School of Nursing Midwifery and Social Science, Central Queensland University, Townsville, Queensland, Australia.
School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia.
PLoS One. 2021 Mar 2;16(3):e0247914. doi: 10.1371/journal.pone.0247914. eCollection 2021.
To understand the impact and causes of 'Failure to Attend' (FTA) labelling, of patients with chronic conditions.
Nurse navigators are registered nurses employed by public hospitals in Queensland, Australia, to coordinate the care of patients with multiple chronic conditions, who frequently miss hospital appointments. The role of the nurse navigator is to improve care management of these patients. Evidence for this is measured through improvement in patient self-management of their conditions, a reduction in preventable hospital admissions and compliance with attendance at outpatient clinics. Failure to attend (FTA) is one measure of hospital utilisation, identifying outpatient appointments that are cancelled or not attended.
The cohort for this study was patients with multiple chronic conditions, and nurse navigators coordinating their care. Data describing the concept of FTA were thematically analysed twelve months into this three year evaluation.
Although the patient is blamed for failing to attend appointments, the reasons appear to be a mixture of systems error/miscommunication between the patient and the health services or social reasons impacting on patient's capacity to attend. Themes emerging from the data were: access barriers; failure to recognise personal stigma of FTA; and bridging the gap.
The nurse navigators demonstrate their pivotal role in engaging with outpatient services to reduce FTAs whilst helping patients to become confident in dealing with multiple appointments. There are many reasons why a patient is unable to attend a scheduled appointment. The phrase 'Failure to Attend' has distinctly negative connotations and can lead to a sense of blame and shame for those with complex chronic needs. We propose the use of the neutral phrase "appointment did not proceed" to replace FTA.
This article advocates for further consideration of collaborative models that engage the patient in their care journey and for consideration of the language used within the outpatient acute hospital setting, proposing the term 'appointment did not proceed.'
了解慢性疾病患者“未就诊”（FTA）标签的影响和原因。
护士导航员是澳大利亚昆士兰州公立医院雇用的注册护士，负责协调患有多种慢性疾病的患者的护理工作，这些患者经常错过医院预约。护士导航员的角色是改善这些患者的护理管理。这方面的证据是通过改善患者对自身疾病的自我管理、减少可预防的住院和遵守门诊就诊来衡量的。未就诊（FTA）是衡量医院利用情况的一个指标，确定取消或未就诊的门诊预约。
本研究的队列是患有多种慢性疾病的患者和协调其护理的护士导航员。在这项为期三年的评估进行到 12 个月时，对描述 FTA 概念的数据进行了主题分析。
尽管患者因未就诊预约而受到指责，但原因似乎是患者与卫生服务之间的系统错误/沟通不畅或影响患者就诊能力的社会原因的混合。从数据中出现的主题是：准入障碍；未能认识到 FTA 的个人耻辱感；以及弥合差距。
护士导航员展示了他们在减少 FTA 的同时帮助患者对多次预约充满信心的重要作用。患者无法参加预约有很多原因。“未就诊”这个短语带有明显的负面含义，会导致那些有复杂慢性需求的人感到责备和羞耻。我们建议使用中性短语“预约未进行”来代替 FTA。
本文主张进一步考虑使患者参与其护理之旅的合作模式，并考虑在门诊急性医院环境中使用的语言，建议使用“预约未进行”一词。
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