其是在资源匮乏的社区背景下。
