Nantsi Evdoxia, Chatziioannidis Ilias, Pouliakis Abraham, Mitsiakos Georgios, Kondilis Elias
Laboratory of Primary Health Care, School of Medicine, General Medicine and Health Services Research Aristotle University, 54124 Thessaloniki, Greece.
Second Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" University Hospital, 56403 Thessaloniki, Greece.
Children (Basel). 2024 Sep 19;11(9):1138. doi: 10.3390/children11091138.
Attendance to neonatal follow-up programs presents a significant factor associated with positive long-term outcomes of high-risk infants. Strategies to maximize participation benefit not only future interventions' effectiveness but also healthcare systems and society. While a number of studies have focused on attrition or loss to follow-up, no studies have focused on the contributive risk factors to abstaining from neonatal follow-up programs specifically during the COVID-19 pandemic. This study aims to reveal the main factors linked to non-compliance in a neonatal follow-up program of a tertiary hospital.
In this ambidirectional observational study, data from 1137 high-risk neonates who participated in a hospital follow-up program were collected (573 before and 564 after the COVID-19 pandemic). The study sample was grouped to three groups: G1 (N = 831), who maintained participation in the program; G2 (N = 196), who discontinued; and G3 (N = 110), who never visited the outpatient clinics. Data were obtained from the hospital's Systems Applications and Products (SAP) Software and a structured questionnaire, answered by parents of newborns either discontinuing (G2) or not attending (G3) the follow-up program through a telephone contact.
The most frequently reported reason for discontinuance before the pandemic onset was the parents' perception of no necessity to maintain participation (44.12%). During the COVID-19 pandemic, provider-related barriers to maintaining hospital access, inability to provide high-quality services (37.14%), and feelings of fear and insecurity (18.5%) emerged as factors for non-attendance. Citizenship and morbidity (respiratory distress syndrome, sepsis, necrotic enterocolitis, jaundice) acted as incentives to join the follow-up program during both study periods. Multiple regression analysis showed that multiple-gestation infants had higher odds of maintaining participation during the COVID-19 period (OR, 4.04; CI, 1.09-14.9).
Understanding the potential impact of COVID-19 and the transformative changes in neonatal follow-up clinics is crucial for applying compliance strategies. Removing barriers to maintain family participation can lead to increased attendance rates.
参加新生儿随访项目是高危婴儿长期获得良好预后的一个重要相关因素。最大化参与率的策略不仅有利于未来干预措施的有效性，也有利于医疗系统和社会。虽然已有多项研究关注失访或随访缺失问题，但尚无研究专门聚焦于在新冠疫情期间不参加新生儿随访项目的促成风险因素。本研究旨在揭示一家三级医院新生儿随访项目中与不依从相关的主要因素。
在这项双向观察性研究中，收集了1137名参加医院随访项目的高危新生儿的数据（新冠疫情前573名，疫情后564名）。研究样本分为三组：G1组（N = 831），持续参与项目；G2组（N = 196），中断参与；G3组（N = 110），从未到门诊就诊。数据来自医院的系统应用和产品（SAP）软件以及一份结构化问卷，通过电话联系由中断参与（G2组）或未参加（G3组）随访项目的新生儿父母填写。
疫情开始前最常报告的中断参与原因是父母认为没有必要继续参与（44.12%）。在新冠疫情期间，与医疗服务提供者相关的维持就医障碍、无法提供高质量服务（37.14%）以及恐惧和不安全感（18.5%）成为未就诊的因素。在两个研究阶段，公民身份和疾病（呼吸窘迫综合征、败血症、坏死性小肠结肠炎、黄疸）都是参与随访项目的激励因素。多元回归分析显示，多胞胎婴儿在新冠疫情期间持续参与的几率更高（比值比，4.04；可信区间，1.09 - 14.9）。
了解新冠疫情的潜在影响以及新生儿随访诊所的变革性变化对于应用依从性策略至关重要。消除维持家庭参与的障碍可提高就诊率。
